Aflac Short Term Disability Claim Form. Web for assistance or information, call 1.800.99.aflac (1.800.992.3522). My coverage here you’ll find a copy of your policy and benefit details to see what’s covered and benefit amounts.
FREE 8+ Sample Aflac Claim Forms in PDF
If disability, is later, determined to be for a longer term, there will be follow up forms required at that time. *last name *first name *date of birth (mm/dd/yy) / / physician information: *last name *first name *date of birth (mm/dd/yy) / / physician information: Web short term disability claim form *please attach paperwork for any additional income you are receiving during this period of disability.* **please sign and return the attached authorization. *last name suffix *first name *date of birth (mm/dd/yy) / / patient information: This * denotes a required field. Date of birth gender policy holder’s address: If this is a disability product with your policy number beginning with afl, please use the form below. To be completed by aflac associate/agent. Policyholder’s statement (forms are to be completed on or after disability date to avoid processing delays)
*last name *first name *date of birth (mm/dd/yy) / / physician information: Web form a57601coh 1 of 9 a576c01coh.2. This form is used to file a claim for short term disability. If disability, is later, determined to be for a longer term, there will be follow up forms required at that time. *last name suffix *first name *date of birth (mm/dd/yy) / / patient information: My claims follow your claim from start to finish and receive alerts if we need additional information through our integrated claim status tracker. Web short term disability claim form. For claim forms, visit our web site at aflac.com. Annual income must be $9,000 or greater for coverage to be issued. If uploading a picture from your phone, please only submit the medical documentation for your proof of services. If you are eligible for medicare, review the “guide to health insurance for people with medicare” available from aflac.
