US Adult Soccer Association

Adult Accident Insurance Forms

Updated Wednesday June 5, 2019 by Knoxville Metro Soccer League.

This is the link for adult insurance. Please read all of the directions before submitting

Do not delay submitting this claim form. This form must be received, with or without attachments, within 90 days from the date of the accident, or benefits may be denied due to untimely filing. We do not need medical bills in order to submit this form, just an incident report from the referee.

All players are covered if the Participant Accident Insurance (PAI) is selected by your state association or league for whatever option is chosen.  As soon as the player completes the player registration process in which they must sign the waiver, their coverage’s begin.

A player gets injured during a sanctioned USASA function and then fills out the current USASA Claim form. (The current USASA Claim Form can be found on the USASA web page).

 The form must then be sent to the State or league verification officer.  The verification officer must review the form for completeness and then signs and dates the form.

The completed and signed form is then forwarded on to the USASA office who again verifies completeness, logs the claim in and forwards it on for insurance processing.

DO NOT SEND FORMS DIRECT TO THE USASA NATIONAL OFFICE - until competed and verified through your state verification officer.