Transcription of Disability Claim Filing Instructions
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Example: dental hygienist
Disability Claim Filing Instructions
Continental American Insurance Company (CAIC), a proud member of the Aflac family of insurers, is a wholly-owned subsidiary of Aflac Incorporated and underwrites group coverage. CAIC is not licensed to solicit business in New York, Guam, Puerto Rico, or the Virgin Islands. For groups sitused in California, group coverage is underwritten by Continental American Life Insurance Company. For groups sitused in New York, coverage is underwritten by American Family Life Assurance Company of New York. Form # 1015 Disability Claim Filing Instructions Have 1. Completed the Employee s Statement in full? 2. Read, signed and dated the Authorization for Release of Information? 3. Had your Employer complete the Employer s Statement, and had it returned to you? 4. Had the physician treating you complete the Attending Physician s Statement, and had it returned to you?
information concerning any fact material thereto commits a fraudulent insurance act, which is a crime and subjects such person to criminal and civil penalties. Arizona – For your protection Arizona law requires the following statement to appear on this form.
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