For an individual disability claim based on a psychiatric condition, New York Life sends the treating clinician this two-page statement instead of a general physician form. It asks for a DSM-5 formulation with supporting data, a structured mental status summary, how the condition affects work, home and social functioning, current psychotropic medications and psychotherapy, and how return to work is being addressed in the treatment plan.
New York Life completes Step 1 with the patient and policy details. The attending physician or treating mental health clinician completes Step 2, Sections 1 to 3, and signs the Step 3 declaration.
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Physician's Statement for Mental Health Conditions – Individual Disability Insurance
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Section 3 asks how return to work is addressed in the treatment plan, the anticipated return date, whether the clinician would support a full-time return if an appropriate opportunity came up by the next appointment, and whether legal or administrative issues are affecting a return.
Section 2 lists each current psychotropic medication with dose, frequency and how it is taken, plus how often medications are reviewed. It also asks the frequency of individual psychotherapy or counseling, the dates of the last and next appointments, and the treatment goals.