Vermont State Employees` Association

PRINT A CLAIM FORM

Please fax all claim forms to: 877-485-3374

For employee's who have the Short Term Disability policy

If you are disabled due to an off the job injury .... Click Here

(on the job injuries are not covered under this policy)

If you are disabled due to a sickness..... Click Here

(including pregnancy)

For a Continuing Disability Claim Form ....Click Here

For employee's who have the Accident Policy

If you have had an off or on the job injury.... Click Here

(This is not a disability policy)

If you are filing for the Accident Wellness ......Click Here

For employee's who have the Cancer Policy

If you have a cancer claim ...Click here

If you are filing a Cancer Wellness Benefit ...Click Here

Fax this form directly to the provider along with your receipt for any cancer screening that was done.

For employee's who have the Colonial Disability Policy

If you have a disability claim.....click here

Please fax all claim forms to:

877-485-3374