Insurance

Field Insurance

2018 Year (Injuries occurring between January 1, 2018 – December 31, 2018)
USASA Accident Claim Form
Formulario de Reclamación por Accidente de USASA

USASA General Liability Summary
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 10K Policy Summary
USASA 25k Policy Summary

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 administrativeservices@calsouth.com.

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 administrativeservices@calsouth.com. Please forward us any specific language or facility requirements along with your Certificate of Insurance Request Form.

In order to initiate the Cal South Insurance Claim Process, please follow the steps below:

STEP ONE: Download and fill out the appropriate Insurance Claim Questionnaire:

2019-2020 season (Injuries occuring July 1, 2019 – June 30, 2020)
2019-2020 Youth Insurance Claim Form

2019-2020 Formulario de Reclamo de Seguro por Accidente

2018-2019 season (Injuries occurring between July 1, 2018 – June 30, 2019)
2018-2019 Youth Insurance Claim Form
2018-2019 Youth Insurance Claim Instructions

2018-2019 Formulario de Reclamo de Seguro por Accidente
2018-2019 Instrucciones del Formulario de Reclamo de Seguro por Accidente

Upon receipt and verification that this is for a Cal South Registered Player, and that the incident took place at a Sanctioned Cal South event, the Cal South Corporate Office will forward the necessary forms to initiate the official claims process.

STEP TWO: Complete and file the actual claim forms. Information on how to file is included on each form.

STEP THREE: Upon receipt of the forms by our insurance carrier, they will finalize the claims process and notify you accordingly. A valid Social Security Number, Visa, or Green Card is mandatory for the claim process to begin. We recommend you keep a copy of the paperwork you send to the TPA for claim filing.

Insurance Contacts

AIG
P.O. Box 25987
Shawnee Mission, KS 66225-5987
P: (800) 551-0824
F: (866) 893-8574