2021 Year (Injuries occurring between January 1, 2021 – December 31, 2021)
USASA Accident Claim Form
Formulario de Reclamación por Accidente de USASA
USASA 2021 General Liability Summary Updated 2021-05-21
Resumen del Seguro de Responsabilidad de USASA
USASA Accident Plan Limitations and Exclusions
Limitaciones y Exclusiones del Plan de Accidentes de USASA
Additional Accident Medical Expense Benefit Available for purchase by Adult Leagues
USASA 5k Policy Summary Updated 2021-05-27
USASA 25k Policy Summary Updated 2021-05-21
USASA 25k Player Insurance Coverage Request Updated 2021-05-27
What is the process for filing an SAI/PAI claim?
The process begins by completing the Adult First Report of Injury Form. The form can be downloaded below under Forms and Downloads. Once a completed form is received and verified by Cal South, the injured participant involvement will be sent to USASA-CHARTIS Claims Insurance for processing.
Is there a deadline and a limitation to filing an SAI/PAI insurance claim?
Yes, the first notice to the insurance carrier must be within 90 days of a covered accident. Excess benefits are paid after a $400.00 deductible is satisfied by the participant. Co-pays will count toward the deductible.
How do we obtain our general liability certificates of Insurance for our fields?
This is a tremendous Member Benefit provided by Cal South to our Member Leagues and teams as part of our insurance program. You can request your certificate by completing the Certificate of Insurance Request Form (See Forms and Downloads below). Complete this form and forward to firstname.lastname@example.org.
What if the facility requesting a Certificate of Insurance will not accept the standard certificate?
Please contact Cal South for assistance at 714-451-1500 or email at email@example.com. Please forward us any specific language or facility requirements along with your Certificate of Insurance Request Form.