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Step
1
Prepare
a record of all Accidents.
The Law requires all fire districts to keep a record of all injuries
sustained by their volunteer firefighters in the course of duty. You
should do this by competing a VF-1 form
VF-1
This
is not an insurance form, but rather a method of keeping an internal
record by your dire districts of all accidents. This form should be
completed after and accident and held with the district. If a claim for
benefits is made at a later date, this form should be submitted with
that claim.
Note: If a
firefighter is exposed to a hazardous substance or a hazardous liquid
(i.e., A.I.D.S. or asbestos) and no medical bills result out of that
exposure, but the firefighter would like to have it on record, complete
a VF-1, have an official initial it and keep it on file for future
reference. (You may also wish to give a copy of that form to the injured
party.) It is not required to forward the form to the insurance company.
Step
2
Report
of Accident or Injury. In addition to completing a VF-1, the
following forms may be necessary. Please report all claims by filing the
applicable forms with FDM and the New York State Worker's
Compensation Board. Be sure that all forms are signed by an
authorized representative.
VF-2
This
form is the actual report of loss to your insurance carrier. We cannot
set up a claim unless a signed and completed VF-2 is received. Please
note that failure to file this form within 10 days is a misdemeanor.
Please submit this form for any accident or injury in which a volunteer
firefighter requires medical treatment beyond ordinary first aid and
medical bills resulting from such treatment. The injured party's social
security number must be completed for proper filing.
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Step
3
Claim
for Benefits for Lost Time from Work. If a firefighter loses time
from work and is due reimbursement, the following form must be filed.
VF-3
This
form must be filed by the injured firefighter, in addition to a VF-2
form, if the accident or injury is one in which a volunteer firefighter
loses time for his/her regular employment. This form should be filed
promptly, but no later than two years after the date of injury.
Step
4
Death
Claims. In the case where a firematic injury should result in the
death of a volunteer firefighter, the following forms should be filed
within 90 days, but no later two years after death to FDM and
the New York State Worker's Compensation Board.
VF-62
This
form must be completed by the fire district following the death of a
firefighter.
C-64
This
form is for proof of death. It must be completed by the physician last
in attendance of the deceased.
C-65
This
form is for proof of burial and funeral expenses. It must be completed
by the undertaker.
To assist in expediting
the initial reporting, we have introduced
FDMfastfax "Notice of Injury". The district can fax us information to get
the claim started, then follow up with the completion of the form. Please
note: This fax is not in lieu of the VF-2. |
