How to File an Insurance Claim
(on a soccer related injury)

The Insurance Claim Form:
[PDF] [DOC]

To receive a reimbursement on medical related expenses on a soccer injury under USASA/NCASA Participant Accident Policy with K&K Insurance ALL CLAIMANTS MUST FOLLOW THESE STEPS:

1.  Be registered with NCASA as a member of their local soccer association, having signed
    the registration form and their player pass.
2.  Suffer an injury during a NCASA sanctioned soccer related event with the local league.
3.  Have been medically treated for the soccer related injury and have reimbursable
    medical expenses.
4.  File a completed USASA Medical Reimbursement Injury Claim Form with NCASA having
     provided:
     a)      your name as it is printed on your player pass
     b)      current and accurate contact information, in the event of questions
     c)   the date of the injury
     d)      details on the accident that caused the injury
     e)      detailed description of the injury
   *All questions need to be answered on the form, but these require special attention.
5.  Send the completed USASA Medical Reimbursement Injury Claim Form with NCASA at
    PO Box 29308, Greensboro, NC 27429, along with any copies of your player pass (front
    and back) and any medical expense statements.  Do NOT send medical expense
    statements without the Claim Form or player pass.  Future medical expense statements
    will be sent directly to claims department of K&K Insurance Company.
6.  If ALL the information on the Claim Form is accurate and the player’s is a registered
    member of NCASA, then the Claim is validated by NCASA and sent to K&K Insurance
    Company for remittance on the claim.  A copy of the validated form is sent to the
    claimant for their records.
7.  If ANY information on the Claim Form is found to be missing, including one of these:
     a)   the date of the injury
     b)      details on the accident that caused the injury
     c)      detailed description of the injury
     Then the Claim will be held indefinitely until the information is provided.  K&K Insurance
     will not accept the Claim for remittance until the Claim Form is complete and accurate.
8.  K&K Insurance will send an acknowledgement to the claimant within 48 hours of having
    received the NCASA Validated Claim.  K&K Insurance will contact the claimant if
    additional information is needed.
9.  K&K Insurance ONLY acknowledges claim remittance to the claimant.  It does NOT
    make any acknowledgement to NCASA once the validate claim is forwarded from
    NCASA.

Notes:
NCASA does NOT communicate with medical offices on medical information.  Occasionally NCASA is called by medical office on billing questions.  All such inquiries are either referred to the player or K&K Insurance.