Please review your policy for specific benefits covered under your plan. Please submit required medical documentation for the specific covered critical illness, the claimant's birth certificate, a list of the names of all doctors and hospitals in the appropriate section, as well as a signed and dated Authorization for Disclosure of Health Information (HIPAA form). I understand I may also receive text messages about the status of my Aflac application and am not required to provide my consent as a condition of accessing Aflac’s website or purchasing Aflac’s products. Please provide all information requested on the Insured's Statement portion of the claim form. /Length 310 /Subtype /Type1 << Mail: Aflac Claims Appeals, PO Box 84065, Columbus, GA 31908-9998. 8;U4*8AZ=@b:l^dJ*L_0.&7i0E^jm_'-W You have the right to appeal a decision up to a maximum of three times per claim. Failure to complete all sections may result in a delay in processing this claim. If your injury occurred on the job, a first report of injury filed with your employer must be attached to the completed claim form.If you were first treated in an emergency room, a copy of the hospital discharge papers is required to verify the first date of treatment, diagnosis, and procedure.Please include all dates of treatment and charges incurred due to the accident.Please date and sign all required forms where indicated.For critical illness claims, we need information from you and your attending physician. /Type /Font Claims may be eligible for One Day Pay processing if submitted online through Aflac SmartClaim®, including all required documentation, by 3 p.m.
Available for PC, iOS and Android. Please be sure to explain why you disagree with Aflac's decision, and include any additional supporting documentation. /CreationDate (8/27/2016 21:34:12) %PDF Font (F154)
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�/�n © 2020 000 8:00 AM - 8:00 PM EST Documentation requirements vary by type of claim; please review requirements for your claim(s) carefully. /BaseFont /Helvetica-Oblique 578 0 obj
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You can provide this information in the designated space on the claim form.If the accident resulted from the use of a motor vehicle(s), a copy of the police or accident report is required. endobj Also, if you are filing during the first year of your coverage effective date, we'll need you to provide the information requested on the Pre-Existing Investigation Statement.Please date and sign all required forms where indicated.Please provide a certified copy of the deceased person's birth certificate and death certificate.
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Please provide a date and complete description of your accident. /Type /Font Customer Service >>
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