# Attending physician statement (APS): underwriting and LTD claims

> What an attending physician statement contains, how underwriters and LTD claims teams read one, the ERISA and HIPAA rules, and 2 templates.

Canonical page: https://medrecords.ai/guides/attending-physician-statement/

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Field guide, September 2026. 14 chapters.

## What is an attending physician statement (APS)? A field guide for underwriting and disability claims

For life and disability underwriters, LTD and STD claims examiners, and ERISA claimant attorneys. You walk away with the rules behind the request, a reading method for both kinds of APS, an underwriting summary sheet and a restrictions letter to send the treating physician.

By [Ahmed Jemaa](https://medrecords.ai/authors/ahmed-jemaa/), Co-Founder and CEO, Medrecords AI. Published 25 September 2026.

An attending physician statement (APS) is medical evidence from a treating physician that an insurer uses to make a decision. In life, long-term care and disability underwriting, it is a copy of the applicant's chart, ordered with a signed HIPAA authorization. In group disability claims, it is a form the claimant's physician completes on diagnosis, objective findings, restrictions, limitations and expected return to work.

The same 3 words name 2 different documents. An underwriter who orders an attending physician statement wants the applicant's chart, every visit and lab for years back. A disability claims examiner who asks for one wants a 2 page form from the treating doctor that says what the claimant cannot do and for how long. Both decide money, both arrive late, and both are read badly when the reader is in a hurry.

This guide is built from the ERISA claims procedure regulation at 29 CFR 2560.503-1, including the disability amendments that apply to claims filed after April 1, 2018; the HIPAA authorization and access rules at 45 CFR 164.508 and 164.524; the Social Security exertional definitions at 20 CFR 404.1567, which many disability policies and vocational reviewers borrow; and the Supreme Court's decision in *Black and Decker Disability Plan v. Nord* (2003). Carrier underwriting manuals are proprietary and differ, so nothing here states a carrier's rating rule. Every case example is a labeled hypothetical. Nothing here is legal, medical or underwriting advice. Insurance law varies by state, individual (non-ERISA) policies follow state claim rules, and your policy language controls.

9 numbers

### The APS in 9 numbers

45 days
for an ERISA plan to decide an initial disability claim
29 CFR 2560.503-1(f)(3)
2 x 30 days
extensions allowed, each for matters beyond the plan's control, each noticed in advance
29 CFR 2560.503-1(f)(3)
45 days
minimum the claimant gets to supply information the plan asks for in an extension notice
29 CFR 2560.503-1(f)(3)
180 days
minimum time to appeal a disability denial
29 CFR 2560.503-1(h)(3)(i) and (h)(4)
45 + 45 days
to decide the appeal, with 1 extension for special circumstances
29 CFR 2560.503-1(i)(3) and (i)(1)
April 1, 2018
claims filed after this date get the disability amendments: impartiality, fuller denial notices, new evidence shared
29 CFR 2560.503-1(p)(3)
6 elements
every valid HIPAA authorization must contain, plus 3 required statements
45 CFR 164.508(c)(1) and (c)(2)
10 lb
the most a person lifts at a time in sedentary work, as SSA defines it
20 CFR 404.1567(a)
30 days
for a provider to answer a patient's own request for records, 1 extension of 30
45 CFR 164.524(b)(2)
Chapter 1 Everyone

### 2 documents called an attending physician statement

Ask a life underwriter and a group LTD examiner what an APS is and you get 2 answers, both right. Mixing them up costs time: a chart sent when the carrier wanted the form, or a broker promising the doctor "just fills out a form" when the underwriter has ordered 6 years of records.

|  | Underwriting APS | Claims APS |
| --- | --- | --- |
| What it is | A copy of the applicant's medical records from a treating provider: office notes, labs, imaging reports, medication lists, letters from specialists | A claim form section the treating physician completes: diagnosis, dates, objective findings, restrictions and limitations, treatment plan, prognosis, expected return to work |
| Setting | Individual life, long-term care, individual disability income, sometimes group coverage above guaranteed issue | Group and individual short-term and long-term disability, waiver of premium riders, some LTC benefit claims |
| When | Before a policy is issued | After a claim is filed, and again at recertification |
| Who asks | The carrier's underwriting team, usually through a retrieval vendor | The carrier's or third-party administrator's claims team, or the claimant who hands the form to the doctor |
| Authorization | The applicant's signed HIPAA authorization, collected with the application | The claimant's authorization, collected with the claim |
| The question | Does the history match the application, and what does it show about risk? | Does the medical evidence support restrictions that stop this person doing the duties the policy measures? |

In both, the insurer knows nothing until paper arrives, and everything slow about an APS sits in that gap.

#### The vocabulary you need for the claims side

RestrictionWhat the patient should not do, because doing it risks harm. "No lifting over 10 lb" is a restriction. It is a medical instruction.
LimitationWhat the patient cannot do, because of the condition. "Can sit 30 minutes at a time" is a limitation. It is a statement of capacity.
Material dutiesThe core tasks of an occupation as the policy defines them, usually the occupation as performed in the national economy rather than at 1 employer.
Own occupationThe period in which the claimant is disabled if unable to perform the material duties of their own occupation. The policy sets its length.
Any occupationThe later period in which the claimant must be unable to perform any gainful occupation for which they are reasonably fitted by education, training or experience, again as the policy words it.
Elimination periodThe waiting period between the date disability begins and the date benefits start. The onset date on the APS starts this clock.
Objective findingsEvidence that does not depend on the patient's report: imaging, test results, measured range of motion, reflexes, observed signs.

If you remember one thing
Before you send or chase an APS, say which one you mean. "The chart from 2019 forward" and "the physician's restrictions form" are different requests with different turnaround and different readers.

Chapter 2 Everyone

### What an APS contains, field by field

An underwriting APS has no fixed form. It is whatever the office copies, and its value depends on what the request asked for. A good request names the period and the parts: office notes, problem list, medication list, lab and imaging reports, consult letters, and hospital discharge summaries held in the chart. Without that list, some offices send the last visit only, and the file goes back for a second request.

A claims APS is a form, and its fields are the same across most carriers even when the layout differs. The mock below is a hypothetical physician section for a lumbar disc claim. Each pin marks a field where claims are won, lost or sent back for clarification.

