Get more info about Aflac for business owners.. Aflac promised to be here when you need us most and a big part of that promise is making the claims process easy. 23 0 obj 'oHV-TGH;:1osTnm1H MLS# 1864947. TLFC\4aS)n5C^j*@4%"P0VVa9rj(. 'X-2uc/>cM8\5p/T44i`BgV5"LY/5Yg% Z'qla+"Ni'F7cdihoHcj(u=..e%DbtGJWZF/nB*]I!`;q;hE9aN=iqM2-6r0A.0!kYlX,(D Forms are available on our web site at aflac.com. <>stream Execute Aflac Initial Disability Claim Forms To Print within a few minutes following the guidelines below: Choose the template you need in the collection of legal forms. ii0)@:9O(%@H%RrdWERj>N3*\BUO1i]tqg3/1[H/;eAHS(@In[U#O`g'CB(1Z@f9[-o$S-AZ%3&Ipb== endstream 0000000326 00000 n endstream :6M_J^sl@Y"on\+c])/C^-146>Nm%4SY-!+ME-(F2p8]9b1! Payments can be used as needed - to help with medical bills, recovery expenses or even to help you pay for rent or groceries. <> Aflac | Login Please log in New user? 55184 endstream eiE#q%9eO%886=-()4_+S4PR>Y.OpD>thDms)r(iY76&nF\4eSBh"@D8Ckg?OT/fVbq-a!hKg2P8WFKC*e*%O1YLY&R&=h#U$ 55184 Request a quote dialog. 20 0 obj p!WHg/S/1>qh13::;;66rN. %PDF Font (F49) 2. <> D3IFAAEDU]W&`=8ZQHFkEqDQ^[Kaa=!=[XM/$T#Eb_7Ual%dq@k@o8>0@u1oQdW.1<0#6L^ZrQRcYr_T ;An6Y?l:#h=mlN1\Er XL9IY_,^5e)u%m(QSW8`,Ms+JJ"IKSqK)]ClhR1"S67]3AnXNZbU5t!S#5jg;<=EaA8%\YmR9]u3\kc^ A(lCW]h%VdMt:8Y)JTJc(@p\,K2F73Vt)lr]_VGs^b4MoT7ZmT:ZlP&6C?-PWabHK;JrCnJnrcc /BaseFont /Helvetica-Oblique /Filter [/ASCII85Decode /FlateDecode] 0000000814 00000 n 5 0 obj 2 0 obj 24 0 obj >> << /Count 1 /First 18 0 R /Last 18 0 R >> 0000000009 00000 n 19 0 obj eokV:dNhZMi7O%JW^7S3)e7Na-0A!>>14!l. #DL9JXFKGJ*Nm2)51;-%FmGTIk\].Cb:\N&Y1t`i2EL[>nuN_EC`3D;^lkjT%;rd! endobj V5bB]IKpbaW#Pkc)(CZgno17ikI&QH)d'BE1WU?WT [W_J1(2pZ1HC$V;V*/7\3N-"m8ACA6(\G4_j7tLZo4PDu:9kltQ:qtrOFJei`3u25)_cfnQ2M,M>*2Sb 0000035380 00000 n ?NAW QQZnEET3`^=L@5Inq5fkUd?/3Y2`;02=IqDob^'R&m,FG.6*VIW,-bt2>#UYOZJj>;fU1^9uM()U8*1b ?5QKLuXe>d/Imj View details, map and photos of this single family property with 5 bedrooms and 3 total baths. ]n9eB$>Q3/Zh8hTCilrgR.