Claim & Other Information

Terms and Conditions

LIABILITY INSURANCE


Some may wonder why we have insurance at all. Mainly we protect the facilities we use with liability insurance. Most Cities, parks departments, school districts or other locations that allow athletic play require some sort of liability insurance coverage for the participants that use the facilities. The United State Adult Soccer Association (USASA) furnishes that insurance at a reduced rate to member leagues and their teams. Only affiliated leagues and teams with USASA through the Idaho State Soccer Association (ISSA) are covered.

So when you play you now know that there is a Five Million Dollar Liability insurance policy in place to help protect the facility you are using, to help protect the league, and to help protect you the player. 

Coverage Definition: Commercial General Liability-Provides coverage for legal liability imposed by law up to the policy limits. The liability must stem from bodily injury to members of the public or damage to their property, caused by the occurrence. The company will defend you, even if the allegations of the suit are groundless, false, or fraudulent. Suits brought by athletic participants are also covered but player claims are excluded. 

 
 MEDICAL / ACCIDENT INSURANCE (PAI)


So why do we have Accident/Excess Medical Coverage insurance? The reason we have a form of Accidental/Excess Medical insurance is because our liability insurance carrier requires that we have some other coverage to help lower the liability; which in turn reduces the liability insurance rate. This requirement also helps those participants that do not have insurance by providing some minimal coverage and it becomes a secondary insurance for those that do have insurance. 

The Accidental Medical insurance coverage is very inexpensive and you get what you pay for as with anything else. This is a token bare bones schedule benefit plan which means, that it pays certain predetermined amounts for certain identified procedures or expenses attributed to the claimed injury. So don't expect to get all your medical bills paid in full by this insurance coverage. Idaho does have several claims paid out annually for participants which indicates that for some of you this is an added benefit.  

Coverage Benefits: Benefit period is 52 weeks. Eligibility includes all registered participants. Maximum medical benefit pre claim is $5,000.00 and there is a $400.00 deductible per claim. You must file a claim with-in 90 days of the accident or incident by submitting a completed claim form to the state verification officer. A pre-existing condition must be treatment free for six months before it is considered a "new" injury. Any chronic, pre-existing condition for which treatment has been recommended or received six months prior to the effective date of enrollments is covered to a maximum of $1,000.00. 

NEW: for 2012 you can upgrade your insurance to $25,000.00 Maximum Benefit Plan as long as the whole league upgrades.  The cost is an extra $5.00 per person.  There are some other requirements so contact Paul Scherer, President at archer831@aol.com.

 
QUESTIONS AND ANSWERS ABOUT
THE ACCIDENT INSURANCE AND THE CLAIM FILING PROCESS
 

1. If I get injured playing soccer how do I file a claim?
To file a claim you need a claim form filled out completely and sent in to the 
ISSA post office box indicated on the form so they can verify that you are a 
registered player in an affiliated league in the state. You must use an original 
USASA claim form. 

2. What should I send with the claim form?
Try to send at least one bill so that it will start the process and be set up as a
working claim. Please double check and make sure the claim form is completely 
filled out.

3. Should I use ISSA as my insurance company for the medical providers I see such as the Doctor of hospital?
No!  ISSA is not the insurance company and to have your bills sent directly to
that post office box could hold up payment of you bills. With the claim form
send one bill and ISSA will forward it to the administrator of the insurance for
United States Adult Soccer Association.

4. How soon after I send in the form and a bill should I expect to be contacted?
You will be contacted as the claimant within 48 hours of receipt of the information to claim processor if you have provided a phone number and the correct address for them to contact you. The Claim will be processed with-in 2 weeks of receipt if you have followed the process and the claim form is complete and there is a bill to go with it so they can open a working claim. ISSA usually sends claim forms and bills forward on the same day mail is picked up at the post office.

5. What do I get as acknowledgement from the insurance company?
Within two weeks of the claims examiner receiving the claim form and one bill you will be sent an acknowledgement letter with a description of benefits. Once the person has received this information they then forward all bills directly to the claims adminstrator at the address provided. The best way to get bills to the Insurance carrier after the initial form and bill is to deal directly with your claims examiner after you have a working claim established.

6. Who should I deal with about my claim?
If you have sent in the completed USASA claim form along with a bill to the ISSA post office box so they can verify that you are a registered player from that point forward you will deal directly with the claims examiner from the insurance provider. You will receive correspondence instructing you where to send the remaining bills and an explanation of your benefits as well as names and numbers of people you can contact if you have questions or concerns about your claim and a claim number you can use as a reference when contacting them.

7. Is the soccer insurance secondary insurance?
Yes. So when you go to the hospital or doctor you should give your own insurance as the primary insurance and the soccer insurance as secondary insurance. If you do not have any other type of insurance then the soccer insurance does become your primary insurance.

8. Should I contact the insurance company right when I get injured?
No. There is no need to contact the insurance company until you establish a working claim. To establish a working claim you need to fill out an official claim form and send it along with one bill to ISSA so they can verify that you are a registered player. ISSA then forwards the information on to the Insurance carrier who then starts a working claim. Part of that process includes contacting you with claim information, a benefit summary and a contact person and address so you can send further bills directly to your claims examiner. 

9. Do I need to contact ISSA about my claim?
No. ISSA is not the insurance company and does not get information about your individual claim. It is best to contact your claims examiner after you have a working claim established for all your claim questions.
 
10. Is there a time limit to file a claim?
Yes. You have 90 days from the date of the accident to file a claim. 

 11. Where can I find a claim form?
Claim forms are distributed to your leagues and are usually kept at the place where you register. Some leagues distribute them to the team captains or team managers. If for some reason you cannot obtain a claim form from you league you can request one from ISSA. Just send a self addressed stamped envelope to:
ISSA
P. O. Box 190069
Boise, ID 83709 

 



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