HOW TO FILE A SOCCER-RELATED INSURANCE CLAIM
The Louisiana Soccer Association (“LSA”) insurance plan is an excess medical plan. This means that benefits are provided only after all other insurance benefits are paid. These other insurance benefits may be through traditional insurance policy, the LaCHIP Plan (see link to the left) or by a HMO, PPO or other similar arrangement. Information about your primary coverage must be included on your Claim Form and all itemized bills must be submitted to your primary carrier first.
STEP 1 Claim Package Checklist
The Claims Package Checklist must be completed and signed. This Checklist shall be used by both the player submitting the Claim and by LSA to insure that all documentation has been completed and submitted to LSA. Please email the checklist, incident report and initial medical reports to email@example.com. Once all documents have been received and electronic claim form has been filled out your claim will be processed.
STEP 2 Incident Report
A player’s Coach, Assistant Coach or Team Manager who is unrelated to the player and who witnessed the incident during which the player received his/her injuries, MUST complete and submit an Incident Report.
STEP 3 Initial Medical Report
A report from the player’s physician and/or from the Hospital which treated the player’s Injuries must be submitted. The report MUST detail
Player’s Name, address and date of birth.
The date of the injury and date of the treatment provided.
An explanation or diagnosis of the injury or injuries suffered.
STEP 4 The Accident Medical Claim Form
Click on link below to complete ALL questions on the electronic Accident Medical Claim Form. Our insurance has switched to Players Health.
STEP 5 LSA Verification
LSA will verify the claim and all supporting documentation, then submit the claim to the Insurance Company. If the Claim Package is incomplete in any way, it cannot be processed and the claimant will be notified.
STEP 7 Insurance Company Acknowledgment
The Insurance Company will forward an acknowledgment form advising you of receipt of your claim. All future correspondence concerning your claim should be directed to the Insurance Company at the address and phone number listed on your acknowledgment. The insurance company may contact the injured player to request additional information after they receive Claim Package. Also, if any additional bills need to be submitted at a later date (after the initial submission of your claim) send them directly to the appropriate insurance company with the following information:
- Name of injured player
- Date of accident
- Name of state association – Louisiana Soccer Association