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Fill out Aflac Continuing Disability Form 2019 in several minutes by following the guidelines below: Select the template you need from our library of legal forms. 26 0 obj /I1 14 0 R /P0 15 0 R /P1 16 0 R /P2 17 0 R trailer<> 1EWs%t3I_6o#k'G^.VY7l!4E5fU,kWcMcPcnu9Vps@:V.*1hGHiRR-8n&.Gf>KTA_?ia$;;29=Lp*@; endobj 0000049255 00000 n ^f8SP@,%81kYF7&7>W`>g^5VpKEtLo)BHCQ9Z^%VoU(+& Online Claim Form Aflac https://www.aflac.com/file-a-claim/default.aspx When you use MyAflac filing your claim online is an easy way to get paid fast. endstream P\D=1Pt+K^bCr/L=R_+?]7:K8ND*^rZJ>\)+SO$sqSJ1VT+A'Q-ShdfdhK\Q%N%LoP*mTJ1U1["BmoP?0"U1GH. GgU]JcO2rI@MJ!M*4mh6R`a.PLnCe-ET<>a;*-c;Tf1f <> endobj endobj '1L#-Ne#BOUYn.SL> >> We built our online claims process to save you time and to help give you peace of mind. )O:TmS'Yten(!-m^G>i5()8T=P8W`gZb#8cl/H/? endobj Take advantage of the quick search and innovative cloud editor to create an accurate AFLAC Short Term Disability. stream 0000037564 00000 n AkJD?1M>up>BcsX+I=_#LC$k%qGLcEUfd4i%!i& 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,~> /I1 14 0 R /P0 15 0 R /P1 16 0 R /P2 17 0 R ;Y'TZ`#NiWQ Claims are subject to underwriting . :0&HC(d$*r1.Y<=jD`$Ia7bVR3*X"Pd8ODQ(-pM4B8oHgR View Site Initial Disability Claim Form https://www.nova.edu/hr/benefits/forms/aflacdisability2017.pdf J"!Z$KNf!aNfZg$c3f9Eif:$>6XgnJ_+WZ+>UN`D_090Sk6pr-./XCf.RcJoIeeA$283Wm0>IEa1k;_GenLoF#=W7kAbUSPPYkck"W#[d8g/CEK/Qj&fT8,quS8O4;583SMLnm&$C16R.4cCjYs)h@>WY-)F 0000000000 65535 f Aflac Group | Columbia, SC ,-TQAaYC[5-ru"XbG^9qf`7Q_V*TD8eW0!d4tTL2](RU^lH!V+k6L3^9)d)_:\E 0000040092 00000 n endobj ;PmE,29/@]Q_gjie3>F*fbNG$7H6^5^trSgt@MX18^JE+B$K ];]KtG'T^mQ6k\65n-CO3CpUj:9mE5T+QAa^Vn$W>6ZWQM=\_oAF,SBqE startxref xref D3IFAAEDU]W&`=8ZQHFkEqDQ^[Kaa=!=[XM/$T#Eb_7Ual%dq@k@o8>0@u1oQdW.1<0#6L^ZrQRcYr_T endobj 17 0 obj 18 0 obj If this is a Disability Product with your policy number beginning with AFL, please use the form below. endobj endstream 4)&nf$tE5"g*2#E``6gl3H_U)RH)m.VU*-AYq=+#%i9Y7;)=6rhbKN=8id"8PGV#c1SW%K9D-r,8`1lZ J"(P!B[I`dqF4n.TukTr5!ON]W=HA3mG[gs/&`.9cLAu2;f?1f)+,ck.qKD:83!]6. o5BD$*Z2jom$PZ&;ZZZSrkbZVqI! 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To file a claim, simply select the appropriate claim form for your specific product and mail or fax it to us at the address on the form. 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Continental American Insurance Company (CAIC), a proud member of the Aflac family of insurers, is a wholly-owned subsidiary of Aflac Incorporated and underwrites group coverage. << Yku1YRdk^9;TD\;*kl4jYjTa8Xl"SC:fUS)e;!AcrDK#l16`LFaGhEJ;`,G>'H*8^Jr\^>/E?FZ]1S?b << 16 0 obj (@(usgg(FDHdtq_aekmXE(BC6eG1C/8GXuO:=']]5O,*cYeJ6rL_T-&cqtYOG-PZ=N]XFkICN-m,r>>:_tp?