The Hartford uses this two-page progress report to update an open group disability claim after the initial statement, LC-7135. The provider completes it from the most recent patient contact, giving current disabling diagnoses with ICD-10 codes, symptoms and exam findings, the projected full-time return-to-work date, treatment plan, medications, level of functionality and diagnostic tests.
The treating provider completes the whole form and signs it with specialty, EIN and license number. The Hartford sends it for each claim with the patient's name and claim ID.
Download the current version from the source each time; forms change without notice.
Attending Physician's Statement – Progress Report
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LC-7135 is the initial statement for a new claim, with onset, first day out of work and first treatment date. LC-7137 is the progress report for an open claim: it focuses on current diagnoses, the projected full-time return-to-work date and current functionality, based on the most recent patient contact.
No. The form states the patient is responsible for completing it without expense to the company. Any fee the practice charges for the progress report is therefore the patient's responsibility, as with the initial statement, LC-7135.