Get Accident Claim Form - Aflac

Filling out the Accident Claim Form for Aflac online is a straightforward process that ensures your claim is processed efficiently. This guide will provide you with step-by-step instructions to help you navigate through each section of the form with ease.

Follow the steps to successfully complete your claim form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor for further processing.
2. Begin with the date of the injury. Enter the date in the designated space provided on the form.
3. Describe how the injury occurred in the provided space. Be as detailed as possible to aid in the processing of your claim.
4. Indicate the location of the injury by selecting either 'On the job' or 'Off the job'.
5. If applicable, specify whether a Worker's Compensation claim has been filed, and provide the current status of that claim.
6. Answer whether the injury resulted from a motor vehicle accident. If yes, you will need to submit the police report along with your form.
7. If death resulted from the injury, indicate 'Yes' and prepare to provide a certified death certificate and the Life-Beneficiary’s Statement.
8. If the injured person stayed in the hospital due to the injury, mark 'Yes' and fill in the admission and discharge dates along with the hospital's name, city, and state.
9. Inform if the injured person was transported by an ambulance; if so, you must include the ambulance bill.
10. For certain injuries, such as coma or paralysis, attach any relevant medical records or notes from the physician.
11. If necessary, check if an aid in locomotion (like crutches, wheelchairs, etc.) was prescribed and include documentation from the prescribing provider.
12. Indicate whether any covered surgeries were performed as a result of the injury and attach the operative report if applicable.
13. State if a major diagnostic exam was performed, like a CT Scan or MRI, and include any related reports or billing.
14. Provide all treatment dates related to the injury, including the initial treatment date and follow-up visits, ensuring to submit supporting documentation.
15. Complete the Electronic Funds Transaction Authorization section by entering your banking details for direct deposit if you wish to receive benefits electronically.
16. Review all information completed on the form for accuracy and clarity.
17. Once all sections are appropriately filled, you can save the changes, download the completed document, print it for your records, or share it as required.

Ensure a smooth claims process by completing your Accident Claim Form - Aflac online today.