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Lacey soccer club

Medical Claim / Release Form

Filing a Medical Claim under NJYSA


  • If a player from LSC is injured during a league sponsored event and it becomes necessary to file a claim, then the parent or guardian needs to follow the directions to the web site below.
  • DO NOT WAIT TO FILE THE CLAIM
  • READ ALL OF THE INFORMATION ON THE WEB SITE TO SEE IF YOU ARE ENTITLED TO COVERAGE
  • DO NOT ALLOW THE PLAYER TO CONTINUE TO PRACTICE OR PLAY IN GAMES UNTIL THEY RECEIVE MEDICAL CLEARANCE
  • THIS IS SECONDARY INSURANCE
  • KEEP THE COACHES INFORMED OF THE PROCESS
  • REMEMBER TO DOCUMENT EVERYTHING IN THE PROCESS

 
To gain access to the information PROCEED AS FOLLOWS:

    1. GO TO http://njyouthsoccer.com/
    2. Select Administrative Information
    3. Go down to Insurance and select the Medical tab
    4. Follow all instructions from there.


Copies of all claims must be submitted to the Lacey Soccer Club VP as soon as the claim is made.

Filing a Claim Under Lacey Soccer Club

  • If a player from LSC is injured during a club approved/sanctioned event and it becomes necessary to file a claim, then the parent or guardian (or adult player) needs to  complete the Bollinger Insurance claims form and submit to the LSC 1st VP to be forwarded to "Bollinger Insurance Solutions" once approved:

 

  • DO NOT WAIT TO FILE THE CLAIM
  • THE INJURED PLAYER SHALL NOT BE ALLOWED TO CONTINUE TO PRATICE OR PLAY IN GAMES UNTIL THEY RECEIVE MEDICAL CLEARANCE TO DO SO AND IS PROVIDED TO LSC
  • THIS IS SECONDARY INSURANCE
  • KEEP THE COACHES INFORMED OF THE PROCESS
  • REMEMBER TO DOCUMENT EVERYTHING IN THE PROCESS
  • YOU MUST PROVIDE A COPY OF THE CLAIMS FORM TO THE LSC CLUB 1st VP FOR AUTHORIZATION PRIOR TO THE CLAIM BEING FORWARDED TO "BOLLINGER INSURANCE SOLUTIONS"
  • PLEASE CONTACT THE LSC CLUB 1st VP WITH ANY QUESTIONS REGARDING SUBMISSION OF CLAIMS

Contact Us

Lacey Soccer Club est. 1972

PO Box 946 
Forked River, New Jersey 08731

Email Us: [email protected]
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