Insurance form
Life insurance attending physician statement
A life-insurance attending physician statement (APS) is the carrier’s request for the treating clinician’s facts: diagnoses, dates, investigations, smoking, blood pressure, and whether a condition was known before the application or the death. Underwriting APS and claim APS are different moments. There is no single Canadian life APS. Complete the PDF the insurer sent. It is not an LTD form and not a CPP medical.
Underwriting versus a claim
Before a policy is issued, underwriting wants a timeline: when you first saw the person, what you treated, last visit, and whether anything material was active. After a death, a claim APS reconstructs the same timeline against the application and the cause of death. You are not approving the policy and you are not a coroner.
Each carrier prints its own APS. Do not send an LTD attending physician statement when they asked for life underwriting. Fees and who pays are on the request letter — often the insurer, sometimes the patient. Follow the letter.
The chart is the source
If you did not see them for three years, say so. Do not reconstruct a smoking history you never recorded. Blank is better than a guess that underwriting will compare with the application.
Who completes it
The most responsible treating clinician named on the request, or the one who holds the chart. If you only did a walk-in, say that. Specialists complete the pages that match their file. Do not sign a death-claim APS for a patient you never met because the family asked nicely.
How to complete the APS
- First visit, last visit, and whether they are still your patient.
- Problem list with onset dates as the chart supports.
- Investigations and specialists with names and years.
- Smoking, BP, lipids, A1c — if you measured them. Do not invent an A1c.
- Mental-health diagnoses you actually treated, without a novel.
- For a claim: date last seen alive, conditions active at death if you know, and that the death certificate is not yours unless it is.
- Copies of key reports if the request asks and privacy rules allow.
If the application said “non-smoker” and your chart says a pack a day in 2025, write what the chart says. You are not the fraud unit. You are the record.
Worked example (fictional)
Life APS — underwriting, family practice
Fictional 48-year-old. Do not copy into a real APS.
Patient since 2019. Last visit 2026-05-12. Still rostered. Problems: hypertension since 2021 (amlodipine 5 mg), BMI 31, no diabetes (A1c 5.7 in 2025). Former smoker, quit 2018 — last chart note still says quit, no contrary note. No CAD, no cancer on this chart. Colonoscopy 2024 elsewhere (letter on file, adenomas none). I am not completing an LTD form. I have not seen a death certificate — this is underwriting, not a claim. Records as above. I am the FP.
Why life APS files stall
- Guessing dates not in the chart.
- Sending the wrong product’s form (disability vs life).
- Refusing all copies when the authorization on the request is valid.
- A walk-in certifying a ten-year history.
- Editorializing about whether the claim should pay.
Draft the life APS from the chart and visit
In Scribeberry, open Forms, search for life insurance APS or attending physician statement, or upload the carrier’s current PDF. Generate from the encounter and your notes, then edit every field before you sign. Scribeberry does not pre-map this form. You still review and sign. Scribeberry does not send the APS to the insurer.
Frequently asked questions
Is this the same as a disability APS?
Related idea, different product. Life underwriting and life claims ask about mortality risk and timelines. LTD asks about work function. Use the PDF they sent.
Who pays the fee?
Read the request. Insurers often pay for APS copies they order. If the patient asked you to complete it for an application, your clinic policy may bill the patient. Do not hold a death-claim APS hostage without saying the fee up front.
What if I disagree with the application?
Write the chart. Do not call the applicant a liar on the form. Inconsistencies are for the insurer to weigh.
Does Scribeberry submit the APS?
No. Scribeberry helps you complete the PDF. You return it to the carrier as instructed. Keep a copy in the chart.
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