1. Be registered with CSSA as a member of their local soccer association.
2. Suffer an injury during a CSSA sanctioned soccer related event with the local league.
3. Have been medically treated for the soccer related injury and have reimbursable medical expenses.
4. File a completed USASA Medical Reimbursement Injury Claim Form with CSSA having provided:
   1. Your name as it is printed on your player pass
   2. Ccurrent and accurate contact information, in the event of questions
   3. The date of the injury
   4. Details on the accident that caused the injury
   5. Detailed description of the injury

   All questions need to be answered on the form, but these require special attention.

5. Claim Forms can be obtained by download, as above,
   or by email request.


6. Send the completed USASA Medical Reimbursement Injury Claim Form with to CSSA at:
   11 Executive Dr. Farmington, CT 06032,along with any copies of your player pass (front and back) and any medical expense statements. Do not send medical expense statements without the Claim Form or player pass. Future medical expense statements will be sent directly to claims department of K&K Insurance Company.
7. If ALL the information on the Claim Form is accurate and the player’s is a registered member of CSSA, then the Claim is validated by CSSA and sent to K&K Insurance Company for remittance on the claim.
   A copy of the validated form is sent to the claimant for their records.
8. If any information on the Claim Form is found to be missing, including one of these:
   1. The date of the injury
   2. The details on the accident that caused the injury
   3. The detailed description of the injury

   then the Claim will be held indefinitely until the information is provided. K&K Insurance will not accept the Claim for remittance until the Claim Form is complete and accurate.

9. K&K Insurance will send an acknowledgement to the claimant within 48 hours of having received the CSSA Validated Claim,
   K&K Insurance will contact the claimant if additional information is needed.

10. K&K Insurance only acknowledges claim remittance to the claimant.
    It does not make any acknowledgement to CSSA once the validate claim is forwarded from CSSA.

Notes:

CSSA does not communicate with medical offices on medical information. Occasionally CSSA is called by medical office on billing questions. All such inquiries are either referred to the player or K&K Insurance.

CSSA does not keep any medical expenses statements on file once the Claim Form has been validated and forwarded toK&K Insurance. Future medical expense statements will be sent directly to claims department of K&K Insurance Company.