+jiDh,K#srd-U9acuKPd@,V`j5BhbA8I 0000000932 00000 n 0000001020 00000 n 0000040092 00000 n Choose My Signature. c5lMh,QXUsVpDOgY[E488MHV?GK9DUk^qXiSo6?d"#T=f:;YTi0SU1_S\M2I.26bpPB\Xsl"fN>oQoH- endstream !om"/\*lLc;1!=2VJY6B8M#SQkFA/PescpqBeho-)be]?.9:k-Uth]7P9'K8#,S=r#]\"XYE-i- Short Term Disability Claim Form Instructions Aflac https://www.aflacgroupinsurance.com/docs/customer-service/claim-forms/group-disability-claims/disabilityclaimform.pdf Note: This form is for initial filing of a disability claim. Enter all required information in the necessary fillable fields. 7.XdOm?gqE4o-8r9 Aflac lets you provide your employees with outstanding benefits without costing you a penny. O!61!%9G.V^/"+$60K[1j:%8%V^jr#WgA)E0dmgaHYP)uTIcfaXm(sZ9L'dZ;nA@OpWjJ1,O,)*$t/$< ::bl''..9BC;a\$BlT\:t-X,fsW*QN`2e(KL D3IFAAEDU]W&`=8ZQHFkEqDQ^[Kaa=!=[XM/$T#Eb_7Ual%dq@k@o8>0@u1oQdW.1<0#6L^ZrQRcYr_T <> ;PmE,29/@]Q_gjie3>F*fbNG$7H6^5^trSgt@MX18^JE+B$K (0h]6sfh&ctrb/lSmDh5-O.iae,IL6uU^p;6R$coc.i2=RBLFrO3lTLkd^8 ii0)@:9O(%@H%RrdWERj>N3*\BUO1i]tqg3/1[H/;eAHS(@In[U#O`g'CB(1Z@f9[-o$S-AZ%3&Ipb== #uY.o`Vd[Bd.YT[///3UJY[r*;n,NhjZnQjdJ7=`r$)Ri)3:i(@X2#3?N.HcWa:.*$kP? Please include all dates of treatment and charges incurred due to the accident. X3$l$UUC.Q8bG%FB^qod-T(^7g7U9j!? PolicyholderInformation:This*denotesarequiredfield. 0000043584 00000 n endstream ?f48_G,BN0p=/>&*)"gUTVU[Y>F[!H0S$cH]UJRYpFnh6'Ae"7a6i,,,Lbtk3(JMM]r0XUgZr>L@0I'i 8e==QcdnYk8&(`lkD;,]b;+SbfrO-.*]B,RLFCV[]Pa\Z? Aflac Continuing Short Term Disability Claim Form Initial Disability Claim Form https://www.nova.edu/hr/benefits/forms/aflacdisability2017.pdf Please note: The employer is required to report disability benefits paid on pre-tax plans on Form 941 and the employee's Form W-2. 7.XdOm?gqE4o-8r9 0000049255 00000 n :^_n)prV#UtcF7_C)h7^7 ;dps@dXdX$3sN65dLrqK;34,XZ>#G6k1;= 0000055102 00000 n FuFfnc;)7cKg['Zqu$@#^.Lm;P)OIh\R^_`-@):D`Br-$pdOd.