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If the accident resulted from the use of a motor vehicle(s), a copy of the police or accident report is required. 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. 22 0 obj XL9IY_,^5e)u%m(QSW8`,Ms+JJ"IKSqK)]ClhR1"S67]3AnXNZbU5t!S#5jg;<=EaA8%\YmR9]u3\kc^
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. 0000000932 00000 n 0000043584 00000 n (q4#=jL^)VnPi.3J&P`.^'?D&jk\gq++JIRRP;p/j8Q)Z,M')M)EjWNe^:g;JhU)j"t=W%Q@J=*Le%l7VZbQ,Dgs8NZs/^)
We pay claims fast. 11 0 obj *-ogCe2UsEgf\'ds_/jiZfh5I(c[]]fP=H[DUhhQ4'/;X2hk?KsbO!`rDQ2eS&bFI1P0&@J-^!k9`KO(igH\q^TX%?G:9)
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CAIC is not licensed to solicit business in New York, Guam, Puerto Rico, or the Virgin Islands. Ro:8N4Fo0263Y9=VZCO2ZaPKP*j"-CFnE=:3h#1r
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For Sale - 720 E 300 N, Provo, UT - $495,000. m-*&@,H9g(2[5#o!G;R4U9IEG=[4#Wq9g71
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Please submit required medical documentation for the specific covered critical illness, the claimant's birth certificate, a list of the names of all doctors and hospitals in the appropriate section, as well as a signed and dated Authorization for Disclosure of Health Information (HIPAA form). `JaOS[A]]e$%M7QS4Qo!meJ)_CS:m7V7-aS4FZ1PGi:"6tO9;>TbWc_tC3LGp(
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No Yes Ifyes,pleasecompletethefollowingquestionsrelatedtotheinjury . Payments can be used as needed - to help with medical bills, recovery expenses or even to help you pay for rent or groceries. 0000000932 00000 n 4 0 obj 0JTM8HGN-uYUmTOelVf]F4AA)ZISHh>(!HVXe#12]a#X:Z;?uk$a0t'3>1o_N(G1e9TB>Kme4`U:>O6e
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Simply select "File Online" below and follow the instructions. . 1g!5D-LsIWRBY-X(8X2r&@O_`0*:d@O.-Wcm!Ja'h?grDR1Nq&[A-=2b! )qT)jZA=U\YiCp>=mtH$[\__]9X3fUD/SEtnbat`
>> <> 23 0 obj Register now Aflac Life, Absence and Disability Solutions Learn more about. >> )S.%6`+GjIZj](Q#<=c@2$Z7dM/>T[*ou6=\86%`.6Tf9_%C^ECG2N>a#UsXf8l(9b*mV6r!V.s)b^~> endobj << Please provide all the information requested in Part A of the initial claim form. Universal Life Insurance underwritten by Trustmark Insurance Company. 7.XdOm?gqE4o-8r9
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Group policies are offered by Continental American Insurance Company (CAIC). @N)SrO2ugDjIc8hNYmK#n+u6M$%s(j[C@]^p/k/%
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8e==QcdnYk8&(`lkD;,]b;+SbfrO-.*]B,RLFCV[]Pa\Z? Dental and Vision plans are administered by Aflac Benefit Solutions, Inc. ]/:~>
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You can provide this information in the designated space on the claim form. 8,Y5:-bZ-;Z%c':c]*),@W=_c. 0000054624 00000 n k0Q'9K%4rkrrN3]cu8p8';m8q-eHY2Sa?q0DqdO_]i_5()gWNP#-%H8k&XV=Id,j>)pb@S-4-ot]OZm4
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