Trauma Counseling Claim Form

Before submitting your Inquiry Form to determine if you are eligible to receive Trauma Counseling, please verify the following:
• The incident occurred within the past year,
• It’s a covered incident,
• And you’re an active, dues-paying member of PEF.

If you qualify, please submit the inquiry form below. After an inquiry has been submitted, you will be contacted within 48 hours with a request for additional documentation or to connect you with a counselor. Contact may be delayed if your request was submitted on a Saturday, Sunday, or U.S. observed holiday.

Like any incident-based insurance coverage, verification that the incident took place will be required, which can come in the form of a police report, a workplace incident, report, or a union report.

We will contact you within 48 hours to discuss your inquiry which may be delayed if you’re request was submitted on a Saturday, Sunday, or a U.S. observed holiday. If you are experiencing a mental health crisis and having thoughts of hurting yourself, you should call the Suicide Prevention Lifeline at 1 (800) 273-8255 or 911. You can learn more about the Suicide Prevention Lifeline at suicidepreventionlifeline.org.

I am submitting information that is true and accurate and understand that any information entered that subsequently is found to be false may result in termination of any service and that I will be personally, financially liable for services. Further, I give my consent for the counseling provider to verify the information I’ve submitted and consent to the release by any person, organization, or other entity of such information to the counseling provider.