Accident Policy Claim – Major Accident
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.
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.
Section B needs to be completed in full by the physician who treated you. Please be sure no sections are left
uncompleted unless they do not apply.
3.
Sections C and D do not apply to your claim unless you are also claiming
from an AFLAC Short Term Disability policy, however you must sign the form at the bottom of page 2.
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:
Include the First Report of Injury from your employer if
this claim is
for a Workers
Compensation injury
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:
1.
Have you completed Section A and the Authorization to
Obtain
Information?
2.
Have you signed at the end of Section D?
3.
Has your physician completed Section B?
4.
Have you included proof of ER and all doctor visits
(including physical
therapy)?
5.
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.
6.
If surgery was required have you included a copy of the Operative
Report? This
should be requested from your surgeon.
7.
If you required an ambulance have you included a copy of the
ambulance bill?
8.
If this injury was caused by an auto accident have you included a copy
of
the
police report?
9.
If this claim is for a Workers Compensation injury, have you included
a
copy of the First Report of Injury from you employer?
10.
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.
11.
Before faxing to our Claims Department have you included your
information
on the fax cover sheet?