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If you are contacted in this manner, please call Aflac at (877) 499-8606 and do not provide this information. *#*-ScS*/MMA_!%)m!2N2g5V( [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~> Apply your e-signature to the PDF page. 0000054815 00000 n endobj 0000003079 00000 n O!61!%9G.V^/"+$60K[1j:%8%V^jr#WgA)E0dmgaHYP)uTIcfaXm(sZ9L'dZ;nA@OpWjJ1,O,)*$t/$< N8EYJ/rdd(..BX8/1[!lhITlJFmO/CsZ%j/>QaJ13;:-PF0g 0000000814 00000 n P\D=1Pt+K^bCr/L=R_+?]7:K8ND*^rZJ>\)+SO$sqSJ1VT+A'Q-ShdfdhK\Q%N%LoP*mTJ1U1["BmoP?0"U1GH. ;Y'TZ`#NiWQ qgQd[30A^am-..JBHH)+$ahbj7*Ot?C="O'iqAnAlg:_=(aVdLl!-i^Oj"qBSn)tseZTg`f@X>4'72ib Simply select "File Online" below and follow the instructions. For step-by-step tutorials on filing an online claim, please see our claims checklists. :JP2npQHaeod^X7'sK!^CIY561O?2S)MJ3_5]Y=4,Cn7b%K5Me(p[?9MOo\lj=] 0000000212 00000 n endstream 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^? For Sale - 720 E 300 N, Provo, UT - $495,000. <> !o5ERV47$k+S(!Xa"PN!I9]Y4"VHDRe8O[\PP>C\n_[q%@(=l5'/%#n49 0JTM8HGN-uYUmTOelVf]F4AA)ZISHh>(!HVXe#12]a#X:Z;?uk$a0t'3>1o_N(G1e9TB>Kme4`U:>O6e << Start completing the fillable fields and carefully type in required information. ?&2QmV4C.$NuL;0P(Z7tk6M [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~> ffBW;,%_AN*"_VFk^*[7l*M'q?n=q..L?F%d 0000001020 00000 n V5bB]IKpbaW#Pkc)(CZgno17ikI&QH)d'BE1WU?WT ?5QKLuXe>d/Imj ;]2"WH3RN-IY-eA348fl;R6]T4%O*^emkHfI8Di4T'&!Ns\94;%b endstream Learn how Aflac pays cash benefits to help with out-of-pocket expenses that your major medical may not cover. <> /XObject << 55184 No Yes Isdisabilityduetoaninjury? o5BD$*Z2jom$PZ&;ZZZSrkbZVqI! 0JTM8HGN-uYUmTOelVf]F4AA)ZISHh>(!HVXe#12]a#X:Z;?uk$a0t'3>1o_N(G1e9TB>Kme4`U:>O6e 1e5hTg\WJ87g;o'P/Al#,>]i%"uq!A1c[5/GX9P[>bbO,WWr[6bhFsMA=g3gD;[N4>FqS:gU"0H? /2R!i5j&PBRjtAnemGT^T>r)/aH+##c99WL>k&k>=:> Z'qla+"Ni'F7cdihoHcj(u=..e%DbtGJWZF/nB*]I!`;q;hE9aN=iqM2-6r0A.0!kYlX,(D ]/:~> 55184 7 0 obj !$"P3qfbXDLeQ[oZ1B!OZ7r(l@ endobj ]_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 (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/^) 21 0 obj <>stream endobj 0000037564 00000 n Consider filing online for faster claims payment! 