endobj Gau11gQ!:3&4M)fO+Bqq68hgpo*+gp=2Y]D/n"iL.5,!&rqt4]k:;$A5NLFAhtQ5bEOn@#^,c5cB!.a)bI[X^$Z/(6Y3*HPeGm7X6?U'%V=rC9[=GjqjWB0seXj;VlVcTeq5_9FHgWfdVe$=P]!o`0j\1-`^3>_A9ZoUTo$WJK1Q:]6WWAVuKI'Y$35ml*7PtOu0J6e7#&o=%qn3o`.E7sK;/h7%\$[-i.7V$.UYlP*?.uFbc7nhCFtIZjOkQrAc7g"Ug9r:8cEafo8627jFXKfYC0A$S9usZ2SDC/"#[+d*"'o%^Q_*Hn&@1AgijL%'P.Kf^i=oG0s!qIUL=aJ[)T&lc>&&=C!Q>:6l;0*KDgPp:O0c64SqnC,A;6e([email protected],;O[!?.Sna&[9^L-dYtESB'GStL%:JFBKQc+/Jhmi-fJJ+7%.r1/J5_ETA"->7L4LD8#&oV*>h\"h(P@^^V"G:N&(p,Bpn`G=k7^Y24.eZ+fU&nc[ckh*cU*E"`DO?WcV^7MJqO'=*3e@o(GH)q32NcZVm,*P7[jK\S5O:+;g@Z5G1ueC"UB1s*3eFeRT>urJqNo1%TmZ]iAKK)'F-cRCQ'b5Gu'h$B>SH,oFG&_(#Nh-lC&bUYsd4"b6Un)pIJ!J:`@=9V^Ou@'51a'T@(>@7J)e!"09oCFq>.M?=XG>0X\o#JKEQ$E-(V^%OrGecoP1N*FRX"Xk)Vh#!Kj[50561k9'CWJs"cU",4`-[FLuf/3'T1k("0op(&%Fi1RNI"'1rI5@hQ]KA(&M=E%)@blK=ilBq])3%^oTlln@er)QXZj0ed[F%F_4[8.973"HF55CWkf:K*@$cO`\BrPBm60$P! #uY.o`Vd[Bd.YT[///3UJY[r*;n,NhjZnQjdJ7=`r$)Ri)3:i(@X2#3?N.HcWa:.*$kP? trailer<> 0000000326 00000 n 2"3sWA960?8;mmK#ZE2_=#C>QJ%q+@gg/`.\j'lY3GBQ_ecS2/`]F/b3$3maOCefRcJ`5!g@1,GaV\/9 "\1ceiPob[!+@J3(3TJ)YX)OUj[W9&;I:dYZ=kc)4eebY'g`kA>>[&O][obn/UEdfgRXrat28;.HM:HQa#NGoYVo#="o%! jd*ZcXe"_QS4SaSM0H8\:kGm7EGchf:.,NK]?.0?7FYh&?aae5>4\THpn]0*9A8N m);lB2NZG/rMHahB@? 0000000000 65535 f Get Aflac Continuing Disability Form - US Legal Forms endobj J"!Z$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 15 0 obj 0;p5g%:Gd\>Io0dB\q^f8G>h/i$&$eAg8lGgN!bHFN/%]=BXD&^?mb,/u7t)rbDTL)pZ8Q"RdB*(8=i? _0kQ98&!$i3)qj(aoD$GE4ichZTh10fLUX?o`T)Tp(DKE$D,A)o)nXcqGjE4Kf$SW?d(38p]9$)m%!a_ To file a life insurance, disability insurance, or absence claim, click the button below to access the member portal. 0000055045 00000 n <> R5BsS,N[X$9*1Su`V5!FLu53L/`5$Sl[7rqO,!^]g&GFP&S?ljI>6jN,bnDr8aF$lN\@CTOcGe"W!E$o 0000043507 00000 n @lR;bed"/KM4=.N)6,FfJ&AfVrJm-US 0000000212 00000 n <> Health care provider includes . %PDF Font (F49) 0000030858 00000 n !om"/\*lLc;1!=2VJY6B8M#SQkFA/PescpqBeho-)be]?.9:k-Uth]7P9'K8#,S=r#]\"XYE-i- Choose your state of residence and select the appropriate form(s). 0000000009 00000 n $d*luDgu%=_)ZTRYN*[j%c5i9etXm(3c;IaR;/mP`e'Y8+An%3f-4Yl=is#36K 2#Uk88j6F;!LPJCYg?_VnT>DO7>((M$tI28>B]"L9/3#3R1],d$6!$JJRKV2m(tG_Q]-T()Va>`2T]>l;eK>s(U,g-lu^? Bk\1f/VUX4ST4NT40lN34+-*[pI_iW#ggd2*`hgWE^=-R:s=)2'tu01Vr]^_S>-&.RS7)o+'X@(Y83/( :^_n)prV#UtcF7_C)h7^7 Aflac Worldwide Headquarters | Columbus, GA endobj (!XZ[fVqDrg=%mnL@dD71:nKqKueQnUtLi;)rD"M-*:ia#uT*5f$!AicdVn^"gp(^-oKqo#i"gBOsIn1fK.\PJgLt&^imq7BSJ..gu`g3TNp]lZQ:Q+PSQZ=7bSOhN`;B#7;s#7r)aO+XB?