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Get and Sign Aflac Accident Benefit 2005-2022 Form
Your doctor also complete and sign Section C Physician s Disability Statement. If you are filing for disability have your employer complete and sign Section D Employer s Disability Statement. Be sure to sign your claim form at the bottom of Page 1. ADDITIONAL NOTES Submit all bills related to this claim such as ambulance follow-up visits physical therapy etc* All bills should be itemized and should include the diagnosis services rendered and actual charges for the service. If you were treated...
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