Notes on using ‘Overuse Insurance’:

1. Only one claim form needs to be submitted per calendar year.  Once you have submitted one claim form for the year, you can continue to send in receipts without having to have multiple forms filled out.
2. If you are submitting for chiropractic therapy or orthotics, the ‘Attending Physician Statement’ MUST be filled out by a physician.  If you are just submitting for physio or massage, this section can be filled out by a physiotherapist or athletic therapist.

Proof of Loss Form:  Accidental Medical Sports Insurance (Massage/Physio/Orthotics)

In the case of a traumatic injury, other services such as hospital charges, prescription drugs, medical equipment (braces, etc.) and other paramedical services may be covered or partially covered.  Please contact Scott Vass directly if more information is needed or read pages 4 and 5 of the ‘Insurance Policy – In Canada’ document on the CAIP website.

The two most common claims by our athletes are for (1) private MRI and (2) post-surgical bracing.  For bronze coverage, medical imagining (MRI, CAT/Bone scan, x-ray, etc) is covered to a maximum of $500 and braces are covered to a maximum of $1,000.  In both of these cases, a ‘Proof of Loss – Accidental Medical’ Form should be submitted following the steps in the ‘Overuse Insurance’ section.  However, the ‘Attending Physician’ section can only be filled out by a medical doctor and must clearly state the nature of the injury and the specific need for the scans and/or bracing.

In the case of an accidental blow to the mouth during practice or competition the insurance will cover up to $1,500 in dental expenses.

Submitting a claim using the ‘Proof of Loss – Accidental Dental’ Form:

1. Athlete fills out and signs the ‘Claimant Section’
2. Coach fills out and signs ’Sport Body Authorization Section’
3. Dentist fills out and signs Part 1 & Part 2 of the dentist report on back of page.
4. Athlete pays for service rendered.
5. Athlete sends in receipt(s) and claim form to SSQ Insurance address on top right of form OR claims can be scanned and submitted electronically to: [email protected]

Proof of Loss Form:  Accidental Dental Claim

Out of Canada insurance is 24 hours a day insurance protection for emergency medical and hospital care, emergency dental treatment, evacuation, repatriation and family transportation & accommodation benefits as the result of an injury or sickness.

Outside Canada coverage also includes The Travel Assistance Program, which provides international emergency assistance to CAIP members when travelling outside Canada.

The medical card should be carried by all athletes when travelling outside of Canada.

• Please do not wait to submit claims to SSQ Insurance Company.  They would prefer if you can to submit the completed claim form together with the receipts within 90 days from the date of accident / overuse injury or the date you received the first treatment for your injury.
• If there are additional receipts relating to the same claim, the claim form does not have to be completed again.  You can simply send the subsequent receipts to SSQ Insurance Company with a covering letter noting all your contact information.  This will allow the insurance company to easily locate your file and process your claim in a timely manner.  You can use the attached (Additional Receipt Letter) form if you wish.
• At some point, the claims adjuster may ask for an updated claim form.  The claims adjuster will advise.
• Please try to keep copies of the claim form and receipts before submitting to SSQ Insurance Company.
• Please note that the “Consent to collect, use and disclose personal information form” may be required by the claims adjuster to obtain personal information for a particular claim.  The claims adjuster will advise if this form is needed.
• DIRECT DEPOSIT:  You can receive your payment by direct deposit, otherwise payment will be mailed to you via cheque. In order to take advantage of this you will need the following:
  • The original of the ‘Direct Deposit Form’ completed and signed
  • Copy of your cheque marked ‘VOID’
  • Both sent with the claim form and receipts to SSQ by mail
• PAYMENT DIRECTLY TO WRESTLING CANADA LUTTE: There may be instances where Wrestling Canada Lutte needs to pay your invoices for you.  In this situation you will be required to furnish SSQ Insurance with a “Letter of Authorization” allowing them to reimburse Wrestling Canada Lutte directly to recoup expenses.
• More information on how to make claims and receive reimbursement can be found here: http://mkirsch.ca/claims/