Aflac Short Term Disability Claim Form. For claim forms, visit our web site at aflac.com. Nt (forms are to be completed on or after disability date to avoid processing delays) policy holder’s name:
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Web notice of claim for short term disability benefits long term disability benefits employee’s statement (to be completed by employee. Web file your claim via fax or mail. This is a supplement to health insurance. Web short term disability claim form *please attach paperwork for any additional income you are receiving during this period of disability.* **please sign and return the attached authorization. This * denotes a required field. Web download aflac short term disability claim form, also known as aflac initial disability claim form. To be completed by aflac associate/agent. *last name suffix *first name *date of birth (mm/dd/yy) / / patient information: *last name *first name *date of birth (mm/dd/yy) / / physician information: If disability, is later, determined to be for a longer term, there will be follow up forms required at that time.
For claim forms, visit our web site at aflac.com. Web file your claim via fax or mail. If disability, is later, determined to be for a longer term, there will be follow up forms required at that time. If this is a disability product with your policy number beginning with afl, please use the form below. Include tax records, at the time of claim. *last name suffix *first name *date of birth (mm/dd/yy) / / patient information: Web aflac group disability claim form_2020 post office box 84075 * columbus, ga. You choose the plan that’s right for you based on your financial needs and income. To avoid delay, all questions must be answered.) please complete both pages of this form for pregnancy disability only: Attending physician’s statement to be completed byphysician certifying disabilityon or after disability dateto. When taking photo copies of the documents make sure the document is flat.