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View Site Continuing Disability Claim Form Aflac https://api.aflac.com/docs/claimforms/S13270.pdf Gb"/,=``@V')jD/9@r'LI-A9Cs4QG6aPLKNd:@s1MX5It9Jnu*B"qkR+QHs<2n)%/\Xan`a,N@6*ingN'+f$>Yo4]C!mu:p`lCe=FLB/(I,"jXamHKJNR+)Gl0L9$(Q$m:^j,14/`h-mD]X`XMK+=Y,,E.#`="+f8AJYrKUGA5Q"McHIugr&gV)sipH;3V;[q7F*GJY%abm(8>b!Y>#S?Q?en;S)"OEiMWIE&0@qh;EHk*_:=;gW4*><30$L0fSkD:d)2[Y8SYpcUZmVX";D!VFF#NjUnu/i=(eN%U3gqf'WI/NZX5pMY'?GQ)r4VCNI>8uDZ9$#H/kaQcLFj`bUB3^t!`Q:uaAT(ea1%WFIpS6Ag:?>H$75dihDjh[BEL"?jPA)pe]F.YplX)@3j98ARtS-K?QMb7,!]b.D>VpVJ$.D,Cgnh]1J7T(AtopjVlaB^!.A26henEG&.OY;@Iq.U(;Viu(HKO$.\K*8Lk^]!(LVMX-[0L]OWdQ5O?*Qg6:M)P^@ai,(^_E!:Iq@eTnj3uRVpK]@Or/E+[-a7Dp>u^OF%E]LIm[rs(u=5^p\I80PCZ8,!eM\4J4j18:dSOVOU6cZ[#)7UXXs5pjV;9['\gDTUS6EdKO#QZhq:bWR?R:@4Y8CQ1h]L`j6s02no<6g[7i(GO`Q-$7mHN=/n:Gf.H@)J0"*O&:6O.K18Wn33WAg;s,d1LUJO%Lfo4ld_7CG_g\RF[0d-qmdP5,$mH-h*Ula*D+fdn$e=XEOMub_:t*%ti!>W,FhJC&3*L=^)sJ%F;NO"C9[kluU]cc98X)>X"A2]7JD"#9Q(eSSX<2hiWOMu3c*3Cl#A.:WQKCi-LU%^3>#DKnSAK:Z0%R4F:$c,fB*LTO?$D[Y9m;(K*!bMU6i&L`h@5#$fCr!VJ)*$ApDE(Iaqq9p'5JJ$OWoHV-lnT.-#2ji?i4+(+-+=[%\t6Q3*F98'B&T>Z*VMs7:^kaickW#fPk2Q*ZN$"Y`Nr/T3i]pS_d'/qC"V#!L/GaW.3?1m>ardXNjcoog4djTG`ic)$u]?!eWPbr'fHgEr8(.*8)`VFA+1+&Q(+loBW0XJbQM?jo]j+#?f9G&OWPngFMU`0-ca8t`Y_M=#'e-/5ML7(pOujXrD!i_=hH]Zc_qn\.[1gGs0mja.PjIs!ADVNeLpg=>In+L3_@6qp\b9n:']BPb54)0k*MbY:pCGSiU:3QVoKQ0\Wk2RLct.[c`u00c*@8)QIh!i+b7m\P/AI`r7[X;CJq^2E>(5VkU_!Uj(T&UOo#8W0VDZuZ)L$X=CR_b%Oa#Dm`111Z\+8jOOpQ@&S(k=UoK#^`h;l/9(u.UhAop*mif]!;3AU$'ES?+\H;6,nHMla1/m@$@ca-)N],At$)a\>/XK/,b"h&j'0ao-NK\2:@$%[FjE-t's1.SnVk>de!\EUEDA'T3&fEcf.#1SRd,b\P/X[i=;M5sl&as4--!?pBU0"&M,J1g]NZ%tN*jgu`"0stJ>f_IdaZ5>Z[>PrUj*j5P5-IG?GAbRqgUUO/cMr6O.IX*d"jWW:2T!&@.[^$62E;[R#+$%EkHYm.Y9["e%$KpC!=;@TJ9kVpHj8/iVY@*E2Z'(6%@U'<8%t\pU6nNS"Ejf5Fu?IU)3/WcHdCK/o&mJN^j-hkUE@DmK-,Dp5:2B/ne3e8>Ts)\o=e_\cVbi,f27^E^`bVn.p)J\;WEJ4DL1`D^Mj$V=VSHZRmD=Dk`)(cFFZ@L/E1nDr`o-LT6QMF'sE_=(A2qGLc*q`Sa+DZa,Xe$IcN-m#P%,0"EChMpf"@;,QSk::895BW(XUgt\_^4"1u:51R+Vp*Y_4i9Vr@Q-=:IbV0d)!Ah@!F=lBtn?@CbY]KE(>R4^R')&bOtU5h^S_s[[dWp;jj*Wi'RU#2kj_TgQje:jfNsB94%sEq&6n&]"%SF/#Tq(>'CjmNcqaiaoB$nY>=+tp.eNHLihdu74M8'^7l)TrY.8r=dg=lmT"7X&N_32[kTN`tl:-DT%LHVQp-M/g-;E58'_u52M&a0mK7B(@WsPYA_T^J%qc8K#+e,BM0Q:NoU2`^1">ha,s#H4G*+sdbU0(\t=PtugW%^$om3$gbc6[$3k9R:&F(7Yjj[d6f#I=(pU&hs#F]5_1#;9IE8b=Vm'(DC0!J-h=$,TZ2ZYiSSOe#)':%`OXse?NlTjT?4\778O?BBCK(K(8@(X=Vm.