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File your claim via fax or mail. Have questions? Connect whenever you need us. Log in to to your account or Chat with us. For step-by-step tutorials on filing an online claim, please see our claims checklists. If you disagree with a claims decision, you may submit an appeal citing supporting policy provisions. Disclaimer.
Follow these five easy steps to file a claim and get paid fast: Schedule and complete your checkup or screening with your doctor. Visit aflac.com/login to log in or register your account using your Social Security Number and Mobile Phone Number. Once logged in, select Submit a new claim.
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.
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.
HOSPITAL INDEMNITY CLAIM FORM INSTRUCTIONS. To avoid delays in processing of your claim form, complete each section attaching documentation below when it applies.
Please complete this section only for W-2 Employees and/or Contract 1099. (Please contact payroll and/or check the policyholder’s Salary Redirection Agreement/Premium Deduction Authorization card for the answer to these questions.)
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. PART A: POLICYHOLDER’S STATEMENT (FORMS ARE TO BE COMPLETED ON OR AFTER DISABILITY DATE TO AVOID PROCESSING DELAYS)