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:
- Fully complete an injury report form
- Fully complete a witness report form
- Fully complete questions 1-5 on a medical expense claim form (or if dental have your dentist complete the dental statement of claim)
- Send a doctor note and/or prescription (or physician referral for treatment)
- Fully complete the authorization to disclose information form
- Email all of the above to email@example.com
Please note that all documents must be fully completed. Documents that are not fully completed could lead to a delay in processing the claim. You must be covered under a Provincial Government Health Insurance Plan to be eligible for the Accident Medical Expense benefit.
General enquiries regarding making a claim can be sent to firstname.lastname@example.org.
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:
- Call 911 or country emergency phone number for an ambulance (if necessary)
- Refer to On Call International Member Card with dedicated phone and member number, call and begin the process
- On-Call International will direct you to the closest hospital (if necessary)
- 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.
- The hospital or medical clinic will work with On Call International to arrange and receive payment.
- The patient will receive treatment.
- Complete necessary paperwork (injury and witness reports and submit to Provincial Union for forwarding to Rugby Canada and Sutton Special Risk)