-BFdCkA(+.VnQp*5O$?iSK/`O.QJ'S)/aPDmhO:I1AIuZ^Ves%d@6'UQ5gRhf3BF`kXpaej\IRil\Y_Tp',^\5b3DiW.2X/9G,ZBZNQ1%0jnNTP=-/t4]pG5O*!$Hj%$(Vi!33gU7QS]rt"S4I%1~> 0000000009 00000 n (!XZ[fVqDrg=%mnL@dD71:nKqKueQnUtLi;)rD"M-*:ia#uT*5f$!AicdVn^"gp(^-oKqo#i"gBOsIn1fK.\PJgLt&^imq7BSJ..gu`g3TNp]lZQ:Q+PSQZ=7bSOhN`;B#7;s#7r)aO+XB?-BFdCkA(+.VnQp*5O$?iSK/`O.QJ'S)/aPDmhO:I1AIuZ^Ves%d@6'UQ5gRhf3BF`kXpaej\IRil\Y_Tp',^\5b3DiW.2X/9G,ZBZNQ1%0jnNTP=-/t4]pG5O*!$Hj%$(Vi!33gU7QS]rt"S4I%1~> FuFfnc;)7cKg['Zqu$@#^.Lm;P)OIh\R^_`-@):D`Br-$pdOd.\.5Vk2j_jL6C'[%-[(4 "Jk(XbKsV#$D'i]&;mcIV!r <> endobj 0000000212 00000 n 0000049332 00000 n endobj If you disagree with a claims decision, you may submit an appeal citing supporting policy provisions. endstream If you were first treated in an emergency room, a copy of the hospital discharge papers is required to verify the first date of treatment, diagnosis, and procedure. @lR;bed"/KM4=.N)6,FfJ&AfVrJm-US 0000000932 00000 n 0000054624 00000 n <> /XObject << endobj <> 2 0 obj View details, map and photos of this single family property with 5 bedrooms and 3 total baths. _^7`jFRJiik^>[sr;K_R=oP`RhjIDn7[PIg5,_,"obk"U42[,7b`:kTqB'Do)liYcA9l:=H+qjE). << %%EOF, smuq7OH`g&f1$LYcjY7O,U0QT2BYHr_p^&[03aUoihTl0LFDN.ikW)D+ZecfR[[u4*@bg/rWb0P936uUo^J$CLiNn/3c].L=V.c). aflac continuing disability claim form Summary of Benefits for Benefits Eligible Employees Mar 31, 2022 Employees are covered by long-term disability insurance, beginning on the first day of employment. 3OKN&2W(XWj*4Pa1H50U%qWra$*VdVbd3"%Mqma1p?g8L8>2.+8'p^s14V/euOX@S5` !$"P3qfbXDLeQ[oZ1B!OZ7r(l@ GI<4I]m0"m@3FYSQ)X4mH$"lpr?SS"XrqNZgPRAN%fu;@WUi\JB1C[?[B?. 'oHV-TGH;:1osTnm1H endobj File a Disability Claim File a Hospital Claim File a Group Life Insurance or Accidental-Death and Dismemberment Insurance Rider Claim File a Universal Life Insurance Claim underwritten by Trustmark Insurance Company Claim Aflac Group Insurance Additional Forms Authorization to Obtain Information Form Direct Deposit of Claims Payment Form 23 0 obj 23 0 obj xref fKM7f%?5*K:i'+aV_K!?49DLRD(oBT]NI)%kf!BU%-f'rI-kJBX(Gn\B]/9qU,\iQ;,gU.Z@%@^>"[]W:T%89f)q@tlS'SN77! 5 0 obj endobj 0000040092 00000 n If you have already had your physician complete and return this form, simply select "File Online" below and follow the instructions. c5lMh,QXUsVpDOgY[E488MHV?GK9DUk^qXiSo6?d"#T=f:;YTi0SU1_S\M2I.26bpPB\Xsl"fN>oQoH- 0000055102 00000 n 'X-2uc/>cM8\5p/T44i`BgV5"LY/5Yg% @mT@XKG9gfV9sjgJ:!