- Start completing the fillable fields and carefully type in required information. Z'qla+"Ni'F7cdihoHcj(u=..e%DbtGJWZF/nB*]I!`;q;hE9aN=iqM2-6r0A.0!kYlX,(D mhQCujn[DM`k5Vu9TL8/lY,n@)69`YnLctGSmP1C9g-Y\7nk0=`m#b/(aquK(k!OU2OhA)L%au^_^KfM /Filter [/ASCII85Decode /FlateDecode] MLS# 1864249. 20 0 obj *PolicyNumber: / / - --PatientInformation: *LastName Suffix *FirstName MI *DateofBirth(mm/dd/yy . )S.%6`+GjIZj](Q#<=c@2$Z7dM/>T[*ou6=\86%`.6Tf9_%C^ECG2N>a#UsXf8l(9b*mV6r!V.s)b^~> O!61!%9G.V^/"+$60K[1j:%8%V^jr#WgA)E0dmgaHYP)uTIcfaXm(sZ9L'dZ;nA@OpWjJ1,O,)*$t/$< lPl9tY-IJ%_lFQbBP+,UB6!AO?&Q*kaBs. 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In CA, CAIC does business as Continental American Life Insurance Company (CAIC NAIC 71730) >> 1;O*2,G$@I\"rb]Q.4D=II@4)^=0+TVqO'Vmr2I;^-/4+)F;?jKG:nrWIe,-on%\in1XBefUaLD^%V#'74qV#Ctu(;N)%J ocp#ophc,on7uVb:-MXb"*(,i/15jO-%hEWBZj$Xoi/8"O.l:b1N/N9e>iZA0.TFk&&Rn5CcH4>d6W(; endstream 0000000446 00000 n 0000000932 00000 n )O:TmS'Yten(!-m^G>i5()8T=P8W`gZb#8cl/H/? . /Type /Encoding mQYc=\E9,ERP]c]=8bqqqY%CP/fB'k8=no-Ws101`o*'eZs]oap*qMF Q[WGEfLmSJlD4aAIQg]>]O"6oFV!6AQ*&I%W1?E?iS+o&0c^Yc&U1]$I6mp;f=sCk)`?#3^FVJTgJrGe_1^q4-mOnYK@c1T5eKoO`M^;`6u-:]MC=Xh]*G+XUYfH(M?5 << YKROsZ>WYNLd_t?65*\J,Z?QVE?JeNB#Lrk^]8>,3&l. *?ZgaJ72F%->d4aYIUb3reE0'[sM)3JY+[(7="R\fM6;Q 02rhl21qBSA"(T]mcU-(M+$l6hA!\lUur6,-iT#]. endobj @oGDmsuR- <> )lM~> IgeDH7TM\#pU10L#Ss`6=>>>RJf3(u"SS*/4)kIZjBeggFpXisbnT"]8aV=2.gG!O"):K$0*DuMhDAGnARk37 ?5QKLuXe>d/Imj )_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~> ,8A591pbF*6H'TJ)2Vei;P*o96rsB5bc053[IE).3_gms2M52R7$UKjL.Sh)0is*/8l=#[kk8`R 25 0 obj Rf;iu7gGe[$chW^;W6Fl=BqZ%6KIFZ'HNb5)TaYYGG:'$r`) U;s(7Es'Hq&:@a]^0oUGCJa3R7thK`//"XdS%5f,bl:[\>V0EGJX9:R[P$&(L2fO4E"!r*bnZA.0JbrSKY5@2H. endobj ["`,abhS3LE"C=T6]&k%"Zl4BdN^JG3F!Y*CQe"Xqj- 21 0 obj R5BsS,N[X$9*1Su`V5!FLu53L/`5$Sl[7rqO,!^]g&GFP&S?ljI>6jN,bnDr8aF$lN\@CTOcGe"W!E$o <> Learn more claim-forms - Georgia Department of Administrative Services 02rhl21qBSA"(T]mcU-(M+$l6hA!\lUur6,-iT#]. HQ$ujRc"9@)AC83@/u';(.AU@8h[,dM5@MBi91i8@]+f5P8hFJ11.%Ec:Brs4lZA';_labWMQK7-EQHe For groups sitused in California, group coverage is underwritten by Continental American Life Insurance Company. <> 0000000326 00000 n endobj !o5ERV47$k+S(!Xa"PN!I9]Y4"VHDRe8O[\PP>C\n_[q%@(=l5'/%#n49 0000037564 00000 n 0000054815 00000 n 0000001422 00000 n ;dps@dXdX$3sN65dLrqK;34,XZ>#G6k1;= "DFX!Fen1$B29'W4#sWKq endobj 0000000009 00000 n X3^f``c_A)\*/"78h!p%/*in2gI^?CblC`0:Dk,=U@Ip$RaFkC-A%5t[ObE/d?Sc8c!X5%k0qkA1$A(f Z]9@&FL3T;C!WW4Ki3jpQoiR!f,B'&Z:-,IO-Zq$&hBkC=HU@Y3)-Z7i/#[6S/+p@I:RnZ,Zu8hna5,OXLi#hGpMO`^lS.s0&6Us=%m@8h6<5u9e[1qBDSkRo7:L?