What the DISB-1010 is for
The attending physician’s statement gives Saskatchewan Blue Cross the medical evidence for a critical illness claim. Critical illness policies pay when the insured person is diagnosed with a covered condition, and the insurer checks your diagnosis, dates and investigations against the policy’s definitions. The statement also asks about prior episodes of the same or a similar condition.
Saskatchewan Blue Cross uses separate forms for disability claims, which ask about the patient’s ability to work.
Who completes it
The patient signs the Patient Authorization at the top of page one, with their name and date of birth, which releases their health information to Saskatchewan Blue Cross. The attending physician completes the rest and signs it. The patient’s own claim details go on a separate claimant statement, the DISB-1023.
Patients usually bring the form in unsigned, or sign it at the front desk, and the clinic holds it until the physician completes the statement. In Medulla, you send the Patient Authorization to the patient over a secure link before or after the visit. They sign it from any device, and their signature lands on the same PDF you complete the statement on, so Saskatchewan Blue Cross gets one complete form.
How to fill in the Attending Physician’s Statement
Diagnosis and dates
Give the diagnosis as precisely as the record allows, including stage or type where it applies. Record the date symptoms first appeared and the date the patient first received treatment, investigations, medication or consultation for this condition. Take both dates from the chart, since the patient’s claimant statement asks for the date of onset too.
Prior history, hospital and surgical treatment
Say whether the patient has ever had the same or a similar condition, with dates and details. Record outpatient care, or the admission and discharge dates, with the hospital’s name and address, and any surgery with dates.
Other treating physicians and enclosures
List the family doctor and specialists who treated the patient for this condition, with contact details. Enclose copies of all relevant results, pathology and hospital records, and consultation reports.
Activities of daily living, prognosis and remarks
Describe how the condition affects eating, dressing, bathing, ambulation and toileting. Give your prognosis and add anything else that helps the review. Print your name and specialty, add your contact details, sign and date.
Common reasons it’s delayed
- A diagnosis with no supporting pathology, imaging or consultation reports enclosed.
- Missing dates of first symptoms or first treatment.
- The prior history question unanswered.
- An unsigned Patient Authorization.
- Other treating specialists not listed, so the insurer has to ask the patient.
Submitting and who pays
The patient or clinic sends the statement to Saskatchewan Blue Cross at the Saskatoon address on the form, or by fax. The form doesn’t say that Saskatchewan Blue Cross pays for it, so clinics typically bill the patient an uninsured service fee.