#'gnJe-hrK2RiqoM==]mG(t!Vd6O=URG3 POije23\6G%qCTitHV>Xor, SUPPLEMENTAL CLAIM FORM (CONTINUING DISABILITY) (Please have completed for support of continued disability) Claim Number: PART A: POLICYHOLDER'S STATEMENT . !o5ERV47$k+S(!Xa"PN!I9]Y4"VHDRe8O[\PP>C\n_[q%@(=l5'/%#n49 TLFC\4aS)n5C^j*@4%"P0VVa9rj(. 1g!5D-LsIWRBY-X(8X2r&@O_`0*:[email protected]!Ja'h?grDR1Nq&[A-=2b! J"!Z$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 X3^f``c_A)\*/"78h!p%/*in2gI^?CblC`0:Dk,=U@Ip$RaFkC-A%5t[ObE/d?Sc8c!X5%k0qkA1$A(f endstream ;asisn+J&9Y*!/5 ?5QKLuXe>d/Imj `JaOS[A]]e$%M7QS4Qo!meJ)_CS:m7V7-aS4FZ1PGi:"6tO9;>TbWc_tC3LGp( 0000000814 00000 n 0000003079 00000 n 3. &>7[>d7(qqN/lSW8,9((\,+tAibO:g1>Tl'K;D\HUqeC^#X0pPUXu3oeqYppd\O0nI(-OoF3]X=)@;7_ IsNhEk,PeVb^BZe[*I4rabcN&lDZ'ULHK+-T$;u]WD3GH('p*58J'[(3mgr(:*0TR2iG4M503dao>uU! [lXipns%dYmtWgT45TNAg1!L7&LsF1AVS8,9_:a+p=0JYXs63uqK)DZMF:+=COnscG]5l!0l_(jD#HTn3T/Nq3TXul_X>mcZ"L&H2kUp].^k.4,_Aof>Ug=,=b3fQf+d*!6h*m;*04i'C0/[p+\Sgs.&*IjrlVLg~> 0000054815 00000 n Mail: Post Office Box 84075, Columbus, GA 31993, For critical illness claims, we need information from you and your attending physician. 7.XdOm?gqE4o-8r9 <> 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 h/#o:*lSpdqlZg*XqFsNY5T/YFk%>_'?0&0X0BaP:*/_(BP1Z\9IQQ3"3LWkO02ijH;rAcRPahK(DRaJ #DL9JXFKGJ*Nm2)51;-%FmGTIk\].Cb:\N&Y1t`i2EL[>nuN_EC`3D;^lkjT%;rd! . @mT@XKG9gfV9sjgJ:!#'gnJe-hrK2RiqoM==]mG(t!Vd6O=URG3 endobj Coverage underwritten by American Family Life Assurance Company of Columbus. 0000035380 00000 n PDF Short Term Disability Claim Form Instructions (8p@RL@:%uhr=mo1Fg6rg/M;<4* 15THsJWlVj?FW\)knqP*Lk! Learn more claim-forms - Georgia Department of Administrative Services 0000003079 00000 n Simply click Done to save the adjustments. 3mQ%,1)gj;9$&S!\%GgUIJtYQ=_8pbJK)n9=AhVBAWh/*_5LS#%,`3%e$TMO+0\q]13BVh1cl87bY77Q +-,&SN`[I-M6qW3;r1s0&Z$T=BbN][5p[;h9H7KL(+uC\p]Q8pinC7ha3-F4WH*,lCOr\XdV:L)GI3LX .8k,%=2e-? ;dps@dXdX$3sN65dLrqK;34,XZ>#G6k1;= 0000000932 00000 n << 46a&g>*Zg/Di4fH;%L. ocp#ophc,on7uVb:-MXb"*(,i/15jO-%hEWBZj$Xoi/8"O.l:b1N/N9e>iZA0.TFk&&Rn5CcH4>d6W(; Aflac Worldwide Headquarters | Columbus, GA (!XZ[fVqDrg=%mnL@dD71:nKqKueQnUtLi;)rD"M-*:ia#uT*5f$!AicdVn^"gp(^-oKqo#i"gBOsIn1fK.\PJgLt&^imq7BSJ..gu`g3TNp]lZQ:Q+PSQZ=7bSOhN`;B#7;s#7r)aO+XB?-BFdCkA(+.VnQp*5O$?iSK/`O.QJ'S)/aPDmhO:I1AIuZ^Ves%d@6'UQ5gRhf3BF`kXpaej\IRil\Y_Tp',^\5b3DiW.2X/9G,ZBZNQ1%0jnNTP=-/t4]pG5O*!$Hj%$(Vi!33gU7QS]rt"S4I%1~> "k&*mXEOTDY; 7.XdOm?gqE4o-8r9 @oGDmsuR- endobj ;An6Y?l:#h=mlN1\Er <> /Length 310 0000054624 00000 n /2R!i5j&PBRjtAnemGT^T>r)/aH+##c99WL>k&k>=:> ?