Accident Policy Claim – Minor 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. If you
required surgery or hospitalization you should use the instructions under the
link Major Accident.
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, and the attached Authorization to Obtain Information. Be sure to complete all sections.
2.
Section B does not need to be completed for minor claims provided
you have the documentation referred to in item 4 below to support your claim. If the documentation you provide does not clearly show a
diagnosis you must have your physician complete Section B.
3.
Sections C and D do not apply to your claim.
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 injury. This is not an all inclusive list – please consult
your policy for a complete list of benefits and then provide corresponding
documentation:
Records
of physical therapy
Include
a copy of the ambulance bill if you were transported in
an ambulance
Include the First Report of Injury
from your employer if this claim is
for a Workers Compensation injury
Include a copy of the police report
if this was an auto accident
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 completed or provided the following:
1.
Have you completed Section A and the Authorization to
Obtain
Information?
2.
Have you included proof of ER and all doctor visits
(including physical
therapy)?
3.
If this claim is for a Workers Compensation injury, have you included
a
copy of the First Report of Injury from you employer?
4.
If this injury was caused by an auto accident have you included a copy
of
the
police report?
5.
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.
6.
Before faxing to our Claims Department have you included your
information
on the fax cover sheet?