Accident Claim – Accident with Disability
Use these instructions if claiming for both Accident and
Disability benefits
Required
forms (click on each form to open and print):
Claims Department
Fax Cover Sheet
After you
have downloaded or printed the above forms, just print this page and follow
these instructions. For faster
service fax directly to our claims department using the Claims
Department fax cover sheet. If you mail anything, please keep copies of
everything you mail until your claim is complete. Please remember that disability caused by an
accident must have occurred off the job.
On the job disabilities are covered by Workers Comp.
It is
important to follow these instructions completely. Failure to do so will result in a delay of
the processing of your claim.
1.
You (or the patient) need to personally complete
Section A. Be sure to complete all
sections.
2.
Sections B and C need to be completed in full by
the physician who treated you. Please
be sure no sections are left uncompleted unless they
do not apply. It
is very important that the physician includes the date
of the accident and a description of how the accident occurred (in Section
B). In many cases
this information is not completed accurately and results in a delay of your
claim because AFLAC must receive physician verification that the
disability was caused by an accident.
3.
Section D is to be completed by your employer.
4.
Please be sure to include backup documentation that includes a diagnosis
to support your claim. This would include any of the following that apply to
your treatment. This is not an all inclusive list – please consult
your policy for a complete list of benefits and then provide corresponding
documentation:
This type of supporting
information is very important because the claim cannot be processed without it.
After you have
sent your claim, please deal directly with AFLAC Claims Department by calling 1-800-992-3522
from 8 a.m. to 6 p.m. Monday through Friday.
Please have your policy number ready so you can be
assisted promptly. Also, if
you have any questions regarding your claim or if you simply want personal
assistance please feel free to call me at 561-776-0098.
Reminder checklist – Please be sure you have you completed or
provided the following:
· Have you completed Section A and the Authorization to Obtain
Information?
·
Has
your physician answered each question in Sections
B and C?
·
Have
you included proof of ER and all doctor visits (including
physical
therapy)?
· If you were confined in a hospital
have you included a copy of the Itemized
hospital
bill? This bill must show a room charge in order for
benefits to be paid. Please click the following link to view a
sample:
[Sample Itemized Hospital
Bill] A copy of
this bill should be requested
from the hospital billing or records department.
·
If
surgery was required have you included a copy of the Operative
Report? This should be requested from your surgeon.
·
If
you required an ambulance have you included a copy of the ambulance
bill?
· If this injury was caused by an auto
accident have you included a copy of
the
police report?
·
Have
you included your policy number(s)? If you do not have your
policy number(s),
please call 800-992-3522 to be provided with it. It is
important to
remember that each policy has a separate policy number.
·
Before
faxing to our Claims Department have you included your
information
on the fax cover sheet?