Accidental Injury Claim Form Aflac In Middlesex
Description
Form popularity
FAQ
Q. How long do I have to file a claim? A. There is a one-year timely filing provision in your certificate.
To file a claim, simply select the appropriate claim form for your specific product and mail or fax it to us at the address on the form. Download the form. Fill it out. Send it in to: PO Box 60676, Worcester, MA 01606.
Accident Claims Checklist. Z2201218R1. Identify your policy. Policyholder's address. What you need to file a claim. HCFA 1500 (non-hospital bill). ER report or operative report. (Please obtain the supporting documents for the corresponding benefit.) ... Proof of services. My Claims. MyAflac® helpful tips: ▪
You can mail your claim form to Post Office Box 84075, Columbus, Georgia 31993. You may also fax your claim form to our claims department at 866.849. 2970 or scan and email your claim form to groupclaimfiling@aflac.
Common Documents: Proof of Insurance (policy document or cover note) Engine number & chassis number. Accident details (location, date, time) Km reading of the car. Duly filled claim form. FIR copy (in case of third-party damage, death, or bodily injury) RC copy of the vehicle. Driving license copy.
Accident Claims Checklist. Z2201218R1. Identify your policy. Policyholder's address. What you need to file a claim. HCFA 1500 (non-hospital bill). ER report or operative report. (Please obtain the supporting documents for the corresponding benefit.) ... Proof of services. My Claims. MyAflac® helpful tips: ▪
POLICYHOLDER'S EMAIL ADDRESS. POLICYHOLDER'S MAJOR MEDICAL INSURANCE PROVIDER. MAJOR MEDICAL ID# ... POLICY NO. SOCIAL SECURITY NO. STREET. CHECK BOX IF THIS IS A PERMANENT ADDRESS CHANGE. ZIP CODE. PATIENT'S NAME (PERSON WHO IS SICK OR INJURED) DATE OF BIRTH GENDER POLICYHOLDER'S TELEPHONE NO. RELATIONSHIP TO POLICYHOLDER. Self.
