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The document is an Accidental Injury Claim Form from Aflac, providing instructions for filing a claim related to accidental injuries. It outlines the necessary information and documentation required from policyholders and patients, including personal details, injury specifics, and medical records. The form emphasizes the importance of completeness to avoid processing delays and includes disclaimers about coverage limitations.

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

How do I make a claim with Aflac?

To file a claim, simply select the appropriate claim form for your specific product and mail or fax it to us at the address on the form. Download the form. Fill it out. Send it in to: PO Box 60676, Worcester, MA 01606.

What documents does Aflac need to submit a claim?

Accidental death - Certified death certificate & beneficiary statement claim form. Police report - Required for MVA and any other occurrence investigated by the police. Physician's office notes. Emergency room - ER or urgent care report.

What is proof of loss for Aflac?

Proof of Loss: Written proof that is required to be furnished to the insurer about a loss to help determine the extent of insurer liability. Provider: A facility, licensed as such, that provides health services for an individual.

How far back will Aflac pay?

We will pay the amount shown when, because of a covered accident, you are injured and those injuries cause confinement to a hospital for at least 24 hours within 90 days after the accident date.

Will Aflac pay for past medical bills?

If you own an Aflac policy, your cash benefits can be used to help pay your deductible and any leftover medical bills, the mortgage or rent, utilities or other expenses you may have.

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How far back can I claim Aflac?

How long do I have to file a claim? A. There is a one-year timely filing provision in your certificate.

How do I file a claim with Aflac cancer?

Send to: Phone:(800) 433-3036. Fax:(866) 849-2970. Email: groupclaimfiling@aflac.com.

How do I get an Aflac form?

Please print a separate form for each additional family member or call 1-800-99-AFLAC (1-800-992-3522) to request additional forms. Claims for all other benefits covered under this policy must be filed separately using the claim forms available at aflac.com or by calling 1-800-99-AFLAC (1-800-992-3522).

How long does it take Aflac to review a claim?

Aflac Aflac cannot process claims until they have the employee's statement, physician's statement, employer statement and the authorization page. Claims approval process takes 5 days to process and pay out claims.

What is a UB 04 form for Aflac?

Itemized hospital bill (IHB). UB04 (itemized hospital bill). ER visit. (Please obtain the supporting documents for the corresponding benefit.)

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How do I make a claim with Aflac?

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How far back will Aflac pay?

Will Aflac pay for past medical bills?

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How far back can I claim Aflac?

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What is a UB 04 form for Aflac?

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