PACIF members: To report an injury, accident, damage, loss, or potential loss, click on the appropriate box below.
For coverage-related functions such as requesting a new vehicle card, please use our Insurance Forms webpage.
Not sure which box to click? Please call Trisha Clark at 1-800-649-7915.
Please follow these claim filing tips
to help us provide you with the most expert claim service available:
File a workers’ compensation claim as soon as possible after learning that an employee has received an injury or illness in the course of his or her employment. This should be well within the graduated parameters of state and federal laws, which require the employer to:
- File a First Report of Injury within 72 hours of receiving notice or having knowledge of the injury.
- If the injury results in in-patient hospitalization, amputation, or loss of an eye, report it to OSHA or VOSHA within 24 hours.
- If the injury is fatal, report the fatality to OSHA or VOSHA within 8 hours of the death.
- For details on reporting a fatality, in-patient hospitalization, amputation, or loss of an eye, go to http://labor.vermont.gov/vosha/vosha-injuriesillnesses-report/ or call 1-800-321-6742 (OSHA's toll-free central telephone number).
The sooner an investigation can begin, the faster the claim can be resolved, whether it is for Workers' Comp or for Property/Vehicle/Liability.
To file a claim at any time of the day or night:
- Click on the appropriate one of the four buttons at the top of this page.
- Follow the directions on the button and the form.
- Include as much information about the incident as you can. (In general, there can never be too much information in a claim report.)
- A PACIF staff member will follow up with you during VLCT office hours.
The following information can all be relevant:
- Names, addresses, and phone numbers of the parties involved
- When and where (the exact geographic location) the incident occurred
- Witnesses' names, addresses, and phone numbers (all are crucial to the investigation of the incident)
- If there were there any injuries, who was injured and how?
- Where did the parties go for medical treatment?
- Were the police contacted? If so, what jurisdiction? If police responded, what is the incident number?
If you have any questions about filing a claim, please call the claim office at 800-649-7915 or email Trisha Clark.