**A claims APS, physician section** — hypothetical — Illustration built on common carrier form fields
Attending physician statement Physician section
Diagnosis
Primary diagnosis (ICD-10) — M51.16 lumbar disc disorder with radiculopathy1
Secondary — None listed
Symptoms first appeared — 01/20/2026
Patient unable to work since — 02/02/20262
First visit for this condition — 02/03/2026
Objective findings
Imaging, tests, exam — MRI 02/14/2026: L5-S1 extrusion contacting left S1 root. SLR positive left at 40 degrees. Left ankle reflex absent.3
Restrictions and limitations
Can lift or carry — 10 lb 20 lb 50 lb4
Sit / stand / walk — Sit 30 min at a time, 4 h per day. Stand 15 min. Walk 10 min.
Restrictions in effect — 02/02/2026 through 05/15/2026
Treatment and outlook
Prognosis — Guarded. Surgical consult 03/10/2026.5
Expected return to work — Unknown 06/01/2026, with restrictions6
HYPOTHETICAL
1. 1
**Diagnosis** Check that the code matches the words and the office notes. A code for a sprain with a narrative about radiculopathy, or the reverse, is the first question a reviewer asks.
2. 2
**Onset date** This starts the elimination period and ties the claim to the coverage period. Compare it with the last day worked from the employer statement and the first visit date.
3. 3
**Objective findings** The field that carries the most weight and is most often left blank or filled with "see notes". Dated measurements are what a reviewing physician can test.
4. 4
**Restrictions and limitations** Specific numbers with a duration. "No work" is a conclusion, not a restriction. Compare every number with the occupation's material duties: a 10 lb limit ends a warehouse job and may not touch an accountant's.
5. 5
**Prognosis** Tells the examiner when to recertify and whether a surgical or specialist opinion is coming. "Guarded" with a dated next step is useful; a blank is not.
6. 6
**Return to work** A date, "unknown", or "never" each sets up a different file. A date with restrictions raises a vocational question about accommodation.

Pins 3 and 4 carry most of the weight in an LTD claim. A form that fills them with specifics, dated and consistent with the notes, needs little follow-up.

#### What an underwriting APS usually holds

- **Problem list and diagnoses** , with the date each first appears. Items the applicant did not disclose surface here.
- **Medications** and every dose change. A second or third agent added for blood pressure or diabetes tells the underwriter how well the condition is controlled.
- **Vitals and build** at each visit: blood pressure, height, weight, BMI.
- **Labs** : A1c, lipids, liver and kidney function, PSA, urine protein, each with a date.
- **Imaging, cardiac testing, pathology and consult letters** , which also name providers the applicant forgot to list.
- **Social history** : tobacco, nicotine, alcohol, drug use, and any counseling to quit.
- **Plan lines** : "recheck in 3 months", "refer to cardiology", "patient declined colonoscopy". These are the lines underwriters miss when they skim.

If you remember one thing
On a claims APS, read the objective findings and the restrictions first, then check them against the office notes. On an underwriting APS, read the plan lines and the medication changes first; they tell you what the diagnoses do not.

Chapter 3 Everyone

### The HIPAA authorization behind every APS request

Most life and disability insurers are not HIPAA covered entities. The physician's office is. So the rule that governs an APS request is the one that governs the office: it cannot send protected health information to an insurer for underwriting or claims without a valid authorization from the patient.

"Except as otherwise permitted or required by this subchapter, a covered entity may not use or disclose protected health information without an authorization that is valid under this section."

That is why the application and the claim form each carry an authorization page. A defective one is a quiet cause of a late APS: the records office returns the request, and nobody tells the underwriter for a week or 2.

#### What makes an authorization valid

Section 164.508(c) lists 6 core elements and 3 required statements. An authorization missing any of them is defective under 164.508(b)(2), and so is one that has expired, has been revoked, or contains information the office knows to be false.

| Requirement | Rule | Where APS requests go wrong |
| --- | --- | --- |
| Description of the information | 164.508(c)(1)(i): specific and meaningful | A form limited to 5 years with a cover letter asking for 10 |
| Who may disclose | (c)(1)(ii): name or class of persons | A named practice that has since merged |
| Who may receive | (c)(1)(iii) | Vendor, reinsurer or administrator outside the named class |
| Purpose | (c)(1)(iv): a description of each purpose | A purpose that omits claims, used on a claims request |
| Expiration date or event | (c)(1)(v) | An application authorization used after its term runs out |
| Signature and date | (c)(1)(vi): plus a description of authority if a personal representative signs | A spouse or adult child signing for an incapacitated claimant without stating their authority |
| Right to revoke | (c)(2)(i) | Exceptions and how to revoke omitted |
| Conditioning | (c)(2)(ii) | Consequence of refusing to sign not stated |
| Redisclosure | (c)(2)(iii) | Redisclosure warning missing |

#### 3 rules insurers and claimant attorneys trip over

**Psychotherapy notes need their own authorization.** Under 164.508(a)(2), a covered entity needs a specific authorization for psychotherapy notes, and under 164.508(b)(3)(ii) that authorization can only be combined with another psychotherapy notes authorization. The chart's ordinary mental health content (diagnoses, medications, visit dates, treatment summaries) comes with a general authorization. The therapist's separate process notes do not.

**Revocation has an insurance exception.** A patient can revoke an authorization in writing at any time, except to the extent the office already relied on it, or, under 164.508(b)(5)(ii), where the authorization was obtained as a condition of obtaining insurance coverage and other law gives the insurer the right to contest a claim under the policy or the policy itself. The exception protects the insurer's right to contest the policy or a claim. How far it reaches in a given dispute is a question for counsel.

**The claimant can get the records faster than the insurer.** A patient's own request under the right of access at 45 CFR 164.524 must be acted on within 30 days, with 1 extension of up to 30 days and a written reason. No such clock applies to an insurer's authorized request. Claimant attorneys who request the chart themselves, then submit it with a completed APS, control both the timing and the completeness of the file.

- **Expiration date checked against today's date** *The top cause of a returned request.*
- **Recipient class covers everyone who will see the records** *Vendor, carrier, reinsurer, administrator.*
- **Purpose matches the request** *Underwriting, claims, or both.*
- **Signature, date, and authority of any representative** *Power of attorney or guardianship named.*
- **Revocation, conditioning and redisclosure statements present** *164.508(c)(2).*
- **Psychotherapy notes requested separately, if at all** *164.508(a)(2) and (b)(3)(ii).*
- **Provider name, practice, address and fax verified** *A request to the wrong office is lost time, not a denial.*

**0** of 7 checked

State law can add stricter conditions for HIV status, substance use treatment, genetic testing and mental health records, and federal rules for substance use disorder programs sit on top of HIPAA. Your compliance team owns those rules; the checklist above is only the HIPAA floor.

If you remember one thing
Check the authorization before the request leaves the building. A records office will not call to say the form expired; it will just not send the chart.

