Insurance Form for injuries - see article below for details
Fields:
Field Work Order - to alert the league to work that needs to be done at Bear Creek, like branches hanging over the field, nets that need repairing, etc. Email the form to hfa@hfasoccer.com
Insurance Filing
HFA, through its affiliation with the U.S. Adult Soccer Association (USASA), maintains limited insurance coverage against soccer-related injuries for all players who are registered with the league. This insurance is intended to be supplemental to primary health insurance as the limits of coverage are quite low.
Coverage is not guaranteed and claims must be submitted within 90 days of injury date.
In the unfortunate event of an injury at an HFA game, practice or scrimmage, the team representative or injured player should follow the following procedures:
1. There is no pre-approval process - go ahead and get treatment and pay the bills as they come in.
4. The injured player should complete the form, get a signature from the coach, manager or referee present at the time of the accident/injury (the signature is to appear on Part B, line 8 of the claim form), sign and date the form, attach any available bills, and submit via regular mail to the State Administrator at 10104 Murmuring Creek Drive Austin, TX 78736. Fill everything out - he'll just return it to you if there are any blanks.
5. Upon receipt of each claim form, the State Administrator will verify the player’s registration, then mail the original form to the insurance company.
6. From this point on, the state and league association’s (TSSAS and HFA) involvement in the process will end. The injured player will deal directly with the insurance company. The insurance company’s claim examiner, upon determination of a viable claim, will notify the injured player where to send all applicable bills and to whom all player and physician inquiries are to be directed. AFTER you receive your acknowledgement letter, you may contact K&K Insurance Group, Inc./Specialty Benefits at 1-800-237-2917, Option 1, if you have any questions about your claim.
Please contact the HFA league office with any questions about this process: hfa@hfasoccer.com or 713-984-7658
