VFIS Forms

CLAIM FORMS

Please report all claims to Cheryl Cook in our office at 800-252-9435.  To expedite the 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
Automobile Loss Notice
Workers Compensation Employer's First Report of Injury or Illness
Equipment Damage/Loss
General Liability Claim
Property Loss Claim

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
www.vfis.com/claims_reporting.htm

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

OTHER FORMS

Accident/Sickness Beneficiary

You will need Acrobat Reader or a PDF viewer to read the forms. To download Adobe Acrobat Reader, please click the button below.