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  • Accident Claim Form - Aflac

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ACCIDENT CLAIM FORM Failure to complete all sections may result in a delay in processing this claim. To prevent delays, please provide documentation from your healthcare provider to support this claim.

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Initial Accident Hospitalization Benefit Aflac will pay $1,000 when a covered person is confined to a hospital for at least 24 hours for injuries sustained in a covered accident. If the covered person is admitted directly to an intensive care unit, Aflac will pay $2,000.

Submit your claim online 24/7 Manage your account, submit and track claims, setup direct deposit and more.

The UB-04 claim form is used to submit claims for outpatient services by institutional facilities (for example, outpatient departments, Rural Health Clinics and chronic dialysis centers).

Q. How long do I have to file a claim? A. There is a one-year timely filing provision in your certificate.

Date and description of injury. Location of the injury. Patient's name and date of birth. Patient's relationship to policyholder.

Injuries and Emergency Services Covered Aflac's accidental injury insurance helps cover a wide span of events, from emergency situations to more common accidents. On one side of the spectrum, we provide coverage for burns, comas, paralysis, concussions, dislocations, and lacerations.

Send to: Phone:(800) 433-3036. Fax:(866) 849-2970. Email: groupclaimfiling@aflac.com.

Grace Period: A period of time beyond the due date for premium payment (usually 31 days) during which time a policyholder may still remit the premium payment without losing coverage. Group Number: A five-digit identification code assigned by Aflac for group billing.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232