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.
This is not an insurance form, but rather a method of keeping an internal record by your fire 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.
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. Be sure that all forms are signed by an authorized representative.
This form is the actual report of loss to your insurance carrier. We cannot set up a claim unless a signed and completed C-2F 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.
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.
This form must be filed by the injured firefighter, in addition to a C-2F 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.
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.
This form must be completed by the fire district following the death of a firefighter.
This form is for proof of death. It must be completed by the physician last in attendance of the deceased.
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 C-2F.