Aflac Initial Disability Claim Form


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What Is an Aflac Initial Disability Claim Form?

It is a simple three-page form that AFLAC policyholders can fill out to request the benefits they are entitled to from the company. Typically, the form is provided by AFLAC itself in response to a request from a client. Depending on the individual situation, you might be required to go through an examination by a physician or provide hospital bills and medical records (especially if you just started using insurance).

Aflac Initial Disability Claim Form Screenshot

What do I need the initial disability claim form AFLAC for?

  • You can only use this form if your health and life are insured by the AFLAC company.
  • It allows you to claim compensation if you lost part of your income because you could not work due to injury or illness.
  • You can also fill out this form to receive reimbursement for the treatment of those also listed in your health insurance (e.g., spouses).
  • Individuals who are not AFLAC clients or are not listed on the client's insurance policy are not eligible to complete the form and claim benefits.

How to Fill Out AFLAC Initial Disability Claim Form Employer Statement?

  1. Provide your insurance policy number, policyholder's full name (including suffix), date of birth, complete address, and contact phone number. If the registration address has changed, check the corresponding box.
  2. Now, fill in the patient's information: full name, date of birth, and gender.
  3. Provide details of the injury/illness and the hospital where the patient was treated.
  4. Enter information about the employer, including their name, address, and contact details. Also, answer questions about sick leave.
  5. Next, provide information about the physician who treated the patient: full name, contact details, and address.
  6. The physician needs to fill in the block regarding the diagnosis, treatment, the patient's current condition, their abilities, and so on.
  7. All individuals who completed the form must put their signatures under their testimony.

Organizations that work with AFLAC initial disability claim form fillable

Fillable online Aflac Initial Disability Claim Form
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