If you are a current US Lacrosse member who is injured during a covered lacrosse activity, you may obtain a claim form and instructions by clicking on the button below:

Claim Form

If you are a non-member who was injured while participating in an insured US Lacrosse tournament, camp or clinic, please contact RPS Bollinger at 800-446-5311, press "5" for Lacrosse. The Bollinger Lacrosse Administrator will verify that the event you participated in was insured and will then provide you with an accident claim form to complete.

Claim Guidelines: You should submit your claim form within 90 days of the injury. For claims to be eligible for coverage you must seek medical attention within 60 days from date of injury.

Benefit Period for Basic Accident and Catastrophic Accident Plans: The Basic Accident policy pays benefits for expenses incurred within 2 years from the date of injury. Medical or dental expenses that are incurred within 2 years of the date of injury are eligible for coverage under this policy.

In the event of serious or catastrophic injury, a claim that exceeds $100,000 in expenses paid through the Basic Accident policy (within the 2 year benefit period) will trigger coverage under the Catastrophic Accident policy. Once the claim exceeds $100,000 within 104 weeks of the date of injury, coverage then continues under the Catastrophic Accident plan. The Catastrophic Accident policy pays expenses that are incurred within 10 years of the date of injury or until the policy limits are exhausted, whichever comes first.

General Liability Claims: If you or your organization are involved in an incident which may give rise to a liability claim, or if you receive a legal summons or a letter from an attorney as a result of such an incident, please  report this information immediately to US Lacrosse’s Insurance Administrator, RPS Bollinger. Legal complaints are time-sensitive matters. Please do not delay in forwarding the liability claims information you receive to RPS Bollinger, along with all supporting materials (police report, incident report, newspaper or internet articles, etc.). RPS Bollinger will report the claim to the liability insurance company, who will then contact you with information on the claims process and your legal representation.

Incident Reports: If you or your team is involved in an incident that may result in a future liability claim, please complete an Incident Report Form

You should file an Incident Report:
• If EMS has been called for an injured participant or spectator
• In the event of any serious catastrophic or fatal injury occurring during a lacrosse activity or other sponsored activity
• For serious damage to the property of others (in excess of $5,000)

Please keep one copy for your records and send the other copy to RPS Bollinger along with your certificate of insurance and the roster of all your players and coaches.​

Insurance and Claims Administrator

All accident claims are handled and paid by RPS Bollinger, the insurance administrator for US Lacrosse.

You may contact RPS Bollinger at:

General Phone: 1-800-446-5311, press "5" for Lacrosse
Fax: 1-973-921-8474

General Email:

[email protected]

Claims Email:

[email protected]

Website:

www.RPSBollinger.com

Please note that you will be leaving the US Lacrosse web site to access some of the insurance services offered by RPS Bollinger.