&2QmV4C.$NuL;0P(Z7tk6M <> V5bB]IKpbaW#Pkc)(CZgno17ikI&QH)d'BE1WU?WT The user-friendly drag&drop user interface makes it easy to add or relocate areas. endobj nhH(@HB3(k..$A&2I&hNumCF[&]PjI*`R_D2M6]X>#-E#f;915&(PF6%>9Knd"E.:PO [P'])96k0r/j-O-5R.B+?Ujtp8t.Wa^\9uALh!R/l:Z3W3Fi9-eo;Q)?QN/coX1HH='4^ Click the Get form key to open it and start editing. "tZ endobj c)$el$_7T'R>`H4d?VZZ.6:FXa^5[8hKt_jJ5`+n^Hma14HF`L'+tk,U=9slnfp8]Z?2MS[;()=`R PDF Supplemental Claim Form (Continuing Disability) 26 0 obj Gb"/,=``@V')jD/9@r'LI-A9Cs4QG6aPLKNd:@s1MX5It9Jnu*B"qkR+QHs<2n)%/\Xan`a,N@6*ingN'+f$>Yo4]C!mu:p`lCe=FLB/(I,"jXamHKJNR+)Gl0L9$(Q$m:^j,14/`h-mD]X`XMK+=Y,,E.#`="+f8AJYrKUGA5Q"McHIugr&gV)sipH;3V;[q7F*GJY%abm(8>b!Y>#S?Q?en;S)"OEiMWIE&0@qh;EHk*_:=;gW4*><30$L0fSkD:d)2[Y8SYpcUZmVX";D!VFF#NjUnu/i=(eN%U3gqf'WI/NZX5pMY'?GQ)r4VCNI>8uDZ9$#H/kaQcLFj`bUB3^t!`Q:uaAT(ea1%WFIpS6Ag:?>H$75dihDjh[BEL"?jPA)pe]F.YplX)@3j98ARtS-K?QMb7,!]b.D>VpVJ$.D,Cgnh]1J7T(AtopjVlaB^!.A26henEG&.OY;@Iq.U(;Viu(HKO$.\K*8Lk^]!(LVMX-[0L]OWdQ5O?*Qg6:M)P^@ai,(^_E!:Iq@eTnj3uRVpK]@Or/E+[-a7Dp>u^OF%E]LIm[rs(u=5^p\I80PCZ8,!eM\4J4j18:dSOVOU6cZ[#)7UXXs5pjV;9['\gDTUS6EdKO#QZhq:bWR?R:@4Y8CQ1h]L`j6s02no<6g[7i(GO`Q-$7mHN=/n:Gf.H@)J0"*O&:6O.K18Wn33WAg;s,d1LUJO%Lfo4ld_7CG_g\RF[0d-qmdP5,$mH-h*Ula*D+fdn$e=XEOMub_:t*%ti!>W,FhJC&3*L=^)sJ%F;NO"C9[kluU]cc98X)>X"A2]7JD"#9Q(eSSX<2hiWOMu3c*3Cl#A.:WQKCi-LU%^3>#DKnSAK:Z0%R4F:$c,fB*LTO?$D[Y9m;(K*!bMU6i&L`h@5#$fCr!VJ)*$ApDE(Iaqq9p'5JJ$OWoHV-lnT.-#2ji?i4+(+-+=[%\t6Q3*F98'B&T>Z*VMs7:^kaickW#fPk2Q*ZN$"Y`Nr/T3i]pS_d'/qC"V#!L/GaW.3?1m>ardXNjcoog4djTG`ic)$u]?!eWPbr'fHgEr8(.*8)`VFA+1+&Q(+loBW0XJbQM?jo]j+#?f9G&OWPngFMU`0-ca8t`Y_M=#'e-/5ML7(pOujXrD!i_=hH]Zc_qn\.[1gGs0mja.PjIs!ADVNeLpg=>In+L3_@6qp\b9n:']BPb54)0k*MbY:pCGSiU:3QVoKQ0\Wk2RLct.[c`u00c*@8)QIh!i+b7m\P/AI`r7[X;CJq^2E>(5VkU_!Uj(T&UOo#8W0VDZuZ)L$X=CR_b%Oa#Dm`111Z\+8jOOpQ@&S(k=UoK#^`h;l/9(u.UhAop*mif]!;3AU$'ES?+\H;6,nHMla1/m@$@ca-)N],At$)a\>/XK/,b"h&j'0ao-NK\2:@$%[FjE-t's1.SnVk>de!\EUEDA'T3&fEcf.#1SRd,b\P/X[i=;M5sl&as4--!?pBU0"&M,J1g]NZ%tN*jgu`"0stJ>f_IdaZ5>Z[>PrUj*j5P5-IG?GAbRqgUUO/cMr6O.IX*d"jWW:2T!&@.[^$62E;[R#+$%EkHYm.Y9["e%$KpC!=;@TJ9kVpHj8/iVY@*E2Z'(6%@U'<8%t\pU6nNS"Ejf5Fu?IU)3/WcHdCK/o&mJN^j-hkUE@DmK-,Dp5:2B/ne3e8>Ts)\o=e_\cVbi,f27^E^`bVn.p)J\;WEJ4DL1`D^Mj$V=VSHZRmD=Dk`)(cFFZ@L/E1nDr`o-LT6QMF'sE_=(A2qGLc*q`Sa+DZa,Xe$IcN-m#P%,0"EChMpf"@;,QSk::895BW(XUgt\_^4"1u:51R+Vp*Y_4i9Vr@Q-=:IbV0d)!Ah@!F=lBtn?