Chapter 4 Deciding

### From APS request to decision: where the time goes

In underwriting, APS retrieval is often the slowest step in a fully underwritten case, and it drives placement: applicants who wait too long buy elsewhere or not at all. In claims, it drives the ERISA clock. Either way, most of the delay is logistics, not medicine.

**The APS path from order to decision** — 6 steps — Illustration of a common workflow; durations vary by carrier and provider
Step 1 — **Order** — Underwriter or examiner picks providers from the application or claim form. Time lost: wrong or incomplete provider details.
Step 2 — **Request sent** — Vendor or carrier sends authorization and cover letter. Time lost: defective authorization, wrong fax, request sits in a general inbox.
Step 3 — **Provider queue** — Office or release-of-information company copies the chart or hands the form to the physician. Time lost: the physician's own queue, fee invoices, follow-up calls.
Step 4 — **Records back** — Pages arrive, often faxed. Time lost: partial production, missing labs, the form returned blank with "see notes".
Step 5 — **Read and summarize** — Someone reads hundreds of pages or reconciles a form with notes. Time lost: duplicates, bad scans, handwriting, a new provider named in a consult letter.
Step 6 — **Decide** — Underwriter rates, or examiner approves, denies or asks for more. Time lost: a second APS round because step 5 found a gap.
Steps 2 to 4 are outside the insurer's control; steps 1 and 5 are not, and a mistake in either restarts the loop.

The expensive failure is the loop from step 5 back to step 1: a consult letter names a cardiologist nobody listed, and the case waits for a second APS.

Where a hypothetical 7-week APS case spent its time — Days — Basis
Provider details corrected after first request bounced — 6 — hypothetical
Primary care office queue and fee invoice — 14 — hypothetical
Waiting for the file to be read — 5 — hypothetical
Second request to a cardiologist named in a consult letter — 19 — hypothetical
Final read and decision — 5 — hypothetical
Total — 49 — 2 of 5 steps were avoidable

#### What the ERISA clock does with a late APS

For an employer-sponsored disability plan, the clock starts when the claim is filed under the plan's procedures, "without regard to whether all the information necessary to make a benefit determination accompanies the filing" (29 CFR 2560.503-1(f)(4)). The plan has 45 days. It can extend twice by up to 30 days, but only for matters beyond its control, and only with a notice sent before the current period runs out that explains the standards for entitlement, the unresolved issues, and the additional information needed (f)(3).

When the extension is needed because the claimant has not supplied information, the claimant gets at least 45 days to provide it, and the decision clock is tolled from the date the notice is sent until the claimant responds (f)(4). A treating physician who has not returned the APS is the most common reason a claims file needs that notice. The practical consequence for claimant attorneys: an APS delivered with the claim, complete and consistent with the notes, keeps the plan on its 45 day clock.

If you remember one thing
Read the first APS to the last page before ordering anything else, and order every provider it implies at once. The second round of retrieval is where weeks go.

Chapter 5 Building

### How underwriters read an underwriting APS

An underwriting APS answers 2 questions. Does the chart agree with the application, the exam and the database checks? And what does the chart show that none of those could? The second question is where the rating comes from, and it is answered by trends and plan lines more than by the problem list.

#### A reading order that catches what skimming misses

1. **Inventory first.** Count pages, list every provider and date range, and mark duplicates. A 400 page APS with 150 duplicate pages is a 250 page APS, and the duplicates hide the 1 page that differs.
2. **Problem list and first-documented dates.** For each diagnosis, find the first visit that names it. The application asks "have you ever been diagnosed", and the answer depends on that date.
3. **Medications over time.** Build a dated list with doses. A drug started and stopped within 2 months, a third blood pressure agent, insulin added to oral agents: each tells you more about control than the diagnosis does.
4. **Build, blood pressure and labs as trends.** Put every reading in a table by date. One high reading is noise; 6 rising readings are a finding.
5. **Plan lines and open items.** Every "recheck", "refer", "order" and "follow up in" line gets a status: done, not done, or unknown. Open items are where postponements come from.
6. **Adherence and behavior.** "Patient did not return", "ran out of medication", "declined", "no-show", "counseled on tobacco". These lines change offers and are the easiest to miss.
7. **Named providers.** Every consult letter, referral and outside result names someone. Check each against the application and the retrieval order.
8. **Discrepancies last.** Only now compare chart and application line by line. Doing it first makes you read the chart to confirm the application, which is the wrong direction.

#### The 5 things underwriters look for

| Category | What it looks like in the chart | Why the underwriter cares |
| --- | --- | --- |
| Rating-relevant findings | A diagnosis with severity markers: ejection fraction on an echo, A1c values, tumor stage and grade, a sleep study index, pulmonary function values | Carrier manuals rate on severity and control, not on the name of the condition |
| Missing tests | "Stress test ordered", no result in the file. "Colonoscopy recommended", no report. An abnormal PSA with no repeat | An open workup can mean postpone until the result is known, whatever the rest of the chart shows |
| Conflicting diagnoses | Primary care lists "chest pain, noncardiac"; the cardiology letter says "stable angina". A problem list carries "COPD" that no spirometry supports | The underwriter needs to know which is current and who says so, often with a specialist's word taking priority |
| Build, BP and lab trends | Weight up 12 kg over 3 years; systolic readings climbing across visits; creatinine drifting up; liver enzymes elevated then normal after alcohol counseling | Trends show direction, which a single exam reading cannot |
| Nonadherence and behavior | Missed appointments, medications not refilled, declined referrals, tobacco use noted after a nonsmoker application | Adherence changes how controlled a condition really is; a tobacco note contradicts a nonsmoker class |

##### What a summary extracts

Facts, each with a page

- Diagnoses with first-documented date
- Dated medications and dose changes
- Vitals, build and labs in date order
- Open orders, referrals and follow-ups
- Adherence and tobacco notes, quoted
- Providers named in the chart
- Chart versus application differences

##### What the underwriter judges

Decisions, against the manual

- Which diagnosis is current and how severe
- Whether an open workup means postpone
- What a trend implies for mortality or morbidity
- Whether a discrepancy is material
- Whether to order more records
- The rating, the offer, or the decline

If you remember one thing
Read the chart for trends, open items and adherence, then compare it with the application. The diagnosis list is the least informative part of an underwriting APS.

Chapter 6 Building

### Worked example: a 212 page APS for a term life application

**Hypothetical.** A 52 year old applies for a 20 year term policy. The application discloses "high blood pressure, controlled on medication", no diabetes, no tobacco in 5 years, and 1 provider: a primary care practice. The paramedical exam shows BP 136/86 and a BMI of 32. The underwriter orders an APS for 5 years of primary care records. It arrives after 3 weeks: 212 pages, of which 61 are duplicate lab reports and faxed copies. Every date, value and page number below is invented for illustration.