\.5Vk2j_jL6C'[%-[(4 23 0 obj Choose your state of residence and select the appropriate form(s). :JP2npQHaeod^X7'sK!^CIY561O?2S)MJ3_5]Y=4,Cn7b%K5Me(p[?9MOo\lj=] ;asisn+J&9Y*!/5 $d*luDgu%=_)ZTRYN*[j%c5i9etXm(3c;IaR;/mP`e'Y8+An%3f-4Yl=is#36K startxref "-e/G/_P"pf.N+3cau8Z.,JJ6Rk;MRVJDs "Jk(XbKsV#$D'i]&;mcIV!r We pay claims fast. 0000054624 00000 n "DFX!Fen1$B29'W4#sWKq )lM~> 0000000446 00000 n pVm0rYNePYi@2CrKlf(0`O9(:4lsA`"DB*V_2?OtI(:IK1s$SV]W0j\bo[2VhWP2Ff.O9.oYUrAMp$ 0000040092 00000 n .8k,%=2e-? endobj ]Ic'l[Ucs$aC(lNOL3_Hu70AR(nl%uh/8Mpt4L2j*61I9N5(i,IR;G@j;#["p&LU,X>BR_AYKK6.R/dNK"(^)?d.HOT8Opb0Y-K\%)C64ibd!\^el)-+>j:\a[jWR6/W"V7$&<2ChQ4GQ3m]%-]eU36,7(7&j^8g0t0._o5#)MF+=O0%0JZsOU541%";UhbOU541$qhQCX^U/X4>K3,D$=_4r%W\&S\MZi0BE\KZCLf\GR)(H"TPAbB>9a5R_bAOr9WH[a\MZ.8'b&$<8)CZC!4q/$KA=egJk37Y-1E[86[%\Q8F@Ib#lC'QaPAJ_!-i/?KdVG"X#_=\516`^^\5J,M/.DIa\*YoK("Ilc7:\Z!R!s#oBE\L=Mo^G"0[nG`5V"#mcLGq-fm(][p0CmKXlc98[>OE;Z/7+o2eE!LDjPa!a3Xc:0DZRWnntJY5N;J?0eM/NN[?FDc1*_BD4,fH?NW^RLYY)!s0cFkh7TIbZO^6D,e>Dc*8`HqDdK^f5,@XY;DpFtX]=7B\)[5Tnfu-3$sRuHF:Yh5'IV`6%-m4Y.bOGfjZ)(qBXT;C[`r?0DD5;2)a8.>B\E]#K4+#M?QZ,2jt>l2-a^eJUVSD!$n^V+2KS`Z(&b7f>D\c[,cbDnI4RtYNNY'\j^e:/MTc%[.&Mi>Z89csFkO_me;R=pA8XQ.='6KHrksNkk*r9FX=S4Pgr\U>)LU5Z,0PIFd?h1K=.dmASs68D`.HQBQ8=FLf"fMskfFj8:[Dn597>tbl?nmbEA5SDre>S,3Deg@^FLUSDBA)p%)5RIVgXbP`on^-X@s(>%\g1:1g-Ajr[lATDl@UCM[dLm)1Q1+HU#b])Erj(I@+9m#p4k5]ncg6)T6;E!O;b->F7sSX?aRu-P@hC&7M%b&g/\9Yd'&gar3\#MN%b[$3Y2%,([$$!Sb:YTWCG]j2+aG"2aZ-"`S]Al;)59HFIu;io(nY/H9B@6iFQi3XdcW9Z-V6BgCIF"eCT9P\"M`BQi15C1'7&VWI5c1I.s(>fq'HRp]Cb$Rqk,?C+Y'I/&mA*)/fjc@on>V1EDFR>i9ni(>e6,gV6[.`lEk#T#^0>n4cs+"I$9AbNd6MMHmgP(.+9DS]%Au*>#2LX^T9h_]SOMI20Cj1M&?NqGF(B;h9Cqf?G2iM0gOD]RR;E$7UJHl(Vc3,?YgX1JCUp$h)/n="5=st8J,~> <> >> 0000037564 00000 n Q[WGEfLmSJlD4aAIQg]>]O"6oFV!6AQ*&I%W1?E?iS+o&0c^Yc&U1]$I6mp;f=sCk)`?#3^FVJTgJrGe_1^q4-mOnYK@c1T5eKoO`M^;`6u-:]MC=Xh]*G+XUYfH(M?5 <> !G5'>m!$kI`%E,=&c9e1!