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Short-Term Disability Claims

To file a short-term disability claim, please complete the appropriate claim form and follow the guidelines below:

First Claim for Short-Term Disability

  • Have the patient complete and sign Section A: Patient Information.
  • Have your physician complete and sign Sections B and C: Physician's Information and Physician’s Disability Statement.
  • Have the employer complete and sign Section D: Employer's Information. Please ensure that the employer completes the pre-tax or after-tax question.
  • If you are self-employed, send a copy of your current business license and most recent quarterly tax records.
  • Include an authorization signed and dated by the patient with every claim.
  • Be sure the claim form includes:
    • Where and when the accident took place (on or off the job)
    • Dates of disability
    • Name and phone number of the physician


Additional information may be required.


Second and Subsequent Claims for Disability (Form S-13270.1)

  • Have the patient complete and sign Section A: Patient Information.
  • Have the physician complete and sign Section B: Physician's Information.
  • Have your employer complete and sign Section C: Employer's Information.
  • Include an authorization signed and dated by the patient with every claim.

Short-Term Disability Insurance Claims | Aflac