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ACCIDENTAL INJURY CLAIM FORM. Thank you for trusting Aflac with your Accidental Injury needs. â To file your claim online, upload documentation on an existing claim, check claim status or get paid fast by signing up for direct deposit, register on Aflac.com or download the MyAflac mobile app.
ACCIDENT CLAIM FORM INSTRUCTIONS. To avoid delays in processing of your claim form, complete each section, attaching documentation below when it applies. Primary medical insurance EOBs alone do not contain the required information to process a claim.
Claims Made Easy. Your claim is processed ten days faster* when you submit a claim online at www.CombinedInsurance.com/Claims. FILING A CLAIM BY MAIL. Download the claim form. Print all pages of the claim form. Complete all sections of the Claimant Statement.
File an Accident Claim via Fax or Mail. Please provide a date and complete description of your accident. You can provide this information in the designated space on the claim form. If the accident resulted from the use of a motor vehicle(s), a copy of the police or accident report is required.
GETTING STARTED. Download the claim form. You can complete the claimant information (first page) online; however, you cannot submit the information electronically. Follow First Page instructions below and upon completion of the first page, print the document (which will be 6 pages).
Please keep a copy of this completed form for your records. Please print a separate form for each additional family member or call 1-800-99-AFLAC (1-800-992-3522) to request additional forms.
Claims Made Easy. For faster claim payment* please submit your claim online at www.CombinedInsurance.com/Claims. FILING A CLAIM BY MAIL. 1. Download the claim form. 2. Print all six pages of the claim form. 3. Complete the first page of the claim form including Section B or C and Sections D and E.
File your claim via fax or mail. Consider filing online for faster claims payment! Download form
Details of all requirements can be found by downloading your state-approved claim form here. File your claim faster using the MyAflac mobile app: 1 Log in to MyAflac or download the MyAflac mobile app. (If you haven’t registered on aflac.com/myaflac you will need your policy number.)
For a paper form, download, print and fax the completed document to 1-800-880-9325 or mail to P.O. Box 100195, Columbia, SC 29202-3195. Accident claim. Catastrophic accident claim. Filing your accident claim form online is the fastest way to start receiving benefits.