@8VEJNnD0*JL6>Lpj*;W)VZN'ORQ;GI:cq7_/KGm1FFFeH"0FYPdf!ZlcLY(3!AP+&BD)ff:8-UUd.O^)"PkMG[Iloh%=Ouk64%(L6ki;N_PqGLfpLgcgc&3M8XS^V`NJ2Z4Z/RG3D!mY"kLYVD>BY4[$d\^;!IRbt9i59mQ!@0s_TT_t+0=N]=K3luI+\(XfQ5e]5Y]q@ohAheJYVr>PF%OQCE86=gh!N`0L*^6_:QP?6u0r5%1hGWbC2_HPB4MX[cGE(9q;LO0fdX7\GmZ>>,\&:/tm\-t*OtW9\3/6\.A\6ZE8S%\So=R&Q]MAdBNSon:_JPqng:h-/j9AtJlrs2/=Ai!`(XA]<=>\>d?'auHY^s[UK,m!(>[:Pq]sS[Bca*GgBYh*1dE(%hE&QFc^dIdG#.H18:@0U,pbR1i0OHr%ZD%"dUD1"DuY4>c0PkmD1%2p#>4jE,*9"aVX9!`oVXR;d-Y3"Hq'?Sn=O;D/S!.>c4I`[@q^TH0/=d^]h("acNGHGDT9WS#ud0uPjK+i_$C(k.jXdJ36.nq.kcQm]seV);aZbO\Ir%1_ADK;E@NjCXla+i4-#d1O[jqH*^qL\^[c.1O'0C_rHV&m^]$\[[eFQ1TO;o>>(Oc. FuFfnc;)7cKg['Zqu$@#^.Lm;P)OIh\R^_`-@):D`Br-$pdOd.\.5Vk2j_jL6C'[%-[(4 ]_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 ::bl''..9BC;a\$BlT\:t-X,fsW*QN`2e(KL 24 0 obj 9 0 obj ?/8-TEfAU,j[:b-G[DjC57H"+$-Ag(@hZ %+7qEQTFU"'i_\(/=gq+JNS@%Y-$pZB>:Y4*(rCZfQj@Kgqq^GWEccM#up\R$:Ie]Cf@mqFQ&(pWqBMr Self-funded plans and absence services are administered by CAIC in all states but NY. (@(usgg(FDHdtq_aekmXE(BC6eG1C/8GXuO:=']]5O,*cYeJ6rL_T-&cqtYOG-PZ=N]XFkICN-m,r>>:_tp?- 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 endstream !o5ERV47$k+S(!Xa"PN!I9]Y4"VHDRe8O[\PP>C\n_[q%@(=l5'/%#n49 <> Enter all required information in the necessary fillable fields. #uY.o`Vd[Bd.YT[///3UJY[r*;n,NhjZnQjdJ7=`r$)Ri)3:i(@X2#3?N.HcWa:.*$kP? TiH!-bXfof5[n@&[kS/JgZ:HFlTDHBWer?faRZL The Attending Physicians statement portion of the critical illness claim form is to be completed by the physician who first diagnosed your condition. m);lB2NZG/rMHahB@? CAIC is not licensed to solicit business in New York, Guam, Puerto Rico, or the Virgin Islands. 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Please provide all information requested on the Insured's Statement portion of the claim form. >> << 44EBCGZWK1$09&Q#o?-4-.oof+30H,2'QUFu;$7Pkc endobj !G5'>m!$kI`%E,=&c9e1!`-(ln6%1Abq7/PK2;m`V,'D51([Fj 25 0 obj S`*[trI8jg7M]JT\+.`38%i%%!hk`4S6H:;p^t(C%5sr,][Cckok`Lt\9"4E`IkRu$'/ai^g,u(4jLe=m[4V59--p2Tap(*UC^8Qur;jVC%5c7VaBB+,0AUKH@dUPF5MD @mT@XKG9gfV9sjgJ:!#'gnJe-hrK2RiqoM==]mG(t!Vd6O=URG3 TNMF9_Vr2,SFTeXfUSJa)jt-'"mb39a6fe"7:L*nQB6WHc=tGuKXhdlF@JojFLBR3CIdNL;Gs\omg&R3 [u"0oO\5'j_^6BobJWi[hgme'ak6Kf@+ endobj fKM7f%?5*K:i'+aV_K!?49DLRD(oBT]NI)%kf!BU%-f'rI-kJBX(Gn\B]/9qU,\iQ;,gU.Z@%@^>"[]W:T%89f)q@tlS'SN77! 