|1. Player downloads
the USASA Claim Form (in English or Spanish, links below) from the CSSA Website, AND
NOWHERE ELSE. Please note that the form is a PDF file
and you will need Adobe Reader (a free download from Adobe.com
-- look under 'Download') to open and/or print the file:
For your convenience, these links below are DIRECTLY from the USASA insurance documents Website
Player Accident Claim Form (English)
Player Accident Claim Form (Español)
|2. Player fills
out the form completely (with help from his team manager/coach, if needed), except section 8. Player signs the
form on page 2.
|3. Player then
sends the form to his team manager/coach for sign-off. Please make sure that the application form is complete and
player’s pass number is added (ADD the player's pass number to Part B.1 , after you fill in Team Name.
|4. Team manager/coach
signs off and mails the form to the "league verification officer" to have the league verify that the
injury is reported in the official USSF match report (referee's report), if applicable. If needed, the league can
ask it's assignor or the referee directly to amend the report to include details of the injury (file a supplemental
|5. League verification
officer signs off and sends the claim form to the USASA verification officer, Marco Viola of CSSA, for final
|6. CSSA then
sends the completed claim form to USASA's insurance company.
|Please go to the USASA Insurance Overview Website
for insurance plan summary information.