File your claim via fax or mail. Consider filing online for faster claims payment!Provide all dates of treatment related to injury on the lines below. Please fully complete the claim form for the Wellness Benefit. Please date and sign all required forms where indicated. Download a Claim Form. Choose your state of residence and select the appropriate form(s). This Directory lists over 2,700 funding sources that have given to cancer related programs in the recent past. This information is provided to help find the. Municipal League (TML) for various injury related insurance claims in FY23.