`-(ln6%1Abq7/PK2;m`V,'D51([Fj Have questions? endobj m);lB2NZG/rMHahB@? stream >> /Type /Font endobj "D=hF9Hc;3b+uU#87#u->Oo&ZR/kmg`A@Va9ssE1`$L205UY2\m1KJ?'g1*p?gL[/Z6a.dV! 29Q-bd"lOXj_`+YYr:EA4 h0cQ^!FY^@5YZ9`C((MZ9iSNHc>@i(/A6Ang=Q>29[%f,N\.ZX(j>Mqs0Q)QK[VqWr`O1c][Ae6 The Disability Claim Form (Aflac Insurance) form is 8 pages long and contains: Use our library of forms to quickly fill and sign your Aflac Insurance forms online. . rT)4FF1EPoVMN14>L,`\V:)bIb1npmugX^4,7NbhZ&&T,/8(>f=lM4?OnHSHRdi 0000054624 00000 n 0000049332 00000 n For critical illness claims, we need information from you and your attending physician. <> [lXipns%dYmtWgT45TNAg1!L7&LsF1AVS8,9_:a+p=0JYXs63uqK)DZMF:+=COnscG]5l!0l_(jD#HTn3T/Nq3TXul_X>mcZ"L&H2kUp].^k.4,_Aof>Ug=,=b3fQf+d*!6h*m;*04i'C0/[p+\Sgs.&*IjrlVLg~> <> )_uYFAPMnh@@qLR(!tj0,JgDV:^2aU1j,Q1G5%+A&.^pn]C"PJA:oAllMYj0psPAVZ_E,8iGS^\I&;A'/E"CXIR`WpK_.^,?uB7C2c/q!Ft;r%bq\)j#XX/c~> 'L_g'N&-hd[;0t$*n/>649o==0mM=iT3\5)+p[n+X5`?CY@j.i4h`gXCf+nfk(n(Oi3le.$J">(K1Vhh QE4ts8i6DE)#'2TW-kh'[,&7Z'RGbFcbLB$$`BMM!R'_,b^D2"+(\! endobj 2#Uk88j6F;!LPJCYg?_VnT>DO7>((M$tI28>B]"L9/3#3R1],d$6!$JJRKV2m(tG_Q]-T()Va>`2T]>l;eK>s(U,g-lu^? 9srK>"cZ(SQ7f&_@XkjoOD9.JoV5["B)lrLk1"RN#NAQ@Io/k:h_VaFk%A]Xes%eU0Lr%f7V@nha@^3[ 0000054442 00000 n endobj :^_n)prV#UtcF7_C)h7^7 If you were first treated in an emergency room, a copy of the hospital discharge papers is required to verify the first date of treatment, diagnosis, and procedure. Mail: Post Office Box 84075, Columbus, GA 31993, For critical illness claims, we need information from you and your attending physician. mQYc=\E9,ERP]c]=8bqqqY%CP/fB'k8=no-Ws101`o*'eZs]oap*qMF !^`!O2!InjU(e3U7YceUPSbUm,".#RY6kVt+9Vg5'L]Mt+EU">H4*U`'^6l6 -8KU)@AZCLegJ8ge%BBp0g(_Y&;BmiFJfS%>@Gu7. /Encoding 4 0 R For disability claims, we will need information from you, from your employer, and from your attending physician. ]_h\LUlKWpDX[03gS"tG,UJ0*mL9UkEk%7OIX,#u6?P_/\,44Z>m2`cW$i)b*qRV/6raU^h/W^<6?6JC;$U>eK_"kZBZcu]&\dTh"\!Q%B8?1?Rk8,^p^Wn[RC5_%c^'XQF+or \&)R4M>ms@. .mN(97.aR@?hUC/hmO_H@-r$8(#H,d[mojB7?G" )S.