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Managing your coverage has never been easier. <>stream <>stream Form # 1015 Disability Claim Filing Instructions Have you 1. [u"0oO\5'j_^6BobJWi[hgme'ak6Kf@+
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Please choose "Individual" or "Business.". "k&*mXEOTDY;
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20 0 obj For Sale - 1420 W 1700 N, Provo, UT - $599,000. *?ZgaJ72F%->d4aYIUb3reE0'[sM)3JY+[(7="R\fM6;Q
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<> For Sale - 720 E 300 N, Provo, UT - $495,000. <> J"!Z$KNf!aNfZg$c3f9Eif:$>6XgnJ_+WZ+>UN`D_090Sk6pr-./XCf.RcJoIeeA$283Wm0>IEa1k;_GenLoF#=W7kAbUSPPYkck"W#[d8g/CEK/Qj&fT8,quS8O4;583SMLnm&$C16R.4cCjYs)h@>WY-)F
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Create your eSignature and click Ok. Press Done. Get rid of the routine and create paperwork on the web! 0000000686 00000 n IsNhEk,PeVb^BZe[*I4rabcN&lDZ'ULHK+-T$;u]WD3GH('p*58J'[(3mgr(:*0TR2iG4M503dao>uU! 0000001020 00000 n 17 0 obj `JaOS[A]]e$%M7QS4Qo!meJ)_CS:m7V7-aS4FZ1PGi:"6tO9;>TbWc_tC3LGp(
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Claims are subject to underwriting . endobj stream 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. h0cQ^!FY^@5YZ9`C((MZ9iSNHc>@i(/A6Ang=Q>29[%f,N\.ZX(j>Mqs0Q)QK[VqWr`O1c][Ae6
/BaseFont /Helvetica-Oblique Manage your account, submit and track claims, setup direct deposit and more. <>stream endobj /BaseFont /Helvetica-BoldOblique >> EMnIpA`\`j9p%8Jb%g?3bB@@W^$A.t>R)@AV[$Gr+1aic5NY;`=A9#XB->:2MDO^@t[9!^9`hM)b9[&5Hfki>iJ2*idRMc*I1K7B)P.Ht.`'k-.R`,bZ1``cJ
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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. "tZ
Do Not Sell or Share My Personal Information. P\D=1Pt+K^bCr/L=R_+?]7:K8ND*^rZJ>\)+SO$sqSJ1VT+A'Q-ShdfdhK\Q%N%LoP*mTJ1U1["BmoP?0"U1GH. -8KU)@AZCLegJ8ge%BBp0g(_Y&;BmiFJfS%>@Gu7. h.*.:`/`($FjUjeMh+%3^KDbf? >/FRGOB+OB[1iVR22-7Lnt@)K1T_gY[7;kiM;`1C&61:AoC42ST7*!-T+uZ3:t]s'Eh(_u3^02+HBBV<
A BenExtend claim requires supporting documentation for review of benefits such as an itemized bill if there was a hospital stay, itemized bill from physician's office, surgical report if surgery took place, Xray/Diagnostic Test reports with dates and charges if applicable, accident report if applicable, and a signed and dated Authorization for Disclosure of Health Information (HIPAA form). /Encoding 4 0 R "iE5=j8``/gXCMXF
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<>stream 0000049332 00000 n This form may be used on all product claims except Group Term Life, Group Whole Life and AD&D claims. Z]9@&FL3T;C!WW4Ki3jpQoiR!f,B'&Z:-,IO-Zq$&hBkC=HU@Y3)-Z7i/#[6S/+p@I:RnZ,Zu8hna5,OXLi#hGpMO`^lS.s0&6Us=%m@8h6<5u9e[1qBDSkRo7:L?^bDtpRqeOlX:eqkU9[p,&in^ADo=rk`A*eP:sf'8Vn
Create an account using your email or sign in via Google or Facebook. /Subtype /Type1 0;p5g%:Gd\>Io0dB\q^f8G>h/i$&$eAg8lGgN!bHFN/%]=BXD&^?mb,/u7t)rbDTL)pZ8Q"RdB*(8=i? N8EYJ/rdd(..BX8/1[!lhITlJFmO/CsZ%j/>QaJ13;:-PF0g
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Offer your clients better benefit options with Aflac supplemental insurance policies. 0000049255 00000 n In New York, coverage underwritten by American Family Life Assurance Company of New York. Please provide a date and complete description of your accident. h/#o:*lSpdqlZg*XqFsNY5T/YFk%>_'?0&0X0BaP:*/_(BP1Z\9IQQ3"3LWkO02ijH;rAcRPahK(DRaJ
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