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U.S.C.S Insurance Claim
  How To

GO TO WWW.USCLUBSOCCER.ORG

UNDER RESOURCES CLICK ON INSURANCE

UNDER CLAIMS USE APPROPRIATE FORM

COMPLETE FORM

FORM TO BE COMPLETED BY CLAIMANT, PARENT OR GUARDIAN

COACH MUST ALSO COMPLETE INS CLAIM VERIFICATION

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To file an accident insurance claim, complete the applicable form and follow the instructions below:

Youth Claim Form

Adult Claim Form (for members registered through May 31, 2015)

Adult Claim Form (for members registered on or after June 1, 2015)

The claimant/parent is to send the completed claim form to US Club Soccer for verification. DO NOT send itemized bills or EOBs to US Club Soccer.

Send via email to: insurancequestions@usclubsoccer.org, or Send via postal mail to: Insurance Claims | US Club Soccer | 716 8th Ave. N. | Myrtle Beach, S.C. 29577

In addition, the team coach, manager or other passcarded staff member present at the time of the injury is to complete and submit an Insurance Claim Verification (#R011)
form when a parent submits a medical/dental claim for one of his or her players. This information provides verification of the player’s injury prior to submitting the claim to the
insurance company for review. Once these two documents have been received, verified and signed by US Club Soccer,
US Club Soccer will email the claimant a signed copy of the claim form along with instructions to submit the itemized bills and EOBs for claim processing.
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