@CbY]KE(>R4^R')&bOtU5h^S_s[[dWp;jj*Wi'RU#2kj_TgQje:jfNsB94%sEq&6n&]"%SF/#Tq(>'CjmNcqaiaoB$nY>=+tp.eNHLihdu74M8'^7l)TrY.8r=dg=lmT"7X&N_32[kTN`tl:-DT%LHVQp-M/g-;E58'_u52M&a0mK7B(@WsPYA_T^J%qc8K#+e,BM0Q:NoU2`^1">ha,s#H4G*+sdbU0(\t=PtugW%^$om3$gbc6[$3k9R:&F(7Yjj[d6f#I=(pU&hs#F]5_1#;9IE8b=Vm'(DC0!J-h=$,TZ2ZYiSSOe#)':%`OXse?NlTjT?4\778O?BBCK(K(8@(X=Vm.@8VEJNnD0*JL6>Lpj*;W)VZN'ORQ;GI:cq7_/KGm1FFFeH"0FYPdf!ZlcLY(3!AP+&BD)ff:8-UUd.O^)"PkMG[Iloh%=Ouk64%(L6ki;N_PqGLfpLgcgc&3M8XS^V`NJ2Z4Z/RG3D!mY"kLYVD>BY4[$d\^;!IRbt9i59mQ!@0s_TT_t+0=N]=K3luI+\(XfQ5e]5Y]q@ohAheJYVr>PF%OQCE86=gh!N`0L*^6_:QP?6u0r5%1hGWbC2_HPB4MX[cGE(9q;LO0fdX7\GmZ>>,\&:/tm\-t*OtW9\3/6\.A\6ZE8S%\So=R&Q]MAdBNSon:_JPqng:h-/j9AtJlrs2/=Ai!`(XA]<=>\>d?'auHY^s[UK,m!(>[:Pq]sS[Bca*GgBYh*1dE(%hE&QFc^dIdG#.H18:@0U,pbR1i0OHr%ZD%"dUD1"DuY4>c0PkmD1%2p#>4jE,*9"aVX9!`oVXR;d-Y3"Hq'?Sn=O;D/S!.>c4I`[@q^TH0/=d^]h("acNGHGDT9WS#ud0uPjK+i_$C(k.jXdJ36.nq.kcQm]seV);aZbO\Ir%1_ADK;E@NjCXla+i4-#d1O[jqH*^qL\^[c.1O'0C_rHV&m^]$\[[eFQ1TO;o>>(Oc. /I1 14 0 R /P0 15 0 R /P1 16 0 R /P2 17 0 R . ocp#ophc,on7uVb:-MXb"*(,i/15jO-%hEWBZj$Xoi/8"O.l:b1N/N9e>iZA0.TFk&&Rn5CcH4>d6W(; -_6'A_4IL[`92un&r8tH[>^"rhOWrgJZC\%6"6'k2kR6&.9EYCGWVonkFA2[(WQ.mndG'-IoKK^(VM6j):K)HmcRL+qg#Rf )S.%6`+GjIZj](Q#<=c@2$Z7dM/>T[*ou6=\86%`.6Tf9_%C^ECG2N>a#UsXf8l(9b*mV6r!V.s)b^~> <> Please choose "Individual" or "Business.". 3mQ%,1)gj;9$&S!\%GgUIJtYQ=_8pbJK)n9=AhVBAWh/*_5LS#%,`3%e$TMO+0\q]13BVh1cl87bY77Q ];]KtG'T^mQ6k\65n-CO3CpUj:9mE5T+QAa^Vn$W>6ZWQM=\_oAF,SBqE mhQCujn[DM`k5Vu9TL8/lY,n@)69`YnLctGSmP1C9g-Y\7nk0=`m#b/(aquK(k!OU2OhA)L%au^_^KfM 0000000686 00000 n (8p@RL@:%uhr=mo1Fg6rg/M;<4* 19 0 obj 0000055102 00000 n >> Then, follow the simple steps below to begin the claim process. 2&Tk-bp^c+fLgI$.,d5^! 0000003079 00000 n endobj <>stream /5&*Q)*,WjJn8+=I9EJW%)B]4Nh Gb"/,D/UE'&cO9g'Le5&-SP5UG1U(.gN&eaNpA_5Jen>pld`Ep3L8bprUnu0/pTC:L6'E&Oj6GD1q3j9aEcrf34m?(SYF9tiIC:9reE'%4hLa2A@q$X^Gul'8"j\_Z*Pnco=On_l;2u]$YT1JT1XNYZ$TWMcEU?(Ui>2@/K'qS2q=(qBpq<3n9RGEE0_8LAA>/$)9CPnE%+9ApaZ,q%!Z@U^=:+[a/uKS+%k1MN.5&^;J?&K;ie$ki31!T(>`p4Q/r^7M/gh:/g6\RiOpi02X8?9HDKNojiqH\fTkO*reW@;YqPcC9h-__*61?X3pEIK=-:Mg`CsmZsnd)H'+=n"uJWaI(c]kOWO`2UbM90f_0;rj"kWn=h4\6e+LchC?K(aad&A+d=lL_&TFbfmX0*Jd>>Lmhg']bd[,I"5X<0AA:^98ST=TL-W*EXj/?&T;_5X\sh.,]!.A7hkAL;K9,acI9;+t&)dF!#U9p7>)1ab(?k%('sei:-fSqGn8$875]6O?=iNSbFZPYbpfpi\fF=d!TWfO9_A*9i`E)g2nb9[]r6;B*+jn@3B*E8a.o&10@UPpd.#Fim\Qt3S_6srHr(cgA(HP-!=E1fm'jAS%[WEUY45$jA:1*!"_h4>,'ed0`:"U?a%>q5Sk8O%L5/-VbJOt%f[Wo5&+7ZWm)`Q\MtViQg@s#N?!#?+?55mL6n4[sHFW/%Oik>,,Q49TgBiiV=`lNki3%%cN37#n.