Aflac accidental injury claim form 2008-2019-2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out the Policyholder/Patient Information section. Include your policy number, name, address, and contact details. Ensure all fields are completed accurately.
3. In the Patient Information section, provide details about the patient including their relationship to the policyholder and birth date. Check if they are a full-time student if applicable.
4. Complete the accident details by entering the date, location, and description of how the accident occurred. Indicate whether it was on or off the job.
5. If treatment was sought far from home, attach hotel receipts for lodging expenses incurred during hospitalization.
6. Have your treating physician complete Section B: Physician’s Statement with their information and signature.
7. Finally, review all sections for completeness before signing as the claimant and submitting your claim form.

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