CSSA Certificate of Insurance Request Form Instructions
Please note that insurance now runs January - December (calendar year) so if you have not submitted your request for 2020, please do so as soon as is convenient. We ask that you do not wait until leagues are cleared to begin play, as we need appropriate time to process these requests.
Please fill out the COI Request Form completely and accurately. Please make sure email addresses for both Team Managers and Facility Owner are included.
Unless you are only going to play on one field, please enter ALL FIELDS in "Facility Name," so you will be covered for all fields in that Town.
If there are several teams that play on the same fields, one COI can be issued for all teams, so, please group all teams to make things easier for everyone.
Email a copy of the form to the COI Coordinator Julia Connor. Her email address is CSSASecGen@gmail.com and is listed at the top of the form.
Do NOT send the form to the U.S.A.S.A.
Normal processing time for a COI is 7-14 days. PLEASE PLAN ACCORDINGLY AND SUBMIT WELL IN ADVANCE.
Expedited service (usually completed within 48-72 hours) is available for a processing fee of $50, in check form, payable to "CSSA, Inc." and mailed to:
CSSA procedure for filing an insurance claim for an injury
*** CLAIMS ARE DUE TO USASA 90 DAYS FROM DATE OF ACCIDENT ***
THEREFORE, SUBMIT YOUR CLAIM TO CSSA AT LEAST 60 DAYS FROM DATE OF ACCIDENT.
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:
Player fills out the form completely (with help from his team manager/coach, if needed), except section 8. Player signs the form on page
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.
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 report).
League verification officer signs off and sends the claim form to the USASA verification officer for the CSSA for final sign-off.
CSSA then sends the completed claim form to USASA's insurance company.
*** CLAIMS RECEIVED AFTER 90 DAYS MAY NOT BE HONORED BY USASA ***