Get Aflac Claim Form.pdf - Azfop44.net

Filling out the AFLAC Claim Form is a crucial step in ensuring that you can receive the benefits you are entitled to following an accident. This guide will walk you through the various sections of the form, providing clear instructions to make the process seamless.

Follow the steps to complete your AFLAC Claim Form accurately.

1. Press the ‘Get Form’ button to obtain the AFLAC Claim Form and open it in your editor.
2. Fill in your policyholder information, including your policy number, first name, initial, last name, mailing address, city, state, and ZIP code. If your address has changed, check the box indicating a new permanent address.
3. Complete the patient information section by providing the patient's first name, last name, relationship to the policyholder, phone number, social security number, sex, and birth date. If the dependent child is a full-time student, check the corresponding box and provide the school name and contact details.
4. Answer the questions regarding the accident. Specify the date, describe how the accident occurred, and indicate the location. Note whether the accident happened on the job, off the job, or elsewhere. If applicable, state whether the patient was driving in a motor vehicle accident and attach the police report.
5. If the patient required lodging for relatives while hospitalized due to the accident, include the hotel receipts and verify if the distance met your policy guidelines.
6. Complete the physician's statement by having the treating physician fill out Section B. This includes their name, address, dates of service, diagnosis code and description, procedure code and description, and details about the hospitalization.
7. The physician must sign and date the statement. Include their tax ID number as required.
8. Review all information for accuracy and completeness. Ensure that the claimant signature is included alongside the relationship to the policyholder.
9. Once completed, save your changes, download the form or print it out, and submit it to AFLAC through the recommended methods.

Complete your AFLAC Claim Form online today to ensure you receive your benefits swiftly.