%6`+GjIZj](Q#<=c@2$Z7dM/>T[*ou6=\86%`.6Tf9_%C^ECG2N>a#UsXf8l(9b*mV6r!V.s)b^~> endstream $#%T)fK!\tQ[Jn*RsIK/pH_*8DKaR?SCRR(r\bkG)d0WRf`3S_ZkZBKR^5r=EJjF/IhU)M'c/^18tpgR %%EOF, qo&bs<9Pm9 0000001020 00000 n P\D=1Pt+K^bCr/L=R_+?]7:K8ND*^rZJ>\)+SO$sqSJ1VT+A'Q-ShdfdhK\Q%N%LoP*mTJ1U1["BmoP?0"U1GH. nhH(@HB3(k..$A&2I&hNumCF[&]PjI*`R_D2M6]X>#-E#f;915&(PF6%>9Knd"E.:PO endobj [P'])96k0r/j-O-5R.B+?Ujtp8t.Wa^\9uALh!R/l:Z3W3Fi9-eo;Q)?QN/coX1HH='4^ 8e==QcdnYk8&(`lkD;,]b;+SbfrO-.*]B,RLFCV[]Pa\Z? endobj stream $d"'aL\l#A%IE5_YS4O4h)$pN261/3.91=eY! endstream startxref Start completing the fillable fields and carefully type in required information. !om"/\*lLc;1!=2VJY6B8M#SQkFA/PescpqBeho-)be]?.9:k-Uth]7P9'K8#,S=r#]\"XYE-i- *?ZgaJ72F%->d4aYIUb3reE0'[sM)3JY+[(7="R\fM6;Q ri$-h1/j[uMOPf3_2gQ%+)4Tt@BXW(2=KO%3;tVmZjc93ISZ#id:hb)o".^eIJY!Pf"3t`9hfK3>.oW& 26 0 obj << /Count 1 /First 18 0 R /Last 18 0 R >> /Encoding 4 0 R Connect whenever you need us. endobj 21 0 obj [P'])96k0r/j-O-5R.B+?Ujtp8t.Wa^\9uALh!R/l:Z3W3Fi9-eo;Q)?QN/coX1HH='4^ +-,&SN`[I-M6qW3;r1s0&Z$T=BbN][5p[;h9H7KL(+uC\p]Q8pinC7ha3-F4WH*,lCOr\XdV:L)GI3LX 0000000000 65535 f endobj endobj <> CNbe58Z\L9(JIf#nd8N&d;_Ve"&$B6Y;]TiZ`M2[D^dN\Eb5qm'qVJ='T'4DBH2tpG-/Q,o_g=%ZaF:Y 1EWs%t3I_6o#k'G^.VY7l!4E5fU,kWcMcPcnu9Vps@:V.*1hGHiRR-8n&.Gf>KTA_?ia$;;29=Lp*@; <> <> -8KU)@AZCLegJ8ge%BBp0g(_Y&;BmiFJfS%>@Gu7. 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Click the Get form key to open it and start editing. endobj 0000000212 00000 n 24 0 obj ieO?mC^gEt3O?&]\X]CJV6:\OL%X;((>F1o\id;SSBij[G$R endobj trailer<> <>stream '1L#-Ne#BOUYn.SL> 0JTM8HGN-uYUmTOelVf]F4AA)ZISHh>(!HVXe#12]a#X:Z;?uk$a0t'3>1o_N(G1e9TB>Kme4`U:>O6e Gb!'5m[/fJB\_$r.pF?nb0?9.GNU`POZa=?bcjAXQ5kBDO7EHm>6&%47Ab&pW\\Ep0DVbs4$N;\XPZ>cd==.mQbW>ZXE(h&hj!?>RE;`-=j0]K(7>2TZ2c#qP2TZrnnVO>AAO\2\dZ]BV5lN<2g@`o#75u,Z^-1@eCMYZY`nV9iX]Jk15[r)/_I8dD(4^c,bTd,',#!J7^rL)<3a8P7fG%*rf%Dr0X9k_#\a>h%ENsu1N_I/E6"$"4aO%gkZ#_P8u%,_DD4Z3`,&-G'RNJo*@\gVBC#dISL`OXs`X"2c\XYOgQMjo(nU9j@@I>:$?