*Participant is recommended to/ visits medical facility*Participant misses school/ work*Any helmet damage or potential brain injury*Any fractures, broken bones or lacerations requiring stitches
Information regarding Colorado League Insurance Overview and FAQ’s are HERE: https://docs.google.com/document/d/1rgbXDryEsrdRJgZo56ti2T4jFZp7rD1WT0zzLoS-mbc/edit?usp=sharing
IMPORTANT: You must fill out, sign, this form: http://agadministrators.com/wp-content/uploads/2014/07/Participant-Accident-Claim-Form-Special-Risk.pdf.
List the "Team Name" - Colorado League as the the Special Risk Organization at the top.
The Head Coach/Team Director signs the bottom as the Special Risk Organization if it was an injury during a practice.
If it was an injury during a race email, it to firstname.lastname@example.org to sign before sending to the following email addresses:
Email the form to ALL of the following:email@example.com info@UBInsurance.firstname.lastname@example.org
OR Send via FAX to ATTN: UBI Claims Department: info@UBInsurance.com or fax (801) 562-6388.
Please attend to this ASAP. Customer support for the insurance carrier 610.933.0800.
Here is a link with information on how to file a claim: http://agadministrators.com/services/how-to-file-a-claim/
The Accident Medical policy is excess over any other available insurance in regard to the injury. This policy will help cover reasonable and customary out of pocket medical expenses related to the injury such as deductibles and co-payments. The policy has an excess accident medical limit of $25,000 with a $250 deductible. The policy has a benefit period of 1 year from the date of the accident.