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Metropolitan DC-Virginia Soccer Association Soccer: Fun, Fitness, and Friends -- for Life

How to file an Insurance Claim

2026 Medical Insurance Coverage

 The MDCVSA currently provides Player Participant Accident, PAI (secondary coverage) to leagues that purchase it. Participant Accident Insurance generally covers medical expenses (within limits) for injuries sustained during sanctioned amateur soccer activities. Participant Accident Insurance is secondary coverage to a member's primary insurance. If no primary insurance exists, then this becomes their primary insurance coverage.
 
**IMPORTANT**
*Please follow the directions on the claim form carefully, in order for it to be processed correctly**
The Insurance carrier asks that the claim be filed as soon as possible from the date of the incident, (ideally within 30 days) but no later than 90 days after the accident occurred.

STEPS TO FILE A CLAIM ARE BELOW:
1) Part 1 of the claim form will need to be completed by the claimant ( injured player) which gathers basic information on the injury.
2) Please scan and email and send to the State Administrator, Mary Beth Falk, at:
MDCVSA State Administrator signs the claim form confirming the player is properly registered and was injured during a sanctioned MDCVSA activity, and emails back to the player. 
3) Part II and III are completed by the claimant (injured player)
4) Once completed player can mail, email, or fax the form directly to HSR, details below:
MAIL
Health Special Risk, Inc.
8400 Belleview Drive, Suite 150
Plano, Texas 75024

EMAIL
[email protected]

FAX
(972) 512-5820

If you have any questions, please contact Customer Service at (866) 523-3199.
They are available from 
8:00 a.m. to 5:00 p.m. Central time, Monday – Friday. Phone: (218) 382-7151




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