Aflac Initial Disability Claim Form


(4.7 / 5) 52 votes
Aflac Initial Disability Claim Form - Thumbnail

Get your Aflac Initial Disability Claim Form in 3 easy steps

  • 01 Fill and edit template
  • 02 Sign it online
  • 03 Export or print immediately

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


What people say

  • Fred Walters
    Now that I’ve switched from Word to PDFLiner, I save lots of time processing and digitally distributing tons of billing forms, work orders, forecast reports, and invoices. In addition to this, thanks to PDFLiner, we’ve significantly minimized our paper consumption. Excellent tool that helps me cope with my business workflow faster and easier.
  • Peter Scheffel
    Self-employed attorney
    PDFLiner allows me to streamline the processes of generating and managing legal documents, as well as collecting electronic signatures for all my contracts and agreements. I like that I can customize forms on the go and access PDFLiner from all my gadgets. No more printing or scanning! That’s just brilliant!
  • Lisa Matthews
    University student
    When you’re a student, you deal with PDFs a lot… Newsletters, various worksheets, official forms you need to fill in and sign, etc… To me, filling out a PDF form used to be among the trickiest and most time-consuming things ever. But then a friend of mine introduced me to PDFLiner, and oh my God, my life has changed since then. It’s easy to use and has so many great features. Just awesome, I love it!
Fillable online Aflac Initial Disability Claim Form
(4.7 / 5) 52 votes
Please, wait...
We use unpersonalized cookies to keep our site working and collect statistics for marketing purposes. By continuing to use this site, you consent to this policy. Learn more