Claims administration requires complying with Aflac's ethical business standards. When one commits a fraudulent claim activity, consequences include an investigation or inquiry from Aflac's SIU. Prohibited Practices related to Claims Administration include: Withholding or not disclosing relevant documentation or information related to a claim Failing to deliver an Aflac claim check upon receipt or as directed by the payee Cashing claim checks. This includes providing cash in exchange for the check as well as presenting the check for cash at a financial institution Requiring a policyholder to share part of claim proceeds or pay a service fee to the producer for handling Aflac claim filing Failure to forward claims documentation the same day of receipt Assisting policyholders or providers in submitting fraudulent claims. This includes fabricated medical records, authorizations, and other altered documents Consider this scenario involving a fraudulent wellness claim concerning treatment dates: If the policyholder tells you she had a mammogram in "early February," you must find out the exact date. "Close enough" dates are not permitted. When you assist policyholders with wellness claims, be sure to file claims with accurate service information including the date services were rendered, the servicing provider name and address, as well as specific services performed. It's a good practice to double check each field on each claim to ensure you have correctly entered information. Claims Requirements Fraudulent Claims Activity / Prohibited Claims Practices
