South Carolina public employees claiming Basic or Supplemental Long Term Disability benefits need a statement from every physician treating the disability. The Standard, which administers the Basic plan and insures the Supplemental plan, uses it to judge whether the condition is disabling, so it asks for diagnoses with ICD codes, history, functional limits, treatment, prognosis and expected return to work.
The employee completes Part A with identifying and plan details. Each physician the employee has seen for the disability completes Part B, covering information, history, assessment, treatment, prognosis and a signed acknowledgement.
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State of South Carolina Long Term Disability Insurance Attending Physician's Statement
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Yes. The claim packet tells employees that if they have seen more than one physician for the disability, each physician should complete a statement. Employees can ask their employer for additional forms, and each physician mails the completed form directly to The Standard.
No. This statement belongs to the State LTD insurance claim. PEBA's disability retirement under SCRS or PORS has no physician form: medical records are gathered with an authorization, form 6255, instead. An employee may pursue both, and SCRS disability benefits are counted as deductible income by the LTD plans.