Download Aflac Short Term Disability Claim Form/ Initial Disability
Aflac Short Term Disability Claim Form. This * denotes a required field. Flatten documents that have been folded or crumbled before uploading.
Download Aflac Short Term Disability Claim Form/ Initial Disability
When taking photo copies of the documents make sure the document is flat. Flatten documents that have been folded or crumbled before uploading. It is not a substitute for hospital or medical expense insurance, a health mainten ance organization (hmo) contract, or major medical expense insurance. If this is a disability product with your policy number beginning with afl, please use the form below. *last name *first name *date of birth (mm/dd/yy) / / physician information: Include tax records, at the time of claim. You choose the plan that’s right for you based on your financial needs and income. If uploading a picture from your phone, please only submit the medical documentation for your proof of services. Annual income must be $9,000 or greater for coverage to be issued. Consider filing online for faster claims payment!
This is a supplement to health insurance. Nt (forms are to be completed on or after disability date to avoid processing delays) policy holder’s name: Attending physician’s statement to be completed byphysician certifying disabilityon or after disability dateto. *last name *first name *date of birth (mm/dd/yy) / / physician information: This * denotes a required field. Web claims checklist claims checklist helpful tips: To avoid delay, all questions must be answered.) please complete both pages of this form for pregnancy disability only: My coverage here you’ll find a copy of your policy and benefit details to see what’s covered and benefit amounts. Web form a57601coh 1 of 9 a576c01coh.2. My claims follow your claim from start to finish and receive alerts if we need additional information through our integrated claim status tracker. Flatten documents that have been folded or crumbled before uploading.