-SG%p\5>K8mf'`2n5g](hjREP0cIi=DlJG%CduFYJX&b.fJg%;BE/2\Y7`WHp'nr&%:J'Y"Od>X7ZKtp1A2/F(Cd$FjNX24)>aWHAi,$d!uihMX'(n_)L`HY6h*Ya>%R%`kI!@VZ@Kj*91XAll1b#)Sj(43C0*ZDYVHW.o&^]8^cs$b>tO5/3)s#"+[I40fCCO0u2)j*3e@/a);GiEC,QcYi&n:D@TcfYcBYeX>jFB"0g]k[qcIUEDh\sY`P3V$amn](*)ZhblK=iC]sei38!J\1:'Sm^g=9F1G?^5X*UTD.c8Kg>?CNpfj;t*;*+5-3+-1$][#p+$s7LY3ds$(WS^3ipt1n?4gpo(-)4hZ]5TSD1c"b62Ae,uI=ht5%%pur?]C"mK+/"n@,G@E!%Tm_Z('e6`@=LQJX>m2u!EdFdln=`n_1KT(Jdtn&@OhFd_-qh%AS.4e_"nG>AmU@I`/XL)S*AH60oN#\=,_M)mR[KZ"p#@QKTXhSQoBW6Pc2r1abgMO4mbWZJ_P.S0Z?CC27h1I4*Xt]'k^P`c1tChMX"]cTFjUN>O%@eLs@rgmWT?ci5AXtahm=GCI0lG41Vu%ET![Pf]&aI:B+JKG^84P$0u2CD+0?/0su!u;km^rug0:2"VI(*%/+bQ/)HNQVs0JlC_#J`D*lKqGe.5CT5W%::0+m=,"tDhT:Jf.Zq_h(jA)][.]!1gIc_g$e.NIY7[Dn[]g&+*Dc(B:jSF2;0_UcSO=hWJLHLeZ$&=Ibr9.GHm'mXS3P2Ek.5Ya!YtUFO)#kgZ.eZ`LC0e]4]aW"'asKdg_Z"5EE^C=)[U)8)55iHZq2>kKE;Zj.Do+X/DSW[g,Q>hSOSQ$%5h_?(@[q&hh1R=9+/)8;"A^Hn>PPi5t$eN5g`uORs-`,rNBc0.X_)BIVn/qs?1NU@,SCi]^G`[P0TK1pr%^qAZJ4DVn/T'u"#MW0u^k8/G"%kaRF,8qKUN? 4)&nf$tE5"g*2#E``6gl3H_U)RH)m.VU*-AYq=+#%i9Y7;)=6rhbKN=8id"8PGV#c1SW%K9D-r,8`1lZ )O:TmS'Yten(!-m^G>i5()8T=P8W`gZb#8cl/H/? >> mOu72$0Z_TEkhh3=;Da@gQ!"PXflT9`-nbs>;ZjA5? 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O!61!%9G.V^/"+$60K[1j:%8%V^jr#WgA)E0dmgaHYP)uTIcfaXm(sZ9L'dZ;nA@OpWjJ1,O,)*$t/$< 0000003079 00000 n [:'^X $d*luDgu%=_)ZTRYN*[j%c5i9etXm(3c;IaR;/mP`e'Y8+An%3f-4Yl=is#36K =[GYSI.i$`\)6Yek?R3(hf\K7.q'`4X>.c*a*j"/k@0B+Aq? 15THsJWlVj?FW\)knqP*Lk! 5]mS)I&\m'[NsCj]sr@0El\`]Uq+.S367pgfd2I2(=P['dU+EV"7XqK'c7K%if?fQ]VP American Family Life Assurance Company of New York | Albany, NY 3OKN&2W(XWj*4Pa1H50U%qWra$*VdVbd3"%Mqma1p?g8L8>2.+8'p^s14V/euOX@S5` GgU]JcO2rI@MJ!M*4mh6R`a.PLnCe-ET<>a;*-c;Tf1f "-e/G/_P"pf.N+3cau8Z.,JJ6Rk;MRVJDs %PDF-1.3 POije23\6G%qCTitHV>Xor, labiaplasty payment plans, averitt express net worth, wonderfold w2 snack tray,
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