TSSAS Insurance Related Forms

Important Insurance Claim Information

USASA has changed Insurance providers starting September 1, 2011. K&K Insurance is the new provider. The old forms for Chartis/AIG are no longer in use. Please destroy them. You will find the new insurance forms in the table below.

After you download the form, you need to fill out all parts as indicated including Part B. The TSSAS office is NOT your local organization as it asks for in the instructions. That is your local league. The ONLY thing the TSSAS office is responsible for is to verify that the injured player is a registered member of TSSAS/USASA and sign the top of the first page. Send the completed forms to Frank Allcorn, TSSAS Registrar, for verification and he will submit them to USASA. Frank's contact information can be found on the left margin of this page.

Player Insurance Claim Form	This is the player insurance claim form to be completed by the player.		English
Claim Filing Instructions	This document gives you instructions on how to complete and file your insurance claim.		English
K&K Information on Player Insurance	This document provides and overview of the coverages provided by player insurance.		English/Spanish
Certificate of Insurance Request Form	Leagues can use this completable document to request a certificate of insurance from TSSAS.		English
Certificate of Insurance Request Form	Leagues can use this document to request a certificate of insurance from TSSAS.		English