**What the chart shows, in date order** — hypothetical — Illustration
1. 03/2021
**Annual visit, treatment starts**
BP 142/90, weight 98 kg, BMI 31. Lisinopril 10 mg started. Matches the disclosure.

Office note p. 14
2. 09/2021
**Follow-up**
BP 138/88. A1c 6.1, assessed as prediabetes. Plan: "recheck A1c in 6 months."

Office note p. 31, lab p. 33
3. 03/2022 to 01/2023
**No visits for 10 months**
The A1c recheck was never done. No refill notes.

No records in the production for this period
4. 01/2023
**Return after lapse**
"Ran out of lisinopril about 2 months ago." BP 156/96. Lisinopril restarted, amlodipine 5 mg added. Weight 101 kg.

Office note p. 58
5. 06/2023
**Chest tightness on exertion**
Referred to cardiology. Consult letter from a cardiology practice not named on the application: stress echo normal, no further testing.

Office note p. 77, consult letter p. 83
6. 02/2024
**A1c 6.6**
Assessment says "prediabetes, lifestyle." The problem list printed on the same visit says "type 2 diabetes mellitus without complications."

Office note p. 104, problem list p. 106
7. 11/2024
**Tobacco note**
"Smokes 3 to 4 cigarettes a day when stressed. Counseled on cessation."

Social history p. 131
8. 05/2025
**Metformin started**
A1c 6.9. Metformin 500 mg twice daily. Sleep study ordered for snoring and daytime sleepiness.

Office note p. 162, order p. 163
9. 05/2025 onward
**Sleep study result missing**
No result, no sleep medicine letter, no mention at later visits.

Implied by the order on p. 163
10. 02/2026
**Most recent visit**
BP 134/84, weight 104 kg, BMI 32.8. A1c 6.4 on metformin.

Office note p. 198, lab p. 201

The last visit looks well controlled. The 5 year view shows a treatment lapse, a diabetes diagnosis, a tobacco note and an unfinished sleep workup, none of them on the application.

#### The trend table

| Date | BP | Weight / BMI | A1c | Page |
| --- | --- | --- | --- | --- |
| 03/2021 | 142/90 | 98 kg / 31.0 | not drawn | p. 14 |
| 09/2021 | 138/88 | 99 kg / 31.2 | 6.1 | pp. 31, 33 |
| 01/2023 | 156/96 | 101 kg / 31.9 | not drawn | p. 58 |
| 02/2024 | 140/88 | 102 kg / 32.2 | 6.6 | p. 104 |
| 05/2025 | 138/86 | 103 kg / 32.5 | 6.9 | p. 162 |
| 02/2026 | 134/84 | 104 kg / 32.8 | 6.4 | pp. 198, 201 |

#### What the summary hands the underwriter

3 discrepancies with the application (diabetes on metformin, a tobacco note, an unlisted cardiologist), 1 treatment lapse, 1 open sleep study and 1 same-day conflict between assessment and problem list, each with its page.

What the summary does not do is say what any of this is worth. What to order, ask or rate is the underwriter's call against the carrier's manual. The summary's job is that none of the 6 items is missed and each can be checked in 10 seconds.

##### 1. Underwriting APS summary sheet

Use it for any underwriting APS. Every line needs a page citation; a line without one is deleted, not guessed. It holds no rating and no recommendation.

UNDERWRITING APS SUMMARY
Applicant: [NAME] Policy/case no.: [NUMBER] Product: [TERM / UL / DI / LTC]
Provider(s) in this APS: [PRACTICE, PHYSICIAN, DATES OF SERVICE COVERED]
Pages received: [N] Unique after duplicates removed: [N] Date received: [DATE]
Request period asked for: [FROM] to [TO] Period actually produced: [FROM] to [TO]

1. DIAGNOSES (first documented date, current status, page)
 [DIAGNOSIS] | first noted [DATE] p. [X] | status [ACTIVE/RESOLVED/UNCLEAR] p. [X]

2. MEDICATIONS (drug, dose, start, changes, stop, page)
 [DRUG DOSE] | start [DATE] p. [X] | change [DATE, NEW DOSE] p. [X]

3. VITALS, BUILD AND LABS (date order)
 Date | BP | Height/Weight/BMI | [A1c] | [Lipids] | [Creatinine/eGFR] | [LFTs] | page

4. TESTS AND IMAGING (ordered, resulted, abnormal findings)
 [TEST] ordered [DATE] p. [X] | result [DATE, FINDING] p. [X] or NO RESULT IN FILE

5. OPEN ITEMS (orders, referrals, rechecks with no documented completion)
 [ITEM] | ordered/recommended [DATE] p. [X] | status: NOT FOUND IN RECORDS PRODUCED

6. ADHERENCE AND BEHAVIOR (quote the chart)
 "[EXACT WORDS]" [DATE] p. [X]
 Tobacco/nicotine: "[EXACT WORDS]" [DATE] p. [X]
 Alcohol/drugs: "[EXACT WORDS]" [DATE] p. [X]

7. PROVIDERS NAMED IN THE CHART
 [PROVIDER, SPECIALTY] | named on p. [X] | on application? [YES/NO] | ordered? [YES/NO]

8. CHART VS APPLICATION
 Application says: "[ANSWER]" | Chart shows: "[ENTRY]" [DATE] p. [X]

9. INTERNAL CONFLICTS IN THE CHART
 [ENTRY A] p. [X] vs [ENTRY B] p. [Y]

Prepared by: [NAME] Date: [DATE]
Facts only. No rating, class or recommendation. Every line cited to a page.
If you remember one thing
Put build, blood pressure and labs in a dated table before you read a single assessment. The table shows the trend the latest visit hides.

Chapter 7 Building

### When the APS contradicts itself or the file

Conflicts are the normal state of a medical record: stale problem lists, templated exams, a specialist and a generalist using different words, a claims form that says more than the notes. The mistake is to resolve a conflict silently by picking the entry you like. The fix is a fixed path that ends in either a documented choice or a specific question.

