MY CHILD HAS BEEN INJURED PLAYING SOCCER AT PRACTICE (OR A GAME), WHAT DO I DO?
SEEK MEDICAL ATTENTION!
All MSA players, coaches, assistant coaches and other rostered individuals are covered by PULLEN INSURANCE SERVICES. If you have other insurance, submit your itemized bills to the other carrier first. You will receive a payment EXPLANATION OF BENEFIT Worksheet (EOB) from your other carrier.
There is a $500 deductible per covered accident for the 9/1/12 - 9/1/13 policy year. Each claim is also subject to the application of an 80/20 co-insurance provision with a $50 physical therapy/chiropractic limit per visit/$2,000 total maximum.
DO NOT wait until your other carrier has processed all your bills before filing aYouth Soccer Accident Claim Form
All the REQUIRED forms are provided in the link below.
CLICK HERE FOR PULLEN INSURANCE FORMS
FILE THIS NEW REPORT OF CLAIM WITHIN 30 DYAS OF THE DATE OF ACCIDENT OR AS SOON THEREAFTER AS IS REASONABLY POSSIBLE!
PLEASE NOTE - THE FOLLOWING MUST BE PROVIDED
1) A copy of the team roster signed by the Member Association / League Registrar
2) A separate written statement from your coach, assistant coach, or team manager, if the injury occurred during a scheduled practice or game
Mail all completed forms to:
NORTH TEXAS STATE SOCCER ASSOCIATION
1740 S. I-35, SUITE 105
CARROLLTON, TEXAS 75006