Workers' Compensation Claim Kit – Vermont

Who will handle your claims?

The New Jersey Regional Claim Office will handle your Vermont claims, located at:

305 Madison Ave.
P.O. Box 1973
Morristown, NJ 07962

Phone: (888)-890-1500
Jeff Van Dyk, Assistant Vice President

How to report Workers’ Compensation claims?

To report via the Internet: Log on to the Crum & Forster website at https://cfconnect.cfins.com. Use your assigned User ID and Password. If you do not have a current User ID, please contact your local Crum & Forster Claims or Marketing resource.

To report e-mail: crumandforsternol@cfins.com

To report via fax: 1-877-622-6218

To report claims via telephone: 1-800-690-5520

(7 day/24 hour toll free reporting line for all states)

In the event of a serious or fatal injury, notify the local claim office immediately by telephone.

What forms and pamphlets does the employer need to be aware of?

Notice of Injured Worker Rights and Responsibilities:
Review the instructions and prominently display the form where each employee is likely to see the notice on a regular basis. The Vermont posting notice is available on the Crum & Forster website.

Employer’s First report of injury form:
If you report the claim via the Internet or by telephone, you do not need to fill out this form. If you report the claim via fax, complete this form, and fax it to Crum & Forster at the fax number provided above.

VT-Employer First Report of Injury

Employer’s Wage Statement:

File this form with the carrier, claimant, and claimant’s representative when the claimant is losing time from work.

VT – Employer’s Wage Statement | VT-Report of Injuries after 7-08

(For Injuries BEFORE 7/1/08) (For Injuries ON OR AFTER 7/1/08)

Waiting Period For Lost Wages in Vermont
The waiting period is 3 days total disability only. The disability must continue for 7 days for retroactive payment.

Choice of Physician Rules in Vermont
An employer may designate the treating health care provider to initially treat an injured employee immediately following a compensable injury. After the initial treatment, an employee may select another health care provider upon giving the employer written Notice of the employee’s reasons for dissatisfaction with the health care provider designated by the employer and the name and address of the health care provider selected by the employee. The “Notice of Intent to Change Health Care Provider” (Form 8) shall be given to the employee by the employer, its insurance carrier, or the employer’s health care provider at or before initial treatment.

VT-Notice of Intent to Change Health Care Provider

Preferred Provider Organization Network (PPO):

Crum & Forster has a PPO network available. Follow the instructions below to access the PPO Network:

Logon to the website at: https://www-sf.talispoint.com/conduent/cfi/