**Decision path for an APS with conflicting information** — 5 questions — Illustration of a review method, not a carrier rule
1
**Are both entries cited to a page you have read?**
YesGo to 2 with both pages open side by side.
NoStop. Find the page. A conflict you cannot cite is a memory, and memories are where summaries go wrong.
2
**Is it a copy-forward or template artifact?**
YesSame text repeated across visits, an exam marked normal in a patient in a cast, a problem list item never addressed in a note. Record it as an artifact with both pages and move on.
NoGo to 3.
3
**Does 1 entry rest on testing or a specialist's examination?**
YesNote which entry is supported and by what: the echo, the biopsy, the nerve conduction study. The reader decides the weight; you show the support.
NoGo to 4.
4
**Would the decision change depending on which entry is right?**
NoDocument both entries in the summary's conflicts section. No follow-up request.
YesGo to 5. This conflict needs an answer, not a note.
5
**Can the treating physician resolve it with 1 specific question?**
YesSend a clarification letter that quotes both entries with dates and pages and asks 1 closed question. Chapter 10 has a template.
NoOrder the missing test result or specialist records, or, on the claims side, consider a peer review or independent medical exam. The ERISA rule requires the denial notice to explain any disagreement with the treating physician.
Many conflicts end at question 2 or 4. The ones that reach 5 are the ones worth a letter.

#### Conflicts you will see again and again

| Pattern | Typical pages | Usual explanation | What to do |
| --- | --- | --- | --- |
| Problem list says X, notes never mention it | Problem list vs 3 or more visit notes | Stale entry, entered by another clinician or imported | Report both; do not treat the problem list as a diagnosis on its own |
| Claims APS restrictions stricter than office notes | APS form vs the visit notes on or near the same date | Form completed from the patient's report, or notes are templated "normal" | Clarification letter asking for the findings behind each restriction |
| Onset date on the form differs from the notes | APS form vs first visit note | Form uses last day worked; notes use symptom start | Record both; the policy decides which date counts |
| Generalist and specialist disagree on diagnosis | Office note vs consult letter | Workup completed after the office note | Show the later, tested diagnosis and the date it was made |

If you remember one thing
Never resolve a conflict by choosing a side in the summary. Show both entries with pages, say which one testing supports, and ask the physician only when the answer would change the decision.

Chapter 8 Everyone

### The ERISA claims rule for disability claims, and what it asks of the APS

Most private-employer group LTD and STD plans are ERISA plans, governed by the Department of Labor's claims procedure regulation at 29 CFR 2560.503-1. Government and most church plans are outside ERISA, and individual disability policies follow state claim rules instead. For an ERISA plan, the regulation shapes when the APS must arrive, what the plan must say about it, and what the claimant may see.

| Stage | Deadline | Rule | What it means for the APS |
| --- | --- | --- | --- |
| Initial decision | 45 days | (f)(3) | Clock starts at filing, even if the APS has not arrived (f)(4) |
| First extension | up to 30 days | (f)(3) | Matters beyond the plan's control, noticed before day 45 |
| Second extension | up to 30 days | (f)(3) | Noticed before the first extension ends |
| Claimant's time to supply information | at least 45 days | (f)(3) | The clock is tolled while the plan waits (f)(4) |
| Time to appeal a denial | at least 180 days | (h)(3)(i), (h)(4) | The window to get a better APS and more records into the file |
| Decision on appeal | 45 days, 1 extension up to 45 | (i)(3)(i), (i)(1)(i) | New evidence the plan generates must reach the claimant before this |

#### What changed for claims filed after April 1, 2018

The Department of Labor amended the regulation for disability claims, and paragraph (p)(3) applies the new paragraphs to claims filed after April 1, 2018. The changes that touch the APS most directly:

- **Impartiality.** Under (b)(7), decisions about hiring, pay, termination or promotion of a claims adjudicator or medical or vocational expert "must not be made based upon the likelihood that the individual will support the denial of benefits."
- **Denial notices must engage with the treating physician.** Under (g)(1)(vii)(A), a disability denial must discuss the decision, including the basis for disagreeing with or not following the views of the claimant's treating health care professionals, the plan's own medical and vocational experts, and any Social Security determination the claimant presented.
- **Internal criteria disclosed.** Under (g)(1)(vii)(C), the notice must give the internal rules, guidelines or protocols relied on, or say that none exist.
- **New evidence and new rationales shared before the appeal decision.** Under (h)(4)(i) and (ii), the plan must give the claimant, free of charge, any new or additional evidence or rationale considered on appeal, early enough to respond.
- **Deemed exhaustion.** Under (l)(2)(i), if the plan fails to strictly adhere to the regulation, the claimant is deemed to have exhausted administrative remedies and may sue, subject to the narrow exception in (l)(2)(ii).

"A discussion of the decision, including an explanation of the basis for disagreeing with or not following: (i) The views presented by the claimant to the plan of health care professionals treating the claimant and vocational professionals who evaluated the claimant"

#### No treating physician rule, but no ignoring the APS either

In *Black and Decker Disability Plan v. Nord*, 538 U.S. 822 (2003), a unanimous Supreme Court held that ERISA does not require plan administrators to give special deference to treating physicians' opinions, and that courts may not impose a special burden of explanation when an administrator credits reliable evidence that conflicts with one. The Court drew the limit in the same passage:

"Plan administrators may not arbitrarily refuse to credit a claimant's reliable evidence, including the opinions of a treating physician."

Read together with the 2018 notice rule, the practical position is plain. A treating physician's APS does not win by being from the treating physician. It wins by being reliable: specific, supported by findings, and consistent with the chart. A plan that disagrees has to say why, in writing.

Standard of review sits on top of all this. Under [*Firestone Tire and Rubber Co. v. Bruch*](https://www.law.cornell.edu/supremecourt/text/489/101), 489 U.S. 101 (1989), a court reviews a denial de novo unless the plan gives the administrator or fiduciary discretionary authority to determine eligibility for benefits or to construe the plan's terms, in which case review is deferential. Some states void discretionary clauses in insured policies: [California Insurance Code section 10110.6](https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=INS&sectionNum=10110.6), for example, does so for life and disability coverage of California residents. Whether a court will look at evidence the administrator never saw depends on the standard of review and the circuit, so an APS that never reached the claim file may never be read by the judge.

If you remember one thing
For an ERISA disability claim, the appeal is usually the last chance to put evidence in the record. Get the specific, findings-based APS into the file during the 180 day window, not after.

Chapter 9 Deciding

### What makes an LTD attending physician statement persuasive

Claims examiners and reviewing physicians read hundreds of APS forms. They sort them fast, and the sort turns on 3 things: are there objective findings, are the restrictions specific and time-limited, and do the office notes say the same thing. A form that fails any 1 invites a peer review.

