When a short-term disability claim rests on a psychiatric condition, Sun Life sends the treating provider GSTDFM-5144 to understand the condition, treatment and return-to-work goal. The provider explains how long the condition has existed, what changed so the claimant can no longer work, stressors in and outside work, mental status findings, DSM diagnosis, impairment level, medications, psychotherapy and the target return date.
The treating behavioral health provider completes the whole questionnaire and signs with specialty. The claimant's identifying details and group policy number go in Section 1; the claimant answers Sun Life's separate claimant questionnaire, GSTDFM-7202.
Download the current version from the source each time; forms change without notice.
Short Term Disability Provider Questionnaire
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Section 3 asks how long the claimant has been in treatment, current psychiatric medications with dosages or why none are taken, recent medication changes, the prescriber's name and phone number, whether psychotherapy is ongoing and its type, the therapist's details, and the last and next appointment dates.
GSTDFM-5144 is the initial questionnaire and includes condition history: how long it has lasted, what changed, and work and non-work stressors. GSTDFM-5145 is the update version, which drops those history questions and focuses on current mental status, progress, medications, therapy and the return-to-work goal.