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| Instructions: |
1. Player downloads the USASA Claim Form (in English or Spanish,
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 here) to open and/or print the file:
USASA Claim Form in English
USASA
Claim Form in Spanish
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 report).
5. League verification officer signs off and sends the claim form to the USASA verification officer, Marco Viola of CSSA, for final sign-off.
6. CSSA then sends the completed claim form to USASA's insurance company. |
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