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Accident insurance claim form (English)
Accident insurance coverages information (English)
Accident insurance claim form (Espanol)
Accident insurance coverages information (Espanol)

Medical Insurance Claims - Accidents
FSSA

Medical Insurance Claims - Accidents

 If a duly and correctly registered player suffers an injury during a game or regular team practice, the player is eligible for USASA’s player insurance according to the insurance policy.  If an injury occurs during a game be sure that the referee notes it in the report.

 For the insurance claim to be verified the following must be received in the FSSA office:

 a)      Completed and signed insurance claim form

 b)      Copy of receipts or invoices if any

 c)      Referee report if injury occurred during game or signed manager’s report if it occurred during practice

 d)      Copy (back and front) of player’s current season pass

 2)     Once the above information is received in the FSSA office the player’s registration is verified and the forms are sent to the insurance company.  This takes about a week.  Claims sent directly to the insurance company will be returned to the FSSA office.  This will delay your claim.

  3)     Once the insurance company receives the claim it takes up to two weeks for them to process the claim.  At that time they will be in touch with the player via mail about coverage or additional information they may need as well as a phone number for the player to call if he/she has questions.

 4)     Insurance claims should be filed within 45 days of the injury.

 5)     Expect it to take at least 3 weeks before you hear from the insurance company about the claim.

 

 

Medical Insurance Claims - Accidents
BASL

Please note the Insurance Program is run by Florida State Soccer Association.  That is where you you should direct any questions.  Go to http://fssa.org for updated forms and information.

The only thing the league provides is the game report.  Please have your captain or field marshal sign the report.

For the game report.  Please send description of injury, game and date.  We will send you a copy of the report.


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