To avoid delays in processing of your claim form, complete each section attaching documentation below when it applies. Note: This form is for initial filing of a disability claim.

Aflac provides supplemental insurance for individuals and groups to help pay benefits major medical doesn't cover.

Note: This form is for initial filing of a disability claim. If your disability is being extended, you will need to complete the listed Supplemental Claim form.

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.

I understand Aflac may release information to my treating physicians and current or prospective employers relating to restrictions, accommodations and possible return to work.

The main differences between short-term disability insurance and long-term disability insurance are how long your coverage lasts and the types of conditions that apply.

For the purpose of evaluating my eligibility for insurance and for benefits under an existing certificate, including checking for and resolving any issues that may arise regarding incomplete or incorrect …

Aflac will not pay benefits for a Disability that is caused by or occurs as a result of pregnancy or childbirth if the pregnancy began prior to the Effective Date of coverage.

If you’re employed, a short-term disability insurance policy from Aflac can help cover living expenses while you’re unable to work. Read on to learn how short-term disability insurance works and how you …

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