Get Aflac Accident Injury Claim Form

Grace Period: A period of time beyond the due date for premium payment (usually 31 days) during which time a policyholder may still remit the premium payment without losing coverage. Group Number: A five-digit identification code assigned by Aflac for group billing.

Send to: Phone:(800) 433-3036. Fax:(866) 849-2970. Email: groupclaimfiling@aflac.com.

Injuries and Emergency Services Covered Aflac's accidental injury insurance helps cover a wide span of events, from emergency situations to more common accidents. On one side of the spectrum, we provide coverage for burns, comas, paralysis, concussions, dislocations, and lacerations.

Date and description of injury. Location of the injury. Patient's name and date of birth. Patient's relationship to policyholder.

Q. How long do I have to file a claim? A. There is a one-year timely filing provision in your certificate.

The UB-04 claim form is used to submit claims for outpatient services by institutional facilities (for example, outpatient departments, Rural Health Clinics and chronic dialysis centers).

Submit your claim online 24/7 Manage your account, submit and track claims, setup direct deposit and more.

Initial Accident Hospitalization Benefit Aflac will pay $1,000 when a covered person is confined to a hospital for at least 24 hours for injuries sustained in a covered accident. If the covered person is admitted directly to an intensive care unit, Aflac will pay $2,000.