Weak APS
Diagnosis — "Low back pain"
Objective findings — "See notes" or blank
Restrictions — "No work"
Duration — "Indefinite"
Office notes the same week — "Pt doing well, full ROM, neuro intact" (templated)
Persuasive APS
Diagnosis — Lumbar radiculopathy, L5-S1, with the ICD-10 code
Objective findings — MRI date and finding, straight leg raise angle, reflex and strength grades, EMG if done
Restrictions — Lift 10 lb occasionally; sit 30 min at a time, 4 h a day; no repetitive bending
Duration — Through a named date, with the next reassessment visit
Office notes the same week — Same findings, same restrictions, in the physician's words

#### 1. Objective findings, dated

Many group policies require objective medical evidence, and every reviewing physician looks for it first. That means imaging with a date and a finding that fits the symptoms, test results (EMG, echocardiogram, pulmonary function, neuropsychological testing), and measured exam findings: degrees of motion, strength graded on a scale, reflexes, observed gait. For conditions with few imaging findings (fibromyalgia, migraine, many psychiatric conditions), the evidence is observations across visits, treatment intensity, standardized test scores and specialist evaluations. "Patient reports" is the phrase that weakens a form most.

#### 2. Restrictions that can be measured against a job

A restriction is only useful if a vocational reviewer can compare it to the material duties of an occupation. Many LTD policies, and most vocational reviewers, borrow the exertional levels Social Security uses:

| Level | Lift at a time (max) | Frequent lift or carry | What else defines it |
| --- | --- | --- | --- |
| Sedentary | 10 lb | small articles, occasionally | Mostly sitting; walking and standing occasionally |
| Light | 20 lb | up to 10 lb | A good deal of walking or standing, or sitting with pushing and pulling of arm or leg controls |
| Medium | 50 lb | up to 25 lb | Includes sedentary and light |
| Heavy | 100 lb | up to 50 lb | Includes medium and below |

Source: 20 CFR 404.1567(a) to (d). A restriction written in these terms ("lift 10 lb occasionally, sit 4 hours in an 8 hour day") translates directly into an exertional level. "Light duty" does not, because it means different things to different employers. Sitting tolerance deserves special attention: a person who cannot sit most of the day may not be able to do sedentary work, which is where many any-occupation disputes end up.

#### 3. Consistency with the chart

A common reason a treating physician's APS loses weight is a mismatch with the physician's own notes. Templated exam text is often the cause: an EHR that defaults to "no acute distress, normal gait, full range of motion" makes the notes say something the physician did not observe. Ambient AI scribes that draft notes from the visit conversation add a new version of the same problem, because a note can be fluent and still omit the measurements a claim needs. Check the form against the last 3 notes before it goes out.

#### Own occupation, then any occupation

##### Own-occupation period

The testCan the claimant perform the material duties of their own occupation?What the APS must showRestrictions that rule out the specific duties of that occupation: a surgeon's fine motor work, a driver's commercial license medical standard, a trader's sustained concentration

##### Any-occupation period

The testCan the claimant perform any gainful occupation they are reasonably fitted for, as the policy defines it?What the APS must showRestrictions that rule out sedentary work too: sitting tolerance, off-task time, absences, cognitive limits, need to lie down
The policy sets the length of the own-occupation period and the wording of both tests, so read the policy before reading the APS. The change date is a predictable denial point in an LTD claim, and the APS that carried the claim for the first period often cannot carry it for the second. Plan the updated APS months before the change date, not after the termination letter.

If you remember one thing
A persuasive APS gives numbers a vocational reviewer can use, findings a physician reviewer can check, and a date for the next look. "No work, indefinitely" gives them nothing.

Chapter 10 Building

### Worked example: an LTD claim that turns on the restrictions

**Hypothetical.** A 44 year old field service technician stops work on 02/02/2026 with low back pain radiating down the left leg. The occupation, as the plan's vocational reviewer classifies it, is medium exertion: lifting up to 50 lb, climbing, kneeling, driving between sites. The group LTD policy has a 90 day elimination period and an own-occupation period of 24 months, then any occupation. All names, dates and page numbers are invented.

#### Round 1: the form that says too little

The claim is filed on 03/20/2026 with an APS from the primary care physician. Diagnosis: "low back pain, M54.50." Objective findings: "see notes." Restrictions: "no work." Expected return: "unknown." The notes include a positive straight leg raise on 02/03 and a 03/10 exam section reading "normal gait, full ROM, neuro intact", a template default that contradicts the same note's history.

The examiner has 45 days. Denying now would mean explaining, under (g)(1)(vii)(A), why the treating physician's view was not followed, and the only reason would be that the physician did not explain it. A clarification letter that quotes the conflict and asks for numbers is the better move. The plan sends an extension notice under (f)(3) naming the information needed, and the claimant has at least 45 days to provide it.

**The APS before and after a specific clarification request** — hypothetical — Illustration
**APS version 1** — signed 03/18/2026
Diagnosis
Low back pain, M54.50
Objective findings
See notes
Restrictions and limitations
No work
Duration
Indefinite
Return to work
Unknown
**APS version 2** — signed 04/22/2026
Diagnosis
Lumbar disc disorder with radiculopathy, M51.16; spine surgery consult pending
Objective findings
MRI 02/14: L5-S1 extrusion contacting left S1 root. SLR positive left 40 degrees (02/03, 03/10, 04/15). Left ankle reflex absent. 03/10 exam template entry "neuro intact" was an error; addendum entered 04/22.
Restrictions and limitations
Lift 10 lb occasionally, nothing frequently. No bending, kneeling, climbing. Sit 30 min at a time, 4 h per day. Drive 20 min maximum.
Duration
02/02/2026 through 05/15/2026; reassess after surgical consult
Return to work
Not expected before 06/01/2026. Medium work not expected within 6 months.
Version 2 gives the examiner findings to verify, numbers a vocational reviewer can compare with medium work, a duration, and a correction to the conflicting note made as a dated addendum rather than a silent edit.

The examiner can now check each finding against its page (MRI p. 22; straight leg raise on pp. 3, 11 and 29), compare the limits with medium work, diary a recertification for 05/15, and ask for the surgical consult report now rather than in May.

#### Month 20: the any-occupation change

Suppose the claimant has surgery, improves, and plateaus with a 20 lb lifting limit and no sitting restriction. That profile rules out medium work and supports the own-occupation claim through month 24, but it fits the light and sedentary definitions in 20 CFR 404.1567. Unless the chart documents something that limits sedentary work (sitting tolerance, medication side effects, time off task, absences for treatment), the any-occupation review will likely find jobs within the restrictions. Claimant counsel who see this coming at month 18 ask the physician to address those capacities, with findings, before month 24.

