Aflac Group uses this supplemental claim form to support continued disability on an open Aflac Group disability claim underwritten by Continental American Insurance Company. The physician assessing return-to-work capability completes Part C, giving total and partial disability dates, the release date and specific restrictions. The policyholder and employer complete Parts A and B on the same page.
The policyholder completes Part A and the employer completes Part B, including whether light-duty earnings exceed 80 percent of pre-disability salary. The physician assessing return to work completes and signs Part C.
Download the current version from the source each time; forms change without notice.
Aflac Group Continuing Disability Claim Form
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.
Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.
Part C is the attending physician statement, completed by the physician assessing the patient's return-to-work capability. It covers diagnosis, treatment dates, complications preventing return, disability dates, the release date, prognosis, and restrictions and limitations related to the patient's occupation.
Part C asks for the date the patient is released to return to work and, if that cannot be determined yet, an estimate. The physician also indicates when a fundamental or marked change is expected: within a month, one to three, three to six or six to twelve months, or never.