Player Injury Section
Insurance Claim Information
STEP 1: The Head Coach must complete the following:
1. Fill out an INJURY REPORT
2. Make and retain a copy of all documents for your records.
3. Forward the completed Injury Report to the parents.
2. Make and retain a copy of all documents for your records.
3. Forward the completed Injury Report to the parents.
STEP 2: The Parents must complete the following:
1. Complete the EXCESS MEDICAL INSURANCE CLAIM FORM
2. Attach current itemized physicians, hospital or other provider's bills for accident medical expense being claimed as well as the primary carrier's Explanation of Benefits showing payment and denials. These bills must show the patient's name, condition being treated (diagnosis), type of treatment given, date of the expense was incurred and the changes made.
3. Claim forms will be returned if not fully completed and signed. Omission of vital information will cause a delay in claim processing.
4. Make and return a copy of all documents for your records.
5. Send all documents (Including the competed Injury Report that you received from the Head Coach) to:
2. Attach current itemized physicians, hospital or other provider's bills for accident medical expense being claimed as well as the primary carrier's Explanation of Benefits showing payment and denials. These bills must show the patient's name, condition being treated (diagnosis), type of treatment given, date of the expense was incurred and the changes made.
3. Claim forms will be returned if not fully completed and signed. Omission of vital information will cause a delay in claim processing.
4. Make and return a copy of all documents for your records.
5. Send all documents (Including the competed Injury Report that you received from the Head Coach) to:
K&K Insurance Group, Inc./Specialty Benefits, Inc.
AYF/AYC Claim Administrator
P.O. Box 2338
Fort Wayne, IN 46801-2338
Phone: 800-237-2917
Fax 312-381-9077
Email: KK.PAClaims@kandkinsurance.com
AYF/AYC Claim Administrator
P.O. Box 2338
Fort Wayne, IN 46801-2338
Phone: 800-237-2917
Fax 312-381-9077
Email: KK.PAClaims@kandkinsurance.com
For more information or with help on making a claim contact:
Dean Lefebvre
Phone: 906-396-2186
Email: dalefebvre@charter.net
Dean Lefebvre
Phone: 906-396-2186
Email: dalefebvre@charter.net