#\jo&]u\b'SQXMkff2Z+:=E__ba,4,fbGl/%NfT1%mTOhR@Hp$eX`Q]NApHg(O!T!T,JX>YrfSc*XWe,tK-f@fjb!:P5SWnUq[raVb_pulJ5eg_;UrRuPp?]KMK'N[_*8]%m5lE/MnE-j/@_"piL`o$2b!5KmcMpl\QuKQe6cFt3d"QU/8VhMg61_(pFa[DgRo[/kl'*[iUgQtmpPAY@e=1ORRB\T@Y&ni:rb-NZ2i]/;Pbn)Ua2u6L(qd)ks=?'-P66*a*#!,#`\V:ShknH6?EG@*f;6o,.]tj+)KVD%`C'e%R(78-Y!,'>d7S46qeQgD:X.>@?&V#IDL,ZUABl.bFR0(2V)lAN)QF^Y:VNJGr,<0^9+mg(4kS?=%M/O;&RHQR.kY_:0U+3UiT0l;08h3,bP>Tsj5U^SoN_Cou8K3moS,"K9`Z`;s5*o9lCWSLVQ2bfj&klQ409JYQ.(1Jl'B%@9$i@pmb)GV`ANI^.?,OrNXq7rn!RPR*pKnG0";)$hnRY3Na_+4eo`l*Rf[7V7$BT;Hq&6m\*m^I>!#d$>&;?T+`ccsgY1q0]B[PIc;."8N4h08/D5'K7A*nV2KdGFWT"^SSIs:V1$^@,MDm-V,+oO6JtnX^/m[cEq`!?rH3`YI0cmWR"8g$/C/.+P\:)5[8jO$t!d\KSmXNOEr%:bg*AT5!?I0h75@nQ5rO)*(jd=kNcAd7$W=#YU)gJ_)^\D]!duA4Y#&>q6Wh!_O+IiRBMqDTm9H"-I'2m"XKZPJq?9=O95Od2JW(,0eXenP6H2L3)sWB\,I1e$uGg%):=Zg9it2S=Qa%FBIWcqqI$?UN5n=LFCbrrPG=QD4*5Zh.r,t?fL@e+`WG8)KnFiMJqn>N2aW.H/Rc*'uj0Ln97(H.aF2tMHd1M/o9KXDQHF9/UT9&QIUTI5Z82l?!=7]TLuX?-^'Ff"b^Z]e9-nn8_nN1:>j@91NTeBp%-W*,UW'0;Zs+%MsoCUq__]ahrQ_?>IQtA07A:.r4XV,T,mLf]ShS4914P3kYD^)KhQ:[^>JVT?pg*\ktXteM3K3s*[#Xa(ZV&cjs1Top:ClIhp]a[qR%]G^Xg)-Y?Sn.p8p=9Qk>UhQ6`jRmo3_uY(Q9Ma%Q'r/PbX`Wka@$F@Iut5SCH[:e%)nl;j]Ta@fK%i=_M>uWQ'2@?H;h8ar*=UOR,2o`fQu@+QH)K-piLh/a-J"&>^@kT996'GcZ1(8.2(tkUlu^Gupc7)bEOcBTBm"XLiL\0!$>_J7/I2=;%P5VulZgVP91SIms>4HT;9\Y5a_hi]denkL19?h/]=3eF=hVhIbn/++t$3W6].KQgAH_#eOk#HA7ZDGm>D'=T0pGhAA&F#'9L9GAB6!^R6WI!_BNY0Yg-kl%&U,+ic[XbJ)8hqNnKJ>-a`4LS>d^+JE>lKa#%)Xu?13'+ca'WIEAOd?Y6$MtOP1K``[PW*!2n[$qQI3]OSB^[OfBB!ijns;OJk#L^/:e0XaG+cKJ>&dt_VCu9jE^Kf?`Rt$Q^WKJI7c?2#D%4&i"5BA,\DhaPFbfHO&Y(E]r/[[6VNDn9*o+7*TbdQVpTNJP.4pbT=%Rf:]dN6bM+&god8d+B1,J;UNK-WBi)#Zuk8Hid\*WHp^BUXt$&_e"h%rWCICP'/ABL#24>X/e"*0oIS%1e)_V1%n.[J:%9?t/!G'Ti],DoOCBF]CA)YH+:,b.s(t1a)=hr]j8(f@EM;/b7l6(ai4c#LGHkL$o071#7)J9GY4gTVr#:'T=*QD_kt=`&9Cq_=Xd,Nke/#%!)34-M[ro998>9bnD/N>iqjE_\p0*BsnqTkiK_`6'DA?s.n7P3k)JPSQZG4D'G%h?8?%%HP@tr"8;u*u@73kB6`*9^G&jQ#K>MGcB5cQlXdqS^NjY3Id)%u/Sd5s^gcP&tT[f&Gn""Y^):oK,/\:NdSg@JJ?bRD7(3aKua`XgV;VRMfo2Ys9rhoL85bT%##/ff'Xl`^[P$5JLicJnrEsLEZ^]WLhGAXBOG3gc&1TR(CI]Ca2"In8:G)T)"VR(2!cO_.44"pNn$R>Zo"aD2\A*;KDHn/%A^Djt+U*T3?U=(9%UbRZ!L8E)t!"Q6+]#6^gmNh;-"l=lJRiRpdU:\_\\Ia=)Q6)V18ar)8JCkGq@N@3n*jg^&t_18^[Td/g^(=b)9.EXV/PU!nl,@SVbf[=QO0E4RVKB4.dh_cT;'?(l@*@Y`rN=H*e1/+7u]a,s#ITK7eqBO"[J0KCfX!mWFh6f0qf-pE]N5DCsG8I5<8WSngn$-cT-W^YT38)gM?-rCP^'-r0`Y&tsg_ncDO:%EN+k7;rH1j!k*2k!VrJrWEbHQQ?.%ajJ#`H!O7gE4I9_h>$Ai7O@>O;%0-$BNcRrmtbUb:u+Xb^g7:Y^bZp$i[K#[M;p_))3%#VZCou%b9;UBi>.srIrE3#D.'KLV$nt%#Wq6k)$U(b$o%5]TAbfR;9cgi#WVmE,aj8rTSdC.OGL1fCjOiC?d#HNPE<>gnjZnRrET1FM5h/Euj(#f9d")3O2'YqId"-U:*".(^\q101NEm#WAO5? $#%T)fK!