MAKING A CLAIM (Injury sustained within Canada)

Provincial Union / Rugby Canada Extended Medical Coverage Injury Reporting And Claims Process

To make an insurance claim after sustaining an injury please complete the following steps:

  1. Fully complete an injury report form
  2. Fully complete a witness report form
  3. Fully complete questions 1-3 on a medical expense claim form (or if dental have your dentist complete the dental statement of claim)
  4. Send a doctor note and/or prescription (or physician referral for treatment)
  5. Fully complete the authorization to disclose information form
  6. Invoices
  7. Email all of the above to injuryclaims@rugby.ca

Please note that all documents must be fully completed.  Documents that are not fully completed could lead to a delay in processing the claim.  General enquiries regarding making a claim can be sent to injuryclaims@rugby.ca.

Download Injury Report Form Click Here

Download Witness Report Form Click Here

Download Medical Expense Claim Form Click Here 

Download Dental Statement of Claim Form Click Here 

Download Authorization to Disclose Information Form Click Here

TRAVEL MEDICAL PROCEDURE (Injury sustained outside of Canada)

Travel Medical Process (tours)

Only sanctioned tours will be able to make a claim against the national insurance program. Players who have been cleared to play international can not be exposed to the National Insurance Program.

Registered Participants of Member Organizations have extensive travel coverage under the National Insurance Program. This coverage will apply while on sanctioned and approved tours for member organizations.

Sutton Special Risk Insurance works with a Medical Assistance Service provider called, On Call International. By utilizing the Travel Medical Assistance Company, On Call International, members will be able to complete the following process if injury or sickness occurs:

  1. Call 911 or country emergency phone number for an ambulance (if necessary)
  2. Refer to On Call International Member Card with dedicated phone and member number, call and begin the process
  3. On-Call International will direct you to the closest hospital (if necessary)
  4. Coach, Manager, Parent, Volunteer or individual themselves must ask for GOP (Guarantee of Payment) from On Call International for all possible medical expenses or treatments or tests that may take place at the hospital or medical clinic.
  5. The hospital or medical clinic will work with On Call International to arrange and receive payment.
  6. The patient will receive treatment.
  7. Complete necessary paperwork (injury and witness reports and submit to Provincial Union for forwarding to Rugby Canada and Sutton Special Risk)

Download Emergency Assistance Card – On Call International