VFIS FORMS

Please report all claims to Cheryl Cook in our office at 800-252-9435. To expedite a claim, please download the appropriate claim form listed below. The completed claim form should then be faxed to us at 512-448-9929.

• Accident/Sickness Claim Report
  
• Accident/Sickness Physicians Statement
• A&S Beneficiary Designation
  
• Public Safety Officers' Benefits (PSOB) Beneficiary Designation
  
• Workers Compensation Employer's First Report of Injury or Illness
• Equipment Damage/Loss
  
• Membership Roster
  
• HR Helpline Request Form
  

For after-hours emergency service, you may report claims directly to the carriers at the phone numbers listed below:

VFIS (Glatfelter Claims Management)
800-233-1957

Texas Mutual (Workers' Compensation claims)
800-859-5995
www.texasmutual.com