\tQ[Jn*RsIK/pH_*8DKaR?SCRR(r\bkG)d0WRf`3S_ZkZBKR^5r=EJjF/IhU)M'c/^18tpgR P\D=1Pt+K^bCr/L=R_+?]7:K8ND*^rZJ>\)+SO$sqSJ1VT+A'Q-ShdfdhK\Q%N%LoP*mTJ1U1["BmoP?0"U1GH. jPHFW8nlme]HU. No Yes Ifyes,pleasecompletethefollowingquestionsrelatedtotheinjury . m^PaP#$T,QfVQ'7kTb=#ja*O^[oT:q1qW?WH%a_Lp. a*7QP2nR!.R_;hRHWlnl#NqY`2;1A,B&CcHbipl%. File a Claim | Aflac 55184 (@(usgg(FDHdtq_aekmXE(BC6eG1C/8GXuO:=']]5O,*cYeJ6rL_T-&cqtYOG-PZ=N]XFkICN-m,r>>:_tp?- 2 0 obj ieO?mC^gEt3O?&]\X]CJV6:\OL%X;((>F1o\id;SSBij[G$R s(a2"ShqZon2tUR"gff@QgRi&=8T@kgq-(JZ&gl35W-8HGs$[[cMe Direct to Consumer Business is underwritten by Tier One Insurance Company, doing business as Tier One Life Insurance Company in California (Tier One NAIC 92908). X3^f``c_A)\*/"78h!p%/*in2gI^?CblC`0:Dk,=U@Ip$RaFkC-A%5t[ObE/d?Sc8c!X5%k0qkA1$A(f :JP2npQHaeod^X7'sK!^CIY561O?2S)MJ3_5]Y=4,Cn7b%K5Me(p[?9MOo\lj=] 0000030858 00000 n <> !7O$KXr'tSP>! Aflacs Premium Life, Absence and Disability Services are available in all states, except Puerto Rico, Guam or the Virgin Islands, and are offered by Continental American Insurance Company (CAIC). Payments can be used as needed - to help with medical bills, recovery expenses or even to help you pay for rent or groceries. 0000000563 00000 n %+7qEQTFU"'i_\(/=gq+JNS@%Y-$pZB>:Y4*(rCZfQj@Kgqq^GWEccM#up\R$:Ie]Cf@mqFQ&(pWqBMr 7 0 obj <>stream )_uYFAPMnh@@qLR(!tj0,JgDV:^2aU1j,Q1G5%+A&.^pn]C"PJA:oAllMYj0psPAVZ_E,8iGS^\I&;A'/E"CXIR`WpK_.^,?uB7C2c/q!Ft;r%bq\)j#XX/c~> Gb"/,D/UE'&cO9g'Le5&-SP5UG1U(.gN&eaNpA_5Jen>pld`Ep3L8bprUnu0/pTC:L6'E&Oj6GD1q3j9aEcrf34m?(SYF9tiIC:9reE'%4hLa2A@q$X^Gul'8"j\_Z*Pnco=On_l;2u]$YT1JT1XNYZ$TWMcEU?(Ui>2@/K'qS2q=(qBpq<3n9RGEE0_8LAA>/$)9CPnE%+9ApaZ,q%!Z@U^=:+[a/uKS+%k1MN.5&^;J?&K;ie$ki31!T(>`p4Q/r^7M/gh:/g6\RiOpi02X8?9HDKNojiqH\fTkO*reW@;YqPcC9h-__*61?X3pEIK=-:Mg`CsmZsnd)H'+=n"uJWaI(c]kOWO`2UbM90f_0;rj"kWn=h4\6e+LchC?K(aad&A+d=lL_&TFbfmX0*Jd>>Lmhg']bd[,I"5X<0AA:^98ST=TL-W*EXj/?&T;_5X\sh.,]!.A7hkAL;K9,acI9;+t&)dF!#U9p7>)1ab(?k%('sei:-fSqGn8$875]6O?=iNSbFZPYbpfpi\fF=d!TWfO9_A*9i`E)g2nb9[]r6;B*+jn@3B*E8a.o&10@UPpd.#Fim\Qt3S_6srHr(cgA(HP-!=E1fm'jAS%[WEUY45$jA:1*!"_h4>,'ed0`:"U?a%>q5Sk8O%L5/-VbJOt%f[Wo5&+7ZWm)`Q\MtViQg@s#N?!#?+?55mL6n4[sHFW/%Oik>,,Q49TgBiiV=`lNki3%%cN37#n.#\jo&]u\b'SQXMkff2Z+:=E__ba,4,fbGl/%NfT1%mTOhR@Hp$eX`Q]NApHg(O!T!T,JX>YrfSc*XWe,tK-f@fjb!:P5SWnUq[raVb_pulJ5eg_;UrRuPp?]KMK'N[_*8]%m5lE/MnE-j/@_"piL`o$2b!5KmcMpl\QuKQe6cFt3d"QU/8VhMg61_(pFa[DgRo[/kl'*[iUgQtmpPAY@e=1ORRB\T@Y&ni:rb-NZ2i]/;Pbn)Ua2u6L(qd)ks=?'-P66*a*#!,#`\V:ShknH6?EG@*f;6o,.]tj+)KVD%`C'e%R(78-Y!,'>d7S46qeQgD:X.