Sun Life sends GDIFM-11252 to the behavioral health provider when it needs a current picture of a disability claim based on a psychiatric or cognitive condition. The provider reports the last and next visits, current ICD-10 diagnoses, symptoms and exam findings, whether the patient has full-time or part-time work capacity, actionable treatment steps taken, coordination of care and specific restrictions and limitations.
The treating behavioral health provider completes Sections 2 and 3 and signs with tax ID and specialty. The claimant's name, policy and claim numbers go in Section 1; the patient does not complete a separate part on this form.
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Disability Behavioral Health Update
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Yes. The first instruction on the form says that if the provider is unable to complete it, they can send a copy of all medical records, examination notes, physical exam findings, test results and the current treatment plan for the period Sun Life specifies, up to the present date.
The provider answers whether the patient has full-time work capacity, defined as 8 hours a day, 5 days a week, and whether there is part-time transitional capacity with hours and days per week. The form also asks when a full-time return is expected and whether vocational support would help.