##### 2. LTD restrictions and limitations letter to the treating physician

For claims examiners and claimant attorneys. Quote the record, ask closed questions, and ask for findings behind every number. Send it with the claimant's authorization. Adapt the occupation facts to the policy and the vocational classification.

[DATE]

[PHYSICIAN NAME], [CREDENTIALS]
[PRACTICE NAME, ADDRESS, FAX]

Re: [PATIENT NAME], DOB [DATE]
 [Claim no. / Our file no.]: [NUMBER]
 Authorization enclosed, signed [DATE]

Dear Dr. [NAME]:

[Your patient has a claim for disability benefits / We represent your patient in a
claim for disability benefits.] The claim turns on what your patient can and cannot
do at work, and your records are the main evidence. We are asking for specifics so
that your opinion can be given full weight.

Your patient's occupation is [TITLE]. As classified for this claim, its material
duties include: [e.g., lifting up to 50 lb, climbing ladders, kneeling, driving
between sites, sitting up to X hours]. [For any-occupation review: the question is
whether your patient can perform sedentary or light work on a sustained basis.]

1. DIAGNOSIS. Please confirm the diagnosis and ICD-10 code you treat, and the date
 you first made it.

2. OBJECTIVE FINDINGS. Please list the examination findings, imaging and test
 results that support your restrictions, with dates. [Your note of [DATE] (p. [X])
 records "[QUOTE]". Your note of [DATE] (p. [Y]) records "[QUOTE]". Please tell us
 which reflects your examination on [DATE].]

3. RESTRICTIONS AND LIMITATIONS. In an 8 hour workday, please state:
 a. Lift/carry: occasionally ____ lb; frequently ____ lb
 b. Sit ____ min at a time; ____ hours total
 c. Stand ____ min at a time; ____ hours total
 d. Walk ____ min at a time; ____ hours total
 e. Bend / kneel / climb / reach overhead: never / occasionally / frequently
 f. Need to lie down or raise legs during the day? Yes / No. If yes, how often.
 g. Expected absences for treatment or symptoms: ____ days per month
 h. Time off task beyond normal breaks: ____ % of the workday
 i. Cognitive or concentration limits from the condition or medication: ____
 For each item, please name the finding or observation it rests on.

4. DURATION. From what date do these restrictions apply, and through what date?
 When will you next reassess?

5. RETURN TO WORK. Can your patient perform the duties listed above? If not now, when
 do you expect to reassess? Could your patient perform [sedentary / light] work
 with the restrictions in item 3?

Please attach your office notes from [DATE] to present, and any imaging, test and
consult reports you hold. If any statement in your notes needs correction, please
make it as a dated addendum rather than an edit to the original note.

Please reply by [DATE] to [FAX/EMAIL/ADDRESS].

Sincerely,
[NAME, TITLE, ORGANIZATION, PHONE]
Enclosures: authorization; [claim form APS section]; [job description]
If you remember one thing
The best time to fix a weak APS is inside the initial 45 days or early in the 180 day appeal window, with a letter that quotes the chart and asks for numbers. After the record closes, a better form rarely helps.

Chapter 11 Everyone

### AI for APS summarization: where it helps and where it fails

APS work splits into reading and judging. Reading means finding every lab value, plan line, restriction and named provider across hundreds of faxed pages. Judging means rating a risk or deciding a claim. AI in life insurance underwriting and AI for insurance claims are useful for the first half and should stay out of the second.

#### What a large language model does well on an APS

- **Extraction at volume.** Clinical NLP pulls vitals, labs, medications and dose changes into dated tables, the step that takes a person hours on a 300 page chart.
- **Finding the lines people skim past.** "Did not return", "declined", "ran out of", "recheck in 3 months", a tobacco note in the social history.
- **Restrictions across visits.** An AI medical chronology that lists each stated restriction with its date and source shows where the claims form and the notes part ways.

#### Where it fails

- **OCR on faxes.** Optical character recognition can read 6.1 as 8.1 on a faxed lab, or 140/88 as 146/88. A misread value is worse than a missing one.
- **Handwritten notes.** Older charts and specialist letters still need a person who knows the abbreviations.
- **Copy-forward text.** A templated "neuro intact" repeated across visits looks like a finding to a model, as it does to a hurried reader.
- **Hallucination.** Ask generative AI "does this claimant qualify?" and it may write a confident answer the record does not support. A tool that fills gaps is the wrong tool for a file whose gaps are the point.
- **Judgment.** No model knows the carrier's manual, the plan's definition of disability, or what a discrepancy means for this applicant.

#### Page-level citations and a human in the loop

An AI medical records summary is only usable if every line opens the page it came from. An underwriter who can click from a summary line to the APS page it came from can clear or reject that line in seconds. That is what grounded, page-level citations buy, and the human-in-the-loop review is where the decision gets made. Courts make the stakes concrete: in *Mata v. Avianca, Inc.* (S.D.N.Y. 2023), lawyers were sanctioned under Rule 11 for filing case citations a chatbot had fabricated. The same duty to verify applies to a restrictions summary a claimant's attorney puts into an ERISA appeal, or an APS summary an underwriter relies on.

#### Choosing a tool for APS and claim file review

Legal AI tools, AI document review platforms and agentic AI systems that promise to run a whole claim workflow all compete for this work. Rank requirements in this order:

1 —

##### A citation on every line

Every value, restriction and quote opens its source page. No citation, no use.

2 —

##### HIPAA compliant AI with a signed BAA

A business associate agreement before any APS is uploaded. Consumer chatbots without one are out.

3 —

##### SOC 2 and no training on your data

An independent security report and a written commitment that applicant and claimant records do not train the model.

4 —

##### Flags, not decisions

Output that says "open order, no result found" or "form and note disagree", never a rating, a class or an approve or deny.

5 —

##### An audit trail of AI use

A log of who uploaded, viewed and edited each file, so you can answer questions about your own process later.

If you remember one thing
Use AI medical record review to read every page and cite it. Keep the rating, the claim decision and the letter to the physician with people.

Chapter 12 Publisher

### What Medrecords AI does with an APS, and what it does not

Medrecords AI is medical record review software. You upload the APS or the claim file you already have. It does not order an APS, contact a physician's office or retrieve records.

