Get Aflac Accident Claim Form 2021-2025

Completing the Aflac Accident Claim Form online can seem daunting, but with step-by-step guidance, it becomes a manageable task. This guide provides clear instructions to help you accurately complete the form, ensuring that your claim is processed efficiently.

Follow the steps to complete the form seamlessly.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering your employer's name, followed by the policyholder's email address and major medical insurance provider. Ensure that you fill in the policyholder's name, address, and major medical ID number accurately.
3. Provide the social security number and date of birth for the policyholder. If this is a permanent address change, check the designated box.
4. Input the patient's name (the individual who is injured or sick) along with their date of birth and relationship to the policyholder. Ensure the gender is indicated correctly.
5. Fill in the date of injury and describe how the injury occurred in the space provided. Answer whether the injury was related to a job incident or a motor vehicle accident, and provide any necessary documentation as requested.
6. Indicate if the patient required hospitalization and provide the hospital name, address, and dates of stay as necessary.
7. If applicable, submit any required documentation for ambulance transport and other medical needs, including prescriptions for mobility aids.
8. You will be asked to provide a list of all treatment dates related to the injury, noting initial and follow-up visits, along with any additional medical records.
9. Complete the fraud warning acknowledgment and any health information disclosures relevant to your claim.
10. Review all entered information for accuracy. Once satisfied, you can save changes, download, print, or share the form as required.

Start filling out your Aflac Accident Claim Form online today to ensure your claim is processed without delay.