^bDtpRqeOlX:eqkU9[p,&in^ADo=rk`A*eP:sf'8Vn >> Fill out all of the required fields (these are yellow-colored). h/#o:*lSpdqlZg*XqFsNY5T/YFk%>_'?0&0X0BaP:*/_(BP1Z\9IQQ3"3LWkO02ijH;rAcRPahK(DRaJ << /Count 1 /First 18 0 R /Last 18 0 R >> 0000054442 00000 n endobj >> h0cQ^!FY^@5YZ9`C((MZ9iSNHc>@i(/A6Ang=Q>29[%f,N\.ZX(j>Mqs0Q)QK[VqWr`O1c][Ae6 << /Creator (OpenText Exstream Version 16.6.20 32-bit) 0h_D=!TqJR_)(mgd\>#ol+75J9jtBIKFJ@V(i4JVZqc++3o&'Oo?S]N51A'u=i0pZ1o;C9[qgcc?S#Dh )_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~> 0000054624 00000 n <> @N)SrO2ugDjIc8hNYmK#n+u6M$%s(j[C@]^p/k/% Z'qla+"Ni'F7cdihoHcj(u=..e%DbtGJWZF/nB*]I!`;q;hE9aN=iqM2-6r0A.0!kYlX,(D $#%T)fK!\tQ[Jn*RsIK/pH_*8DKaR?SCRR(r\bkG)d0WRf`3S_ZkZBKR^5r=EJjF/IhU)M'c/^18tpgR O!61!%9G.V^/"+$60K[1j:%8%V^jr#WgA)E0dmgaHYP)uTIcfaXm(sZ9L'dZ;nA@OpWjJ1,O,)*$t/$< endstream 15THsJWlVj?FW\)knqP*Lk! 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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. endobj @t8o'GZ4D)sCs51c+#T4\n6>"b>\hV.b\NHH "Jk(XbKsV#$D'i]&;mcIV!r .8k,%=2e-? << Products may not be available in all states and may vary depending on state law. (V.ea8oM1meVG5&2$R&VHdRmbM`,/jQ'iTTlk_NLi7Pu8>hqB>F6,at#]$=1\UL'_o 19 0 obj /Author (Registered to: AFLAC ) /2R!i5j&PBRjtAnemGT^T>r)/aH+##c99WL>k&k>=:> Your dentist should complete the Billing Dentist section, Boxes 4266 (excluding Box 53). If you were first treated in an emergency room, a copy of the hospital discharge papers is required to verify the first date of treatment, diagnosis, and procedure. 22 0 obj 0000000212 00000 n endobj 0000049332 00000 n [u"0oO\5'j_^6BobJWi[hgme'ak6Kf@+ Nq.&`'\L*3M[AYZ6ll!-TD@!G8Dg.9W*C\Zs0MVFFq.Qdq@5EcSUjS9Pe3%!0kB*T4F "tZ File a Group Life Insurance or Accidental-Death and Dismemberment Insurance Rider Claim, File a Universal Life Insurance Claim underwritten by Trustmark Insurance Company Claim, File a Universal Life Insurance Claim underwritten by Trustmark Insurance Company, Do Not Sell or Share My Personal Information. In NY both group and individual coverage is offered by American Family Life Assurance Company of New York. American Family Life Assurance Company of New York | Albany, NY mQYc=\E9,ERP]c]=8bqqqY%CP/fB'k8=no-Ws101`o*'eZs]oap*qMF 0000001020 00000 n endobj XL9IY_,^5e)u%m(QSW8`,Ms+JJ"IKSqK)]ClhR1"S67]3AnXNZbU5t!S#5jg;<=EaA8%\YmR9]u3\kc^ 8*C9[J(Cl:;Gi9qfiditHQ#'L]jC2sPgd`'`W#[3J"LQg0%?W3t_5VRgmCJ5=M#ORRY\sAH6Rq;5+ChV$?jn,^o9SGo>Ha Learn how Aflac pays cash benefits to help with out-of-pocket expenses that your major medical may not cover. endobj ;]2"WH3RN-IY-eA348fl;R6]T4%O*^emkHfI8Di4T'&!Ns\94;%b 0000001020 00000 n <> /XObject << POije23\6G%qCTitHV>Xor, p!WHg/S/1>qh13::;;66rN. 0 27 24 0 obj /BaseFont /Helvetica-Bold DCl*mJUg=pq^:YnVX2rH-?MoX;V+!pDt12?)+Ag/%cNZV^V$#m+E*A#TQr? /Subtype /Type1 29Q-bd"lOXj_`+YYr:EA4 0000054815 00000 n Universal Life Insurance underwritten by Trustmark Insurance Company. >/FRGOB+OB[1iVR22-7Lnt@)K1T_gY[7;kiM;`1C&61:AoC42ST7*!-T+uZ3:t]s'Eh(_u3^02+HBBV< 9 0 obj

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