##### What it does

Every line cited to its source page

- [Collapses duplicate pages](https://medrecords.ai/product/medical-record-deduplication/) so a 212 page APS reads as what it is
- Builds a [cited chronology](https://medrecords.ai/product/chronology/) of visits, labs, vitals and medications
- [Flags missing records](https://medrecords.ai/product/missing-records-identification/): ordered tests with no result, named providers not produced, date gaps
- [Extracts each stated restriction](https://medrecords.ai/product/work-limitation-extraction/) with its date, and [tracks how restrictions change](https://medrecords.ai/product/work-capacity-functional-restriction-tracking/) across visits
- Compares a [second APS or new production](https://medrecords.ai/product/supplemental-record-review/) with the file: agrees, conflicts, adds
- Answers questions from the record [with citations](https://medrecords.ai/product/qa/)

##### What it does not do

These stay with your team

- Order, request or retrieve an APS
- Assign a rating, class or table
- Approve, deny or recommend a claim decision
- Decide whether a discrepancy is material
- Give a medical or legal opinion
- Write to the treating physician for you

Its flags are signals, not verdicts. A flag that says an ordered sleep study has no result tells an underwriter where to look; what that means for the offer is the underwriter's decision. Security is SOC 2 and HIPAA with a BAA. See [APS medical summaries](https://medrecords.ai/solutions/aps-medical-summary/), [life and disability underwriting](https://medrecords.ai/solutions/life-disability-underwriting/) and [ERISA disability claim file review](https://medrecords.ai/solutions/erisa-disability-claim-file-review/).

The offer

#### See your next APS as a cited summary.

Book a demo on an APS or claim file like the ones on your desk, then run your first case free on us. Every line comes back cited to its source page. You review, you revise, you sign.

[Book a demo](https://medrecords.ai/demo/) [See work limitation extraction](https://medrecords.ai/product/work-limitation-extraction/)
Scheduling only. No records move from a public page.

Chapter 13 Everyone

### Frequently asked questions

What is an APS in life insurance?An attending physician statement is a copy of the applicant's medical records from a treating provider, requested by the insurer with the applicant's signed HIPAA authorization. Underwriters use it to check the application and to see trends, open workups and adherence that an exam cannot show.
How long does an APS take?It depends on the provider's office, the accuracy of the provider details, and whether the first production is complete. No federal deadline applies to an insurer's authorized request. A patient's own access request under 45 CFR 164.524 must be answered within 30 days, with 1 extension of up to 30 days.
What is an attending physician statement for a disability claim?A form the treating physician completes on diagnosis, onset date, objective findings, restrictions and limitations, prognosis and expected return to work. The claims team compares it with the office notes and the material duties of the occupation.
Does an ERISA plan have to follow my doctor's APS?No special deference is required. The Supreme Court held in *Black and Decker Disability Plan v. Nord* (2003) that ERISA imposes no treating physician rule, but also that administrators "may not arbitrarily refuse to credit" reliable evidence from a treating physician. For claims filed after April 1, 2018, a denial must explain the basis for disagreeing with the treating physician's views.
Does an APS include psychotherapy notes?Not with a general authorization. Psychotherapy notes need a separate, specific authorization under 45 CFR 164.508(a)(2). Mental health diagnoses, medications and treatment records in the ordinary chart are included.
Can AI summarize an attending physician statement?Yes, for the reading part. AI medical record review tools extract vitals, labs, medications, restrictions and open orders into dated, cited tables. OCR errors on faxes, handwriting and copy-forward text still need a person to check each cited page, and no tool should assign a rating or decide a claim.
Is it HIPAA compliant to upload an APS to an AI tool?Only if the vendor signs a business associate agreement and protects the records under the HIPAA Security Rule. Consumer chatbots without a BAA are not appropriate for applicant or claimant records. Ask for a SOC 2 report and a written commitment that your data does not train the model.
Can ChatGPT read an APS for an LTD claim or appeal?A general chatbot can summarize text, but without page-level citations its output cannot be checked, and it may fill gaps with plausible statements the record does not contain. In an ERISA appeal, every fact you submit should trace to a page in the claim file.
Does AI make underwriting or claim decisions?It should not, and Medrecords AI does not. It organizes, cites and flags what is in the file. The underwriter rates against the carrier's manual and the claims examiner decides under the policy.

Chapter 14 Everyone

### Sources and method

Regulations, the *Nord* syllabus and the *Firestone* opinion were checked against primary sources in September 2026, and quoted text is verbatim. Carrier underwriting manuals are proprietary and are not quoted or summarized. The mock APS, the term life case, the LTD case and the time ledger are hypothetical. Product facts come from this site's product pages. Nothing here is legal, medical or underwriting advice.

- [29 CFR 2560.503-1](https://www.law.cornell.edu/cfr/text/29/2560.503-1), ERISA claims procedure: (b)(7), (f)(3), (f)(4), (g)(1)(vii) and (viii), (h)(2)(iii), (h)(3), (h)(4), (i)(1), (i)(3), (l)(2), (m)(4), (p)(3).
- [45 CFR 164.508](https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-C/part-164/subpart-E/section-164.508), HIPAA authorizations: (a)(1), (a)(2), (b)(2) to (b)(5), (c)(1) and (c)(2).
- [45 CFR 164.524(b)(2)](https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-C/part-164/subpart-E/section-164.524), the 30 day access deadline and its 1 extension.
- [20 CFR 404.1567](https://www.ecfr.gov/current/title-20/section-404.1567), sedentary, light, medium and heavy work.
- [Black and Decker Disability Plan v. Nord](https://www.law.cornell.edu/supct/html/02-469.ZS.html), 538 U.S. 822 (2003), syllabus; the [United States amicus brief](https://www.justice.gov/osg/brief/black-decker-disability-plan-v-nord-amicus-merits) filed in the case.
- [HHS sample business associate agreement provisions](https://www.hhs.gov/hipaa/for-professionals/covered-entities/sample-business-associate-agreement-provisions/index.html).
- [*Firestone Tire and Rubber Co. v. Bruch*](https://www.law.cornell.edu/supremecourt/text/489/101), 489 U.S. 101 (1989), on the de novo and deferential standards of review; [California Insurance Code section 10110.6](https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=INS&sectionNum=10110.6), voiding discretionary clauses; *Mata v. Avianca, Inc.*, 678 F. Supp. 3d 443 (S.D.N.Y. 2023): Rule 11 sanctions for fabricated AI-generated case citations.

Related guides: [medical source statements and RFC](https://medrecords.ai/guides/medical-source-statement-rfc/), [how to get medical records for a lawsuit](https://medrecords.ai/guides/how-to-get-medical-records-for-a-lawsuit/), [medical abbreviations for legal professionals](https://medrecords.ai/guides/medical-abbreviations-for-legal-professionals/), [HIPAA-compliant AI record review](https://medrecords.ai/guides/hipaa-compliant-ai-medical-record-review/), and [long-term disability record review](https://medrecords.ai/solutions/long-term-disability/).

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