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Insurance

Youth Player Insurance

What to do when an injury occurs:

  1. Fill out and mail/fax/email the Accident Medical Claim Form to the state office within 30 days of the injury. Please provide the referee report (long form) if possible.
  2. The state office will verify that you are a registered player participating in a sanctioned event. Players electing to participate in non-sanctioned events are not covered by this policy.
  3. If approved the state office will send the claim form to the insurance company for processing.
  4. The injured player is then responsible for providing the insurance company with bills and requested information. The state office does not handle any bills or payments.

The Arkansas State Soccer Association's insurance provider:  Pullen Insurance

pdf icon  Explanation of coverage

Email form to: Gayle Smith

Fax: 501-835-2176

Mail:  ASSA, 1100 E. Kiehl Ave. Suite 3, Sherwood, AR 72120


Adult Soccer Insurance

What to do when an injury occurs:

  1. Fill out and mail/fax/email the Special Risk Accident Claim Form (below) to the state office within 30 days of the injury along with the referee report (long form) if possible.
  2. The state office will verify that you are a registered player participating in a sanctioned event. Players electing to participate in non-sanctioned events are not covered by this policy.
  3. The state office will send the insurance forms to the national office for approval. If approved, the national office will forward the claim to the insurance provider.

Hyperlink  Explanation of Insurance - English and Spanish

pdf icon  Special Risk Accident Claim Form - English

pdf icon  Special Risk Accident Claim Form - Spanish

Email form to: Gayle Smith

Fax: 501-835-2176

Mail:  ASSA, 1100 E. Kiehl Ave. Suite 3, Sherwood, AR 72120

 
 
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© 2013 Arkansas State Soccer Association
1100 East Kiehl Ave, Suite 3
Sherwood AR 72120
(501) 833-0550