Once a New York Life individual disability claim is open, the insurer asks the attending physician for periodic updates on this two-page form. The physician confirms current diagnoses and codes, treatment and hospital dates, the work capacity level from no work to full capacity, specific restrictions with the objective findings behind them, and the estimated recovery period.
New York Life fills in Step 1 with the patient's name, birth date, policy and claim numbers before sending it. The attending physician completes and signs Step 2, Sections 1 to 3, and the Step 3 declaration.
Download the current version from the source each time; forms change without notice.
Physician's Statement for Continuing Claim – Individual Disability Insurance
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.
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Form 25027 is the four-page statement for a new individual disability claim, covering history, functional, visual and mental capacity in detail. Form 25033 is a two-page update for a claim already open: condition, treatment, restrictions and estimated recovery, with Step 1 pre-filled by New York Life.
The physician checks each activity the patient currently cannot do: sit, stand, walk, lift, reach, kneel, squat, climb, carry, crawl or drive, and adds any time limit and weight limit. A free-text box asks for a summary of the specific restrictions and limitations.