WHAT TO DO WHEN YOUR CHILD IS INJURED

Accident coverage is automatically provided to registered members of the Florida Youth Soccer Association as part of the registration fee. The Accident policy provides coverage for registered players during sanctioned events, including regularly scheduled practices and games. This coverage is excess above the player’s own family health insurance. If there is no family health coverage, then FYSA’s coverage is primary. There is a $350 deductible on each claim. You are responsible for the first $350 of bills submitted, whether or not you have other insurance. If you have primary health coverage, and after the $350 deductible is met, FYSA’s policy will work in conjunction with your policy.

1. If a member is injured during a sanctioned activity, obtain medical attention as needed.
2. Complete the Youth Soccer Case Report (claim form), which is obtained from your District Commissioner, coach , Club Vice President or by downloading the Adobe PDF Form. (Use Adobe Acrobat Reader to display and print the form - available free using link at the bottom of the page) The form must be signed by the Coach, District Commissioner and parent or legal guardian.
3. The correct form is numbered LC-34 (8/97) or (9/99)

The fully completed, signed claim form must be returned to M. E. Wilson Company, Inc. for processing.
Be sure to include any itemized doctor bills as well as all Explanation of Benefits that you receive from your primary insurance carrier.

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What keeps K&K Insurance Company from paying your claim?
Incomplete or unsigned claim forms
"Balance forward statements" from the Healthcare providers rather than Itemized Billings.
Failure to provide your insurance company’s explanation of benefits.


PLEASE REMEMBER
You are responsible for the first $350 of your claim.
If you have any questions about reported claims, completing the claim form, or need additional copies of the claim form, feel free to call the FYSA Claims Department at M. E. Wilson Company, Inc.
1-888-229-8021

Club Procedures when an injury occurrs