This form should be filled out immediately when an incident or injury occurs that results in the following at a Practice or a Race:
* Referral or visit a medical facility
* Unable to complete or attend team practices, train or race
* Unable to attend school or work
* Unconsciousness or potential brain injury
* More than minor first aid is performed
This report form is required even if you do not intend to file a claim.
This ensures that if an injury results in further care beyond the initial assessment the report is complete to accompany a potential future claim.
Information regarding Colorado League Insurance Overview and FAQ’s are HERE: http://bit.ly/COmtbInsuranceFAQs
Written notice of incidents must be submitted within 30 days after the incident. Treatment must begin 30 days from the date of the injury. Benefits are payable 104 weeks from the date of an injury.
Upon signing the Liability Waiver, participants agreed to be fully responsible for their own medical expenses. The League understands that accidents can happen, and it is not the fault of anyone. The League has purchased an excess accident medical policy that can help pay for eligible medical expenses that are in excess of expenses payable by any other available insurance in regard to the injury.
Colorado League participants (including coaches, students, staff and volunteers) are eligible to submit claims that are over and above what your own medical insurance covers, up to a limit of $25,000, with a $1,000 deductible.
* $1,000 Deductible
* $500 Dental Maximum
* $25,000 per person
* 52 weeks Benefit Period
* Accidental Death/Dismemberment: $10,000
If you intend to file an accident medical claim with the League’s insurance, you must:
1. Log into the Players Health insurance claim report system:http://bit.ly/COmtbInsurancClaim
* List the "Team Name" and the Colorado League
Notice of incidents must be submitted within 30 days after the incident.