If an injured member’s claim exceeds the $100,000 limit of expenses paid under the Basic Accident policy (within the Two Year Benefit Period), that will trigger coverage under the Catastrophic Accident policy. The Catastrophic Medical Expense Benefit provides up to $1,000,000 for medical expenses resulting from a covered injury. Claims will be paid on a reasonable and customary basis relative to the geographic area where treatment was rendered.
Once a claim is eligible for coverage under the Catastrophic Accident plan, any subsequent medical expenses resulting from that injury, such as additional surgeries or rehabilitation, would be covered for up to 10 years from the date of injury. In the event of a serious injury, this is meaningful since medical expenses can spread out over a period of many years.
Who is Covered?
The Catastrophic Accident policy covers: all currently registered member players, coaches and officials whose covered injuries exceed the $100,000 Basic Accident Policy limit within two years of the date of injury.
Catastrophic Accident Coverage Description
Catastrophic Accident Policy Limits:
|Accident Medical Expense Limit
||10 Year Benefit Period
|Catastrophic Cash Benefit
||$250,000 lump sum
||$100,000 (integrates with Basic Accident policy)
|Deductible Incurral period
||2 years from date of injury
Catastrophic Cash Benefit: If a covered injury to a member of US Lacrosse results in Paralysis or Coma within 180 days from the date of injury, the policy will pay a lump sum cash benefit to the injured participant, subject to the following conditions.
1. The paralysis or coma must last 12 consecutive months (the waiting period).
2. After the waiting period, a physician must determine that the condition is irreversible and has resulted in permanent disability.
3. The benefit is payable according to the schedule below:
For Coma --- $250,000 (100%)
For Paralysis of 2 or more limbs (upper and/or lower) --- $250,000 (100%)
For Paralysis of one limb (upper or lower) --- $125,000 (50%)
For Paralysis of one or more other parts of the body --- See Note
NOTE: If the insured’s paralysis is a part of the body other than a limb, the percentage of the cash benefit used to determine the amount of the benefit will be adjusted in proportion to the extent of the paralysis. The final determination of comparable extent of the disability will be made by the insurance company's case management team.
Basic Accident and Catastrophic Accident Policy Exclusions
This policy covers only those medical/dental expenses arising out of accidental injuries that occur during covered activities. The policy does not provide coverage for claims arising out of sickness, illness or bodily conditions.
This policy does not cover any loss, fatal or non-fatal, incurred or resulting from the following:
1. Suicide, or intentionally self-inflicted injury;
2. Infections except pyogenic or bacterial infections caused wholly by a covered injury;
3. Injury resulting from any declared or undeclared war;
4. Loss resulting from air travel, except as a fare-paying passenger on a commercial airline;
5. Expenses for treatment on or to the teeth, except for treatment resulting from injury to natural teeth;
6. Eyeglasses, hearing aids, and examination for the prescription or fitting therof;
7. Injury covered by any workers' compensation or occupational disease law;
8. Hernia, unless it results from a covered injury;
9. Injury resulting from the insured being intoxicated or under the influence of any narcotic unless administered on the advice of a physician.
How to File an Accident Claim
If you are injured during a covered lacrosse activity, you may obtain a claim form and instructions on filing the claim by clicking here: How to File a Claim
No new claim needs to be filed in the event of a catastrophic accident claim. The catastrophic accident claim will be coordinated with the claim filed under the Base Accident policy.
All claims are handled and paid by Bollinger, insurance administrator for US Lacrosse.
This summary is a brief description only of the coverages, conditions and exclusions of the policy, and in no way affects or alters the scope of coverage provided. For the full details of terms and limitations, please refer to the actual policy, which is made available for review at the US lacrosse National Office in Baltimore, Md.