Aflac Accident Claim Instructions

Here is the claim form that you need to fill out for your accident:  Accident Claim


You will need your Policy # ___________________________


Please follow these steps:

  1. Fill out Page 1 of 2 with your information and a description of the accident
  2. Complete the questions on Page 2 of 2
  3. Attach any applicable documents from the lists below
  4. Fill out this form to authorize Aflac to have access to your medical records:
  5. Send the above documents completed to Omnia Benefits if you would like our assistance -or- you may upload the documents yourself online via your SmartClaim account

Fax: 443-740-9214




If any of the following apply to your accident, please submit the corresponding document:

  • MRI or CT Scan bill
  • Ambulance bill
  • Police Report for auto accident stating details of the accident in their entirety


If you went to the emergency room, please submit:

  • ER Report (may be obtained from the medical records)
  • Itemized Bill from the Hospital
  • Discharge Summary


For any follow-up visits, please submit:

  • Summary of Service for your visit
  • Physical Therapy (PT) itemized bill for up to 10 visits