h0cQ^!FY^@5YZ9`C((MZ9iSNHc>@i(/A6Ang=Q>29[%f,N\.ZX(j>Mqs0Q)QK[VqWr`O1c][Ae6 0000040092 00000 n Direct to Consumer individual coverage underwritten by Tier One Insurance Company. CNbe58Z\L9(JIf#nd8N&d;_Ve"&$B6Y;]TiZ`M2[D^dN\Eb5qm'qVJ='T'4DBH2tpG-/Q,o_g=%ZaF:Y << /Count 1 /First 18 0 R /Last 18 0 R >> >> If your disability is being extended, you will need to complete the listed Supplemental Claim form. s(a2"ShqZon2tUR"gff@QgRi&=8T@kgq-(JZ&gl35W-8HGs$[[cMe Get filing requirements, supporting documentation details, and more. endobj <> The Disability Claim Form (Aflac Insurance) form is 8 pages long and contains: Use our library of forms to quickly fill and sign your Aflac Insurance forms online. If this is a Disability Product with your policy number beginning with AFL, please use the form below. 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Please date and sign all required forms where indicated. >> #18R:]\1;,nqN5j4@OmooAng>Dj7\$6I5WEl9T2tR'\SuV`NS+%%o_@bX'RnWu4:b)*k#n1R(+?O9$>r endobj 1EWs%t3I_6o#k'G^.VY7l!4E5fU,kWcMcPcnu9Vps@:V.*1hGHiRR-8n&.Gf>KTA_?ia$;;29=Lp*@; ]/:~> 1g!5D-LsIWRBY-X(8X2r&@O_`0*:d@O.-Wcm!Ja'h?grDR1Nq&[A-=2b! 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). Once completed you can sign your fillable form or send for signing. 0000049255 00000 n nBr?OjbmGB*-+c"Gfs=pq`pf\5/qG=9-4ag[=%5G2c]U@?7%qhqm. File a Disability Claim File a Hospital Claim File a Group Life Insurance or Accidental-Death and Dismemberment Insurance Rider Claim File a Universal Life Insurance Claim underwritten by Trustmark Insurance Company Claim Aflac Group Insurance Additional Forms Authorization to Obtain Information Form Direct Deposit of Claims Payment Form 25 0 obj endobj 2 0 obj Aflac Group Policies: endstream @N)SrO2ugDjIc8hNYmK#n+u6M$%s(j[C@]^p/k/% Universal Life Insurance underwritten by Trustmark Insurance Company. cC5a$qEUFt(E8e->F3f^Yr:J8cr+o+V8SWC.sUDP!9a:YTD`h-6Dlku'HCEL>"u[SakEau h.*.:`/`($FjUjeMh+%3^KDbf? 0000001020 00000 n Decide on what kind of eSignature to create. ;]2"WH3RN-IY-eA348fl;R6]T4%O*^emkHfI8Di4T'&!Ns\94;%b [W_J1(2pZ1HC$V;V*/7\3N-"m8ACA6(\G4_j7tLZo4PDu:9kltQ:qtrOFJei`3u25)_cfnQ2M,M>*2Sb /Subtype /Type1 ;Y'TZ`#NiWQ Register now Aflac Life, Absence and Disability Solutions Learn more about. endstream endobj PolicyholderInformation:This*denotesarequiredfield. <> >> Aflac is here to help. All forms are printable and downloadable. Nq.&`'\L*3M[AYZ6ll!-TD@!G8Dg.9W*C\Zs0MVFFq.Qdq@5EcSUjS9Pe3%!0kB*T4F TLFC\4aS)n5C^j*@4%"P0VVa9rj(. endstream :JP2npQHaeod^X7'sK!^CIY561O?2S)MJ3_5]Y=4,Cn7b%K5Me(p[?9MOo\lj=] << endobj Apply your e-signature to the PDF page. P\D=1Pt+K^bCr/L=R_+?]7:K8ND*^rZJ>\)+SO$sqSJ1VT+A'Q-ShdfdhK\Q%N%LoP*mTJ1U1["BmoP?0"U1GH. 0000037564 00000 n Download the data file or print out your PDF version. FXd-mhfj\dS((^`0K6!.q%j)EYH;^Rd.Aa`hf%gahFK:H:&//7pMV3D2qV#r4Oea\q/upjBMGec[O,Y:5n_u^Q$*P(4j$+WU5q!\lQS0:!H;gK mOu72$0Z_TEkhh3=;Da@gQ!"PXflT9`-nbs>;ZjA5? 0000003079 00000 n 32h0$$08-8TYS-cMZH4Z@mV"tA/C(INdbs#Y3A\%VXCNMeOT)V?mHH\@]`s8D$dlP#B>-]=L]c3bUZ5nds%jlGpH>? :JP2npQHaeod^X7'sK!^CIY561O?2S)MJ3_5]Y=4,Cn7b%K5Me(p[?9MOo\lj=] ?f48_G,BN0p=/>&*)"gUTVU[Y>F[!H0S$cH]UJRYpFnh6'Ae"7a6i,,,Lbtk3(JMM]r0XUgZr>L@0I'i -_6'A_4IL[`92un&r8tH[>^"rhOWrgJZC\%6"6'k2kR6&.9EYCGWVonkFA2[(WQ.mndG'-IoKK^(VM6j):K)HmcRL+qg#Rf The Attending Physicians statement portion of the critical illness claim form is to be completed by the physician who first diagnosed your condition. 19 0 obj Aflac lets you provide your employees with outstanding benefits without costing you a penny. 0000055045 00000 n 55184 "kt65Ko1TNq1+;X4?fH1W0SbI2D-F(6cs2(!E?1oM!HZ/`bJ.Cb4@4gWrBVNX,G01o;?NA0^%)?aS>EJ $d"'aL\l#A%IE5_YS4O4h)$pN261/3.91=eY! endobj Simply select "File Online" below and follow the instructions. 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Please provide a date and complete description of your accident. Please choose "Individual" or "Business.". *?ZgaJ72F%->d4aYIUb3reE0'[sM)3JY+[(7="R\fM6;Q endobj 2. View Site Continuing Disability Claim Form Aflac https://api.aflac.com/docs/claimforms/S13270.pdf ;]2"WH3RN-IY-eA348fl;R6]T4%O*^emkHfI8Di4T'&!Ns\94;%b You will be automatically redirected in 10 seconds or click the button below to be redirected immediately. 0000003079 00000 n %%EOF, 3T;C!WW4Ki3jpQoiR!f,B'&Z:-,IO-Zq$&hBkC=HU@Y3)-Z7i/#[6S/+p@I:RnZ,Zu8hna5,OXLi#hGpMO`^lS.s0&6Us=%m@8h6<5u9e[1qBDSkRo7:L?^bDtpRqeOlX:eqkU9[p,&in^ADo=rk`A*eP:sf'8Vn #uY.o`Vd[Bd.YT[///3UJY[r*;n,NhjZnQjdJ7=`r$)Ri)3:i(@X2#3?N.HcWa:.*$kP? 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