SE District Risk Management Team
For help with filing an insurance claim, obtaining a certificate of insurance or if you have a question concerning any risk management issue, please contact Skip Williams your SE District Risk Manager.
To obtain an insurance claim form you need to contact your local association registrar to obtain the proper claim form. The claim form will have K&K Insurance and their address in Ft. Wayne, IN in the upper right hand corner. Please complete the claim form and have an association officer or coach sign off on the claim stating that the injury occurred during a USA Hockey sanctioned event. Once completed please return the claim form with all of the primary insurance carrier’s explanation of benefits (EOB’s) relating to the injury and any other requested information to K&K in Ft Wayne, IN. They will assign a claim number and begin processing your claim once the claim form is received. The participant accident coverage is for excess medical and you have just over one year to file your claim. More information about all of our insurance benefits that are provided to our USA Hockey membership is also on the USA Hockey website.
To obtain a certificate of insurance for ice usage please complete the Request for Certificate of Insurance form on the www.usahockey.com website under the About USAH tab-Insurance/Risk Management tab in the middle of the page. Submit this form with a copy of your unexecuted ice rental contract(s) to Skip Williams at email@example.com or fax it to 865-470-8756 for contract review and approval. These requests may take up to 30 days to process depending on the number of requests that are being submitted from all over the country.
Please report all serious injuries immediately to your local association and the SE District Risk Manager.
Have a fun and safe season! Skip
Risk Manager for Southeastern District
2421 Piney Grove Church Road
Knoxville, TN 37921-3765