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Insurance

e-Travel System

If you are traveling to a Non-Cal North Sanctioned event, you can instantly obtain your approval to travel by completing a travel request in Cal North's Data Management System. Please note you must have a user account, and you must be rostered to the team as a team official (e.g. head coach, assistant coach, or team manager). 

Click here for detailed instructions on completing the travel request online.

If you do not have a user name or password, you can contact your league/club registrar to have one setup, or you can alternatively use the forgot password option. 



Cal North Injury Claims

Cal North injury claims can now be submitted through an online submission process.  Please note that online claims can only be processed for accidents on or after September 1, 2012.  If the accident date occurred before this date, please do not proceed with the online claim submission; instead, you will need to contact Debbie Alvarez at dalvarez@calnorth.org for the appropriate case report/claim form.
 

Click here to access the online claims program.

 

Claims Process Overview


  1. Authorized team official completes online claim form.  The authorized team official will need the following information about the injured person:


    First and Last Name
    Complete Mailing Address
    Date of Birth (DOB)
    Gender
    Parent / Legal Guardian’s First and Last Name
    Parent / Legal Guardian’s Phone #
    Parent / Legal Guardian’s Email Address
    CYSA ID #
    District #
    League #
    League Name
    Team Name
    Type of Event Injured at
    Date of the Injury
    Description of Injury
    Name of Field / facility Where Injury Occurred
    City Name Where Injury Occurred

    A confirmation email indicating the submission was received will be sent to the team official, the parent, and the state office (DAlvarez@calnorth.org).  The emails will be sent from pullenins@pullenins.com

  1. The state office will review and either approve or deny the claim.
    1. If approved, the parent will receive an email with the claim form and instructions attached as a PDF document.  The parent will complete sections VI and VII and email, mail or fax the claim form and other documents to the insurer.
    2. If denied, the parent will receive an email indicating the claim was denied and the reason for the denial.
  2.  The insurer will mail a letter to the parents acknowledging receipt of the claim form and will request additional information from the parent, if necessary.

 

Submit Paper Forms

Document Description Post Date
Cal North Insurance Outline .PDF Document Use: Important information regarding Cal North's player insurance coverage. Oct 03, 2014
Insurance Certificate Request Form .PDF Document Use: League Officials - form should be submitted when requesting an insurance certificate for a facility or field. We will begin to process 2014 Certificates of Liability Insurance on December 2, 2013. Certificates will be processed on a “first come, first serve” basis. Nov 25, 2013
California Youth Soccer Association Incident Report Form (Form 2614) .PDF Document Use: Tournament Director, Team Official or parent This form is to report a situation that is out of the ordinary or could be anticipated as requiring any further league of Cal North involvement (such as accident reports, police reports, insurance claims, property damage, or other noteworthy occurrences that took place at the event). This report must be submitted to the Cal North office within 72 hours of the conclusion of the tournament. Apr 24, 2012
Insurance Case Report (Accident Report Form 8206) .PDF Document Use: Team Official This form is to be completed by a registered Cal North team official when a Cal North registered player or team official is injured. This form is to be submitted to the Cal North office in a timely manner to insure adequate insurance coverage or injury documentation. You can also submit the form online by visiting https://two.pullenins.com/CAN/CANOverview.asp Apr 13, 2012
Results: 4 Record(s) Found.
 
 

1040 Serpentine Lane Suite 201
Pleasanton, CA 94566
Office: 925.426.KIDS (5437) Fax: 925.426.9473

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