When an employee or member insured under Pacific Life group life has a terminal illness and asks for part of the benefit early through the Accelerated Benefit Option, the attending physician completes this statement. The physician confirms whether the condition is terminal, the date it became terminal and the life expectancy in months, with diagnoses, objective findings and hospital confinement dates supporting the claim.
The patient completes Section 1. The attending physician completes Section 2, Employee/Retiree Medical Condition, and signs Section 3; the employee completes the claim statement and the employer submits its own Employer Claim Statement.
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Attending Physician Statement for Accelerated Benefit Option
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The physician states whether the condition is terminal, the date it became terminal and the life expectancy in months. Pacific Life's package refers to less than 12 months to live, and its instructions note the requirement is typically 12 to 24 months or less as stated in the insured's certificate.
Objective findings should include copies of any X-rays, lab tests, EKG, MRI, scans and office notes. The employee instructions also call for supporting medical or hospital records confirming the terminal illness, and the physician checks which items are included before signing.