Youth Soccer Accident Medical Claims
The online claims submission program is for accident dates on or after September 1, 2012. If the accident date occurred before this date, DO NOT PROCEED WITH THE ONLINE SUBMISSION OF THE CLAIM; instead, you should contact California Youth Soccer Association for the appropriate claim form.
Online Claims Submission Process
1) The authorized team official should complete the online claim form on this website. A confirmation email will be sent to you upon completion.
2) The claims information will be sent to your state soccer association for approval or denial. Once approved, the parent will receive an email with the claim form as a PDF attachment. The parents will need to send the claim form to the insurer, Mutual of Omaha, with the itemized medical provider bills and explanation of benefits (EOB) from the claimants primary insurance carrier (if applicable). If the claim was denied by the state soccer association, the parent will receive an email indicating the reason for the denial.
3) Additional bills and EOBs can be submitted by the claimant at a later date (after the initial submission of the claim form) to Mutual of Omaha. The claim form will have insurers contact information on it.