Download Aflac Short Term Disability Claim Form/ Initial Disability
Aflac Short Term Disability Claim Form. To avoid delay, all questions must be answered.) please complete both pages of this form for pregnancy disability only: This * denotes a required field.
Download Aflac Short Term Disability Claim Form/ Initial Disability
Web short term disability claim form. This form is used to file a claim for short term disability. Nt (forms are to be completed on or after disability date to avoid processing delays) policy holder’s name: Annual income must be $9,000 or greater for coverage to be issued. This * denotes a required field. If uploading a picture from your phone, please only submit the medical documentation for your proof of services. My coverage here you’ll find a copy of your policy and benefit details to see what’s covered and benefit amounts. Policyholder’s statement (forms are to be completed on or after disability date to avoid processing delays) This * denotes a required field. *last name suffix *first name *date of birth (mm/dd/yy) / / patient information:
If disability, is later, determined to be for a longer term, there will be follow up forms required at that time. Include tax records, at the time of claim. If disability, is later, determined to be for a longer term, there will be follow up forms required at that time. This * denotes a required field. Attending physician’s statement to be completed byphysician certifying disabilityon or after disability dateto. This * denotes a required field. If this is a disability product with your policy number beginning with afl, please use the form below. 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. For claim forms, visit our web site at aflac.com. Web file your claim via fax or mail. Web for claim forms, visit our web site at aflac.com.
