INCIDENT & INSURANCE

 HOW TO FILE A MEDICAL INSURANCE CLAIM 

YOUTH    $ 250 deductible per claim     Youth Instructions & Procedures

ADULT     $ 400 deductible per claim     Adult Instructions Claim- (English)    (Adult Claim- Espanol)

Print out the attached.   Make a copy of pages 1-3 and give to injured person.  They should complete these pages and return to Jade Beaulieu (information below), state verification officer, at the Georgia Soccer office.  Social security number (box 4) is not required but the rest of the form should be completed in its entirety.  Adult claims are not processed until player information is received and verified by the state.  After information is verified, it is electronically submitted to the AIG claim department.  Injured party will receive written notification from AIG within 7-10 business days. 

All other information is enclosed.

LIABILITY INSURANCE

YOUTH AND ADULT:

 Certificates of liability insurance are provided,  upon request, for obtaining proof of liability insurance.  These requests should be made by contacting Jade Beaulieu (information below) directly.  They are issued per location and the following information is required:

Name and address of location being used, where field is located:
                ie-  Atlanta Park, 123 Main Street, Atlanta, GA 30000

 Name, address and contact information for owner of property where field is located:

ie:  Atlanta Park & Recreation Authority, 456 Work Street, Atlanta, GA 30001                   Mark Smith, Park Director, 770-789-1001  Fax

Adults Only:  Name and address of league and teams using requested location.  

Director and Officer Liability Insurance Information  

WHO IS OUR PROVIDER:

Youth
Bollinger Sports
101 JFK Parkway
PO Box 390
Short Hills, NJ 07078
General Toll-free number: 1-800-350-8005
Sports Claims Toll-free number: 1-866-267-0093
Sharon Davino, Assistance VP, Extension 8278
Bollinger Soccer  

 Adult
AIG Claim Services
A&H Claims Department
PO Box 25987
Shawnee Mission, KS 66225

General Toll-free number: 1-800-551-0824
Sports Claims Toll-free number: 1-866-642-5246
Angelica Cruz-Forero, Extension 1983.  Direct Number 678-240-1983 

 
WHO IS GEORGIA SOCCER CONTACT: