FMLA AND DISABILITY FORMS
DISABILITY FORM PROTOCOL
Disability and work form requests require significant time on the part of the physician and office staff to complete, as they require parsing through medical records to find exact dates, nature of treatment, exact diagnosis and other required information. As such, Lowcountry Orthopaedics & Sports Medicine, a member of Arcis Healthcare, L.L.C., has developed a standard form for disability benefits that will be sent to your disability carrier.
1) We understand many of our patients depend upon the income from insurance and disability forms for support during recovery. ALL forms (disability, FMLA, loan, Return-to-work, etc.) are completed in the order in which they are received, after the chart and medical records are made available. Please allow one to two weeks for the form to be completed.
2) Forms are not emergencies, it is the patient’s responsibility to supply them far enough in advance of deadlines.
3) Our office does not complete forms related to Social Security disability, veteran’s administration disability or student loan discharge forms. Submitting such forms will result in their return to your home address on record. Please request a copy of your medical records to support your claim instead.
4) A $15.00 fee applies to each form request in accordance with SC Code of Laws 44-115-90 and 44-115-110. You may pay in person at any of our offices or via Patient Portal. After the first form has been completed, all patient account balances must be paid and kept current before any additional disability form will be completed.
5) We MUST have a SIGNED authorization to send forms and medical records to third parties including employers and insurance companies. Please read and complete the “Claimant Information for Disability Benefits” form in its entirety. If you do not, your form will be held until you sign one at your next appointment or pick up a copy of the completed form to submit yourself.
6) We are not responsible for employee/employer sections of forms.
7) If you are missing work, you must ask your provider for an updated copy of a “Work Status Report” at each visit EVEN if you have FMLA or Worker’s Compensation leave. Failure to do so may result in the holding of your forms for lack of documentation or the requirement of an additional visit for assessment.
8) It is suggested every patient call their employer or insurance company and verify receipt of form after the two week period. If they say it wasn’t received, PLEASE confirm the fax number and the claim or incident number and provide that information to us as a double check. We will happily supply the date and time our records show confirmation forms were sent as well as resend them again if necessary at no additional cost to the patient.
TO SUBMIT FORMS:Fax: 843-203-5719 or 843-735-5914
Attn: Adrienne F. / M.R. Dept Rep.Email: email@example.com
Walk-in: Or in person at any of our offices.
IF YOU HAVE A QUESTION:See the Frequent Asked Questions Section
Inquire via the Patient Portal
Leave a voicemail at: 843-793-6753