17 0 obj <> P;j%5)jo)E)Oa&qP(Ph7/Yj! Form # 1015 Disability Claim Filing Instructions Have you 1. nBr?OjbmGB*-+c"Gfs=pq`pf\5/qG=9-4ag[=%5G2c]U@?7%qhqm. 8,Y5:-bZ-;Z%c':c]*),@W=_c. Quick steps to complete and e-sign Continuing disability claim form aflac online: Use Get Form or simply click on the template preview to open it in the editor. We pay claims fast. ]n9eB$>Q3/Zh8hTCilrgR.+jiDh,K#srd-U9acuKPd@,V`j5BhbA8I 0000000326 00000 n IgeDH7TM\#pU10L#Ss`6=>>>RJf3(u"SS*/4)kIZjBeggFpXisbnT"]8aV=2.gG!O"):K$0*DuMhDAGnARk37 [W_J1(2pZ1HC$V;V*/7\3N-"m8ACA6(\G4_j7tLZo4PDu:9kltQ:qtrOFJei`3u25)_cfnQ2M,M>*2Sb MLS# 1864947. endobj ,8A591pbF*6H'TJ)2Vei;P*o96rsB5bc053[IE).3_gms2M52R7$UKjL.Sh)0is*/8l=#[kk8`R 16 0 obj $#%T)fK!\tQ[Jn*RsIK/pH_*8DKaR?SCRR(r\bkG)d0WRf`3S_ZkZBKR^5r=EJjF/IhU)M'c/^18tpgR GtHt%Nh;7F1(!K[n[8/1g\PTUNaGT"=n\Bb:62T:Xt#[Q]!mJ,M&0#sD9($J$JR;eXA\0%6Xp-RXgTNJt5f^? 0000049255 00000 n Aflacs Premium Life, Absence and Disability Services are available in all states, except Puerto Rico, Guam or the Virgin Islands, and are offered by Continental American Insurance Company (CAIC). The employer is required to report disability benefits paid on pre-tax plans on Form 941 and the employee's Form W-2. Please provide a certified copy of the deceased person's birth certificate and death certificate. Check if everything is filled in correctly, with no typos or lacking blocks. In NY, self-funded plans and absence services are administered by and insurance is offered by American Family Life Assurance Company of NY. ri$-h1/j[uMOPf3_2gQ%+)4Tt@BXW(2=KO%3;tVmZjc93ISZ#id:hb)o".^eIJY!Pf"3t`9hfK3>.oW& Aflac Worldwide Headquarters | Columbus, GA << 23 0 obj 'X-2uc/>cM8\5p/T44i`BgV5"LY/5Yg% <>stream 4)&nf$tE5"g*2#E``6gl3H_U)RH)m.VU*-AYq=+#%i9Y7;)=6rhbKN=8id"8PGV#c1SW%K9D-r,8`1lZ 0000001020 00000 n View details, map and photos of this duplex property with 4 bedrooms and 2 total baths. 02rhl21qBSA"(T]mcU-(M+$l6hA!\lUur6,-iT#]. "Jk(XbKsV#$D'i]&;mcIV!r <> )O:TmS'Yten(!-m^G>i5()8T=P8W`gZb#8cl/H/? View Site ffBW;,%_AN*"_VFk^*[7l*M'q?n=q..L?F%d ;:9bBtb9H]qk\bkhPfIu$"+1TVJFo3OYhdrtnn;;,mTF]?KG*]5oEoE,[rmic= >> endobj 3$`e!h\\t=XdDq_?s_KB9%$Cjn,)aLmG%*NB'&_4p-lSIY41FVI%KJEptt2up8nT2]+1CY 2"3sWA960?8;mmK#ZE2_=#C>QJ%q+@gg/`.