To learn how to file a claim, follow this link for instructions in English:
Claim Instructions -English
To learn how to file a claim, follow this link for instructions in Spanish:
Claim Instruction - Spanish
Accident Claim Form (English):
Claim Form English
Accident Claim Form (Spanish):
Claim Form Spanish
Note: Claims must be filed within 90 days of the date of the accident.
pass fee includes accidental medical coverage up to $5000 which can be used in
addition to an existing medical coverage or without. Injuries occurring
directly from playing in the Central Indiana Amateur Soccer Association (CIASA)
are covered by this insurance (up to $5000).
forms can be found in www.ciasa.org main home page along with
further instructions. However, please note that there is a 2 months window from
the date & time of the accidental injury to make any claim.