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 Here is the information you need to file a claim with the USA Rugby insurance:

 

Step 1:      Print out the form at the bottom

Step 2:      Complete all information in Part A.  Do not leave any questions unanswered, as this will only delay the processing of your claim.

Step 3:      Sign and date the claim form (directly under Part A).  Be sure to read the statements directly above your signature to be sure you understand what you are authorizing.

Step 4:      Your claim form must be signed and dated by an authorized representative. An authorized representative includes a coach or referee who was present or witnessed the accident. PLEASE NOTE:  This section CONFIRMS you were injured at a Rugby event (club practice or game)

Step 5:      Mail or fax your FULLY completed, SIGNED claim form to Tara Salerno at Zurich American Insurance at fax 866-255-2962, or mail directly to the address listed below.

Step 6:      Zurich will contact USA Rugby to verify that you are a member and that you were a member at the time of your injury.

Step 7:      Zurich will assign a claim number for your claim.  They will notify you by mail with a Claim number.  PLEASE KEEP THIS INFORMATION AS YOU WILL NEED IT IF IT IS NECESSARY TO FOLLOW UP.

Step 8:      If you have PRIMARY INSURANCE, please keep copies of all EOB’s (Explanation of Benefits) you receive from your primary insurance carrier.  Zurich will need these to determine what has been paid and what they will need to pay.

Step 9:      Please forward all copies of medical treatment direct to Zurich.  Your adjuster will provide the appropriate mailing address or fax number. 

 

PLEASE DO NOT CALL USA RUGBY IF YOU HAVE QUESTIONS.  THEY WILL NOT BE ABLE TO ASSIST, AND WILL SIMPLY REFER YOU BACK TO ZURICH.

Zurich General Contact Information:

Zurich American Insurance Company

P.O. Box 968041

Schaumburg, IL  60196-8041

Telephone:  877-287-4805

Fax:  866-255-2962

REMEMBER:  Keep all correspondence you receive from Zurich.  This will have your CLAIM NUMBER which is how they identify you.

 

Form is here:

http://freeteams.net/files_public/4/4192/files/Player_Packet/2011_Rugby_Accident_Claim_Form_Zurich_(1).pdf

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