** On September 1, 2021 MSYSA switched to a new insurance provider. Any injury claims for injuries received up to August 31, 2021 should be submitted to K&K Insurance (link below). Injury claims for injuries received from September 1, 2021 should be submitted to A-G Administrators, LLC (link below) **
Insurance Claim Checklist
- Claimant must be registered at time the injury took place
- Claimant’s injury must have taken place on an insured field location.
- The initial report of the injury must be received by MSYSA via e-mail within 7 days of injury by the player’s CLUB or LEAGUE (not the
parent/guardian of the injured person).Injuries should be reported by the club before a claim is filed by the injured party. Injury reports should be emailed to: Julie Pearson at firstname.lastname@example.org Injury reports should include:
(a) Injured player/officials first/last name.
(b) Injured player/officials date of birth.
(c) Nature of injury (e.g.: suspected broken wright wrist).
(d) Date of injury.
(e) How it happened (e.g.: during a league game player collided with an opposing player resulting in a suspected concussion. Player was taken to emergency).
- Claim form must be submitted and received by MSYSA State Office for verification no later than 30 days from date of injury
- $500 deductible applies for all eligible claim
- Include a copy of Permission to Travel approval (if injury took place outside Michigan)
All injuries from MSYSA or US Youth Soccer activities must be reported, in writing, to both the member organization and MSYSA via e-mail within 7 days. All claims are required to first be made through member’s primary insurance carrier prior to being submitted to MSYSA. The Michigan State Youth Soccer Association excess accident medical insurance policy is secondary insurance. Failure to follow the rules of your primary healthcare coverage will result in a benefit reduction of eligible expenses to 50% of the amount otherwise paid. Any claims not submitted to MSYSA within 30 days will be denied. Once a claim has been approved by MSYSA, the insurance provider A-G will review the claim within 24-48 hours.
** NOTE: For players that reside in Canada but participate in Michigan, MSYSA accident medical coverage is extended for care in the State of Michigan only.
For insurance claims or to report an injury, email email@example.com
Field Insurance / Certificate of Insurance (COIs)
To request for an insurance certificate click here
For more information, see the FAQs
Indoor protection, as a result of indoor participation, is now provided if:
- An MSYSA affiliated league (where players are already registered with MSYSA affiliated teams), in writing to MSYSA (via email to Tom Faro at firstname.lastname@example.org), sanctions or endorses indoor soccer participation/activities (e.g., practice, scrimmages, matches, training, futsal, etc.).
- An MSYSA affiliated league hosts or coordinates indoor practices, scrimmages, matches, training, futsal, etc.
- MSYSA affiliated leagues must request insurance certificates (COI’s) online from www.michiganyouthsoccer.org in advance of player and/or team indoor soccer participation/activities.
- Coaches, Assistant Coaches, Team Managers, and other Team Officials must be registered with MSYSA and must be MSYSA Risk Management cleared, and SafeSport trained.
Insurance Forms & Resources
A-G Administrators Claim for Injuries (for all injury claims from September 1, 2021)