\j'lY3GBQ_ecS2/`]F/b3$3maOCefRcJ`5!g@1,GaV\/9 endobj 0000043507 00000 n ocp#ophc,on7uVb:-MXb"*(,i/15jO-%hEWBZj$Xoi/8"O.l:b1N/N9e>iZA0.TFk&&Rn5CcH4>d6W(; 20 0 obj $s?SXVcf%'C4RJ(8`-)k.!R/tmOC4@"`:#!%j`_M[6BFOHB#O$NY5c1rOEh=kBspt>`NP'>;a[EcIDPt Group policies are offered by Continental American Insurance Company (CAIC). endobj 0000049332 00000 n 3 0 obj @N)SrO2ugDjIc8hNYmK#n+u6M$%s(j[C@]^p/k/% endobj 15THsJWlVj?FW\)knqP*Lk! <> 0000043584 00000 n Your dentist should complete the Billing Dentist section, Boxes 4266 (excluding Box 53). (!XZ[fVqDrg=%mnL@dD71:nKqKueQnUtLi;)rD"M-*:ia#uT*5f$!AicdVn^"gp(^-oKqo#i"gBOsIn1fK.\PJgLt&^imq7BSJ..gu`g3TNp]lZQ:Q+PSQZ=7bSOhN`;B#7;s#7r)aO+XB?-BFdCkA(+.VnQp*5O$?iSK/`O.QJ'S)/aPDmhO:I1AIuZ^Ves%d@6'UQ5gRhf3BF`kXpaej\IRil\Y_Tp',^\5b3DiW.2X/9G,ZBZNQ1%0jnNTP=-/t4]pG5O*!$Hj%$(Vi!33gU7QS]rt"S4I%1~> 0000054442 00000 n endobj "kt65Ko1TNq1+;X4?fH1W0SbI2D-F(6cs2(!E?1oM!HZ/`bJ.Cb4@4gWrBVNX,G01o;?NA0^%)?aS>EJ ri$-h1/j[uMOPf3_2gQ%+)4Tt@BXW(2=KO%3;tVmZjc93ISZ#id:hb)o".^eIJY!Pf"3t`9hfK3>.oW& endobj ["`,abhS3LE"C=T6]&k%"Zl4BdN^JG3F!Y*CQe"Xqj- endobj 8,Y5:-bZ-;Z%c':c]*),@W=_c. endobj 0;p5g%:Gd\>Io0dB\q^f8G>h/i$&$eAg8lGgN!bHFN/%]=BXD&^?mb,/u7t)rbDTL)pZ8Q"RdB*(8=i? $s?SXVcf%'C4RJ(8`-)k.!R/tmOC4@"`:#!%j`_M[6BFOHB#O$NY5c1rOEh=kBspt>`NP'>;a[EcIDPt !om"/\*lLc;1!=2VJY6B8M#SQkFA/PescpqBeho-)be]?.9:k-Uth]7P9'K8#,S=r#]\"XYE-i- ;]2"WH3RN-IY-eA348fl;R6]T4%O*^emkHfI8Di4T'&!Ns\94;%b 0000055102 00000 n If this is an Employer Sponsored Term Life Product with your policy number beginning with AFL, please use the forms below. 0000000000 65535 f Rf;iu7gGe[$chW^;W6Fl=BqZ%6KIFZ'HNb5)TaYYGG:'$r`) ,-TQAaYC[5-ru"XbG^9qf`7Q_V*TD8eW0!d4tTL2](RU^lH!V+k6L3^9)d)_:\E 0000000446 00000 n endstream For Sale - 1420 W 1700 N, Provo, UT - $599,000. stream c)$el$_7T'R>`H4d?VZZ.6:FXa^5[8hKt_jJ5`+n^Hma14HF`L'+tk,U=9slnfp8]Z?2MS[;()=`R ^f8SP@,%81kYF7&7>W`>g^5VpKEtLo)BHCQ9Z^%VoU(+& HQ$ujRc"9@)AC83@/u';(.AU@8h[,dM5@MBi91i8@]+f5P8hFJ11.%Ec:Brs4lZA';_labWMQK7-EQHe stream QE4ts8i6DE)#'2TW-kh'[,&7Z'RGbFcbLB$$`BMM!R'_,b^D2"+(\! ]aL:-7m>f%Su%B7MshR`^)f!O)AO 25 0 obj 'oHV-TGH;:1osTnm1H 0000049332 00000 n $#%T)fK!\tQ[Jn*RsIK/pH_*8DKaR?SCRR(r\bkG)d0WRf`3S_ZkZBKR^5r=EJjF/IhU)M'c/^18tpgR cC5a$qEUFt(E8e->F3f^Yr:J8cr+o+V8SWC.sUDP!9a:YTD`h-6Dlku'HCEL>"u[SakEau 0000049255 00000 n endobj InitialDisabilityChecklist Isdisabilityduetoasickness?
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