Doña Ana County

Claim Forms for Volunteers

Claim Forms for Volunteers

 

THIS PROCESS IS FOR VOLUNTEERS ONLY!

If you are an authorized Doña Ana County volunteer for the Fire Department or Sheriff’s Department please read the following directions below before clicking the links:

VFIS- Sheriff and Firefighter Volunteers Claim Form

VFIS- Sheriff and Firefighter Volunteers Claim Form

 

There are two things you need to do:

  1. Get medical treatment as needed. See directions below.
  2. Report the injury or illness. See directions below.

 

A. Getting Medical Treatment – Emergency v. Non-Emergency

  1. If the injury requires emergency care immediately call 911 or go to the nearest ER.
  2. Notify your supervisor. Your supervisor or his/her designee shall transport you to your first visit to the medical provider. (see options below), or to the nearest urgent care facility.
    1. Work Med

      Open: 8 a.m. – 5 p.m. Monday – Friday
      Located at: 2525 S. Telshor Blvd. Las Cruces, NM
      (575) 521-1919

    2. Any Urgent Care Facility
  3. Make sure that a drug and alcohol screening is conducted at the medical facility you are receiving treatment at. In the event the medical facility refuses the screening, it is your responsibility to make arrangements with WorkMed to have it done.
    1. Note: WorkMed is available on-call to complete the screening.

 

B. Reporting the Injury

  1. Your supervisor has been instructed to fill out a Notice of Accident on El Sol, which will inform Legal of your injury. 
  2. You are responsible for filling out the Claim Form.
  3. If you are a Sheriff’s Department volunteer click on the “Sheriff” link above.

    If you are a Fire Department volunteer click on the “Fire” link above

  4. You will need to fill out the claim form in its entirety and provide it to the Legal Department for processing.  You can fax it to (575) 525-5965, or hand-deliver it to a Legal representative.       
  5. It is your responsibility to get the claim form to Legal to be processed.  If you do not fill out the Claim Form we cannot process your claim with the insurance.
  6. If you have any questions or concerns contact the Legal Department at (575) 647-7225.