Disability Policy Claim Form

Disability Policy Claim Form - Accidents

Required forms (click on each form to open and print):

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.

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 need to personally complete Section A, the Authorization to Obtain Information. Please be sure that you have passed (or will pass) your elimination period before filing for disability. This is usually 0, 7 or 30 days elimination for accidents and depends on your choice at the time of enrollment. If you are unsure which elimination period you have elected please call AFLAC at 800-992-3522 so you can be provided with this information.

2. Section 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.

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.

Claim checklist (Have you included or completed the following):

· Have you completed Section A and the Authorization to Obtain

Information?

· Have you verified that you have passed your elimination period?

· Has your physician answered each question in Sections B and C?

· Has your employer completed Section D?

· Have you included your policy number? If you do not have your

policy number, 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?

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