Aflac accident injury claim form 2026

1. Click ‘Get Form’ to open the Aflac Accident Injury Claim Form in the editor.
2. Begin by filling out the Policyholder Information section. Ensure you complete all required fields marked with an asterisk, including your last name, first name, date of birth, and home address.
3. Next, provide Patient Information. Again, fill in all mandatory fields such as the patient's last name, first name, and date of birth.
4. In the Accidental Injury Checklist section, detail the date of the injury and describe how it occurred. Answer any relevant questions regarding employment-related incidents or motor vehicle accidents.
5. If applicable, indicate whether surgery was performed or if major diagnostic exams were conducted due to the injury. Attach necessary documentation as specified.
6. Complete any additional sections related to transportation or lodging claims if relevant. Be sure to submit receipts and mileage information.
7. Finally, review all entries for accuracy before signing and dating the form at the bottom.

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