What the 83730 is for
The 83730 is RBC Life Insurance Company’s claim package for group disability, group life waiver of premium, and individual disability claims. It has four detachable statements: the claimant’s, the employer’s, an occupation statement, and the attending physician’s. RBC adjudicates the claim on the medical information you give about the diagnosis, signs and symptoms, and the patient’s limitations and restrictions.
The form dates from 2009. RBC’s current group benefits forms page sends plan members to the industry Initial Disability Insurance Medical Statement for the long-term disability physician’s statement, so some patients arrive with that form instead.
Who completes it
The claimant completes the Claimant’s Statement and, on the Attending Physician’s Statement, only the Patient’s Information section. The employer completes the Employer’s Statement and, for a group claim, the Occupation Statement, which a self-employed claimant completes themselves. The attending physician completes the rest of the Attending Physician’s Statement and returns it directly to RBC.
The sections are detachable and travel separately, which is why RBC asks for the policy number at the top of every one. Patients usually fill in the Claimant’s Statement at home and bring the physician’s pages to the clinic. In Medulla, you send the Claimant’s Statement and the Patient’s Information section to the patient over a secure link. They fill it in on the form from any device, and their answers land on the PDF you complete your statement on, so the policy number and patient details are already there when you sign.
How to fill in the Attending Physician’s Statement
Patient’s history
Give height and weight, the dates symptoms first appeared, of the first visit for this condition, and when the patient stopped work. Describe the symptoms on the day work stopped and at the first visit. Say who suggested the patient stop work, and whether time off is therapeutic, with goals and a suggested duration, or due to an inability to function. Note any previous similar condition, whether it’s chronic, the referring physician, whether it’s work-related, and any licence or certification restricted or revoked.
Physician’s diagnosis
Give the primary diagnosis, using each DSM axis for a psychiatric condition, and for a cardiac condition the last blood pressure and the American Heart Association class. Add the secondary diagnosis, symptoms, and objective findings with the type, date, and result of each test. Then answer the two questions the form sets in capitals, what the patient should not do and why, and what the patient cannot do and why. Note handedness and any pregnancy due date.
Patient’s treatment
List hospitalizations, surgery done or planned, and each medication with its start date, dose, response, side effects, and changes. Add other treatments with expected duration, rehabilitation programs, psychiatric consultation, and other providers. Comment on the response to treatment, whether the patient is following the plan, whether treatment will change, and whether maximum medical improvement has been reached.
Return to work plan
Choose the prognosis: recovery without impairment, stabilization with continuing impairment, each with a number of weeks, or permanent impairment. Describe your understanding of the patient’s job, whether they could try their own job or any other work, with or without modifications, and the return-to-work plan you’ve discussed or the barriers to one. Say whether you’re reporting to other insurers.
Common reasons it’s delayed
- Restrictions and limitations left blank, or answered with a diagnosis.
- No objective findings, or tests listed without dates or results.
- No prognosis category or number of weeks.
- Copies of the file for the treatment period not sent.
- The forms reaching RBC more than 90 days after the claimed disability date.
- No policy number on the detached physician’s statement.
Submitting and who pays
Return the Attending Physician’s Statement directly to RBC Life Insurance Company’s Life and Health Claims Department at P.O. Box 4435, Station A, Toronto, or by fax, as printed on the form, with copies of your file for the treatment period. All the forms must reach RBC within 90 days of the claimed disability date. RBC offers $50 toward photocopying the file, and the charge for completing the form is the patient’s responsibility.