Get Aflac Accident Injury Claim Form

Filing an Aflac Accident Injury Claim Form online can ensure a smoother, faster claims process. This comprehensive guide will walk you through each section of the form, so you can provide accurate and complete information for your claim.

Follow the steps to successfully complete the claim form online.

1. Click ‘Get Form’ button to obtain the Aflac Accident Injury Claim Form and open it for editing.
2. Enter your policy number in the designated field, ensuring it corresponds with your coverage details.
3. Provide your policyholder information including last name, suffix, first name, middle initial, and date of birth. Ensure all fields marked with an asterisk are completed, as they are required.
4. Fill out your contact details including telephone number and home address. Indicate if there is a permanent address change by checking the appropriate box.
5. Input patient information by completing the necessary fields including patient's last name, first name, date of birth, sex, and relationship to the policyholder.
6. Address the Accidental Injury Checklist by entering the date of the injury and providing a description of how it occurred. Answer 'yes' or 'no' to the questions regarding employment-related incidents, motor vehicle accidents, and hospitalization.
7. If applicable, provide the hospital name and city where the patient received treatment.
8. Complete subsequent questions as instructed, submitting required documentation for each 'yes' response to ensure your claim can be processed without delays.
9. Fill in the dates of treatment related to the injury along with healthcare providers' names, addresses, and phone numbers, making sure all necessary supporting documentation is submitted.
10. Finalize the claim by reviewing all provided information for accuracy, and then save your changes. You can download, print, or share the completed form as needed.

Complete your Aflac Accident Injury Claim Form online today for efficient claims processing.