1 USA Boxig s surace Program Revised October, 2009 Uited States Amateur Boxig, c.'s (USA Boxig) participat sports accidet isurace policy is with Federal surace, a member of the Chubb Group of Compaies. The policy is i effect from October 1 through September 30 of each year. Complete iformatio o claim filig procedures ad claim forms are provided i this issue. Please read all iformatio cotaied i this brochure i order to be well iformed ad able to aswer questios from your membership. Followig the recommeded procedure will esure accurate ad prