Mutual of Omaha uses this report for each continuing period of an individual disability income claim. The policyowner reports treatment since the last report, activities, changes in condition and any return to work on page 1. The attending physician completes the supplementary statement on page 2, confirming the diagnosis, treatment dates, and periods of total and partial disability.
The policyowner completes and signs page 1. The attending physician completes page 2, the Attending Physician's Supplementary Statement, and signs with degree and employer ID number.
Download the current version from the source each time; forms change without notice.
Policyowner's Continuance of Disability Report (with Attending Physician's Supplementary Statement)
If your copy of the form is a fillable PDF, upload it once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.
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Yes. Mutual of Omaha posts a Spanish version of the continuance of disability report alongside the English form in its online forms finder. Both contain the policyowner's report and the Attending Physician's Supplementary Statement.
It is completed for each continuing claim period on an open individual disability claim. The policyowner fills in the date of the last report, and the physician covers treatment since that report, so each report picks up where the previous one ended.