Disability Physician Expense Claim Form
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2Physician Expense Claim
Filing Instructions
Save Time and Paper – File Your Claim Online!
We offer two ways to file your physician expense claim: online or by mail/fax.
How to File Online:
1. Login to your secured Online Service Center (OSC) account at
2. From the “My Claims” tab, click “File a Claim” to get started.
3. On the “Type of Claim” screen, select “Disability” and then “Physician Expense”.
4. Conveniently upload an itemized billing with diagnosis for each date you are claiming the physician expense benefit.
Please submit a separate claim for each diagnosis.
5. Follow the step-by-step instructions to complete your online claim filing process.
6. Check the status of your claim by selecting the “My Claims” tab at the top of the screen!
How to File By Mail or Fax:
1. Complete the Statement of Insured.
2. Attach an itemized billing with diagnosis for each date you are claiming the physician expense benefit.
3. Mail the completed forms to American Fidelity at the address listed below.
4. If you wish to fax your completed forms, please fax to 800-818-3453.
Whether completing this claim online or with the below packet, all portions must be completed to avoid undue delay in
processing your request for benefits. If you have any questions regarding completion of your claim, please call:
Toll Free: 800-662-1113 | Local: 405-523-5025
ATTN: AFES BENEFITS DEPT.
P.O. Box 25160
Oklahoma City, Oklahoma 73125
Toll Free: 1-800-662-1113
Fax: 1-800-818-3453
BN-PE-0514
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Parent category: Business