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 Volunteers Claim Form Provident-Volunteer Firefighters Claim Form

VFIS- Sheriff Volunteers Claim Form

Provident-Volunteer Firefighters 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. Otherwise call Company Nurse at (575) 647-7234.  Company Nurse is available 24 hours a day, seven days a week.
    1. Select option #1 to speak with a triage nurse and provide him/her the code “NMDAC”.
  3. If Company Nurse refers you to a medical provider for treatment, have your supervisor transport you to the nearest 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. Foothills Medical Center

      Open 8 a.m. – 8 p.m. Monday – Friday and 8 a.m. – 5 p.m. on Saturday
      3530 Foothills Rd. Las Cruces, NM
      (575) 526-6054

    3. Any Urgent Care Facility
  4. 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.