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Get Aflac Intensive Care Claim Form

All documents. Failure to complete this form in its entirety may result in a delay in processing this claim. INSTRUCTIONS: Complete Section A: Policyholder/Patient Information and sign your claim form. Have the treating physician complete Section B: Physician's Statement and sign the claim form. If you are filing for disability, please complete the Initial Disability Claim Form (NY-S00224) as well. Forms are available on our web site at aflacny.com. Submit all bills related to this claim, such.

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