The Employer Claim Form is to be completed by your benefit coordinator, who will complete the employer section of the form and return it to you. This form must be completed by the benefit coordinator or your HR representative. This form cannot be completed by your direct manager or supervisor. Please include your job description with this form. The original form must be signed by your benefit coordinator or HR representative and faxed or mailed to TIPP Customer Care (fax number and address are shown on the form).