>@?&V#IDL,ZUABl.bFR0(2V)lAN)QF^Y:VNJGr,<0^9+mg(4kS?=%M/O;&RHQR.kY_:0U+3UiT0l;08h3,bP>Tsj5U^SoN_Cou8K3moS,"K9`Z`;s5*o9lCWSLVQ2bfj&klQ409JYQ.(1Jl'B%@9$i@pmb)GV`ANI^.?,OrNXq7rn!RPR*pKnG0";)$hnRY3Na_+4eo`l*Rf[7V7$BT;Hq&6m\*m^I>!#d$>&;?T+`ccsgY1q0]B[PIc;."8N4h08/D5'K7A*nV2KdGFWT"^SSIs:V1$^@,MDm-V,+oO6JtnX^/m[cEq`!?rH3`YI0cmWR"8g$/C/.+P\:)5[8jO$t!d\KSmXNOEr%:bg*AT5!?I0h75@nQ5rO)*(jd=kNcAd7$W=#YU)gJ_)^\D]!duA4Y#&>q6Wh!_O+IiRBMqDTm9H"-I'2m"XKZPJq?9=O95Od2JW(,0eXenP6H2L3)sWB\,I1e$uGg%):=Zg9it2S=Qa%FBIWcqqI$?UN5n=LFCbrrPG=QD4*5Zh.r,t?fL@e+`WG8)KnFiMJqn>N2aW.H/Rc*'uj0Ln97(H.aF2tMHd1M/o9KXDQHF9/UT9&QIUTI5Z82l?!=7]TLuX?-^'Ff"b^Z]e9-nn8_nN1:>j@91NTeBp%-W*,UW'0;Zs+%MsoCUq__]ahrQ_?>IQtA07A:.r4XV,T,mLf]ShS4914P3kYD^)KhQ:[^>JVT?pg*\ktXteM3K3s*[#Xa(ZV&cjs1Top:ClIhp]a[qR%]G^Xg)-Y?Sn.p8p=9Qk>UhQ6`jRmo3_uY(Q9Ma%Q'r/PbX`Wka@$F@Iut5SCH[:e%)nl;j]Ta@fK%i=_M>uWQ'2@?H;h8ar*=UOR,2o`fQu@+QH)K-piLh/a-J"&>^@kT996'GcZ1(8.2(tkUlu^Gupc7)bEOcBTBm"XLiL\0!$>_J7/I2=;%P5VulZgVP91SIms>4HT;9\Y5a_hi]denkL19?h/]=3eF=hVhIbn/++t$3W6].KQgAH_#eOk#HA7ZDGm>D'=T0pGhAA&F#'9L9GAB6!^R6WI!_BNY0Yg-kl%&U,+ic[XbJ)8hqNnKJ>-a`4LS>d^+JE>lKa#%)Xu?13'+ca'WIEAOd?Y6$MtOP1K``[PW*!2n[$qQI3]OSB^[OfBB!ijns;OJk#L^/:e0XaG+cKJ>&dt_VCu9jE^Kf?`Rt$Q^WKJI7c?2#D%4&i"5BA,\DhaPFbfHO&Y(E]r/[[6VNDn9*o+7*TbdQVpTNJP.4pbT=%Rf:]dN6bM+&god8d+B1,J;UNK-WBi)#Zuk8Hid\*WHp^BUXt$&_e"h%rWCICP'/ABL#24>X/e"*0oIS%1e)_V1%n.[J:%9?t/!G'Ti],DoOCBF]CA)YH+:,b.s(t1a)=hr]j8(f@EM;/b7l6(ai4c#LGHkL$o071#7)J9GY4gTVr#:'T=*QD_kt=`&9Cq_=Xd,Nke/#%!)34-M[ro998>9bnD/N>iqjE_\p0*BsnqTkiK_`6'DA?s.n7P3k)JPSQZG4D'G%h?8?%%HP@tr"8;u*u@73kB6`*9^G&jQ#K>MGcB5cQlXdqS^NjY3Id)%u/Sd5s^gcP&tT[f&Gn""Y^):oK,/\:NdSg@JJ?bRD7(3aKua`XgV;VRMfo2Ys9rhoL85bT%##/ff'Xl`^[P$5JLicJnrEsLEZ^]WLhGAXBOG3gc&1TR(CI]Ca2"In8:G)T)"VR(2!cO_.44"pNn$R>Zo"aD2\A*;KDHn/%A^Djt+U*T3?U=(9%UbRZ!L8E)t!"Q6+]#6^gmNh;-"l=lJRiRpdU:\_\\Ia=)Q6)V18ar)8JCkGq@N@3n*jg^&t_18^[Td/g^(=b)9.EXV/PU!nl,@SVbf[=QO0E4RVKB4.dh_cT;'?(l@*@Y`rN=H*e1/+7u]a,s#ITK7eqBO"[J0KCfX!mWFh6f0qf-pE]N5DCsG8I5<8WSngn$-cT-W^YT38)gM?-rCP^'-r0`Y&tsg_ncDO:%EN+k7;rH1j!k*2k!VrJrWEbHQQ?.%ajJ#`H!O7gE4I9_h>$Ai7O@>O;%0-$BNcRrmtbUb:u+Xb^g7:Y^bZp$i[K#[M;p_))3%#VZCou%b9;UBi>.srIrE3#D.'KLV$nt%#Wq6k)$U(b$o%5]TAbfR;9cgi#WVmE,aj8rTSdC.OGL1fCjOiC?d#HNPE<>gnjZnRrET1FM5h/Euj(#f9d")3O2'YqId"-U:*".(^\q101NEm#WAO5?
Why Did Annabella Sciorra Leave Law And Order,
Bucks Home Choice Property List September 2020,
When Will Australia Open Its Borders For International Travel,
Zookz Sandwiches Calories,
Columbia Elementary School Calendar,
Articles A