FRSA Self Insurers Fund is now BrightFund

Claims Forms & Documents

Downloadable Documents

Notice of Injury

Download

Treatment Authorization Letter (Employer)

Download

Refusal of Medical Treatment or Observation

Download

Refusal of Medical Treatment or Observation (Español)

Download

Generic - Light Duty Offer Letter (Employer)

Download

Detailed - Light Duty Offer Letter (Employer)

Download

Notice of Injury Procedures for policy manual

Download

USIS Claims Services

For direct contact with the USIS Claims team, please call the number below or reach out
directly to your trusted representative.

Phone

Fax

  • 407-352-5788

Address

  • P.O. Box 616648
    Orlando, FL 32861-6648

Sondra Eid

Claims Supervisor
407-373-6550

Purdita Persaud

Claims Manager
407-373-6315

April Saffold

Claims Adjuster
407-373-6385

Jen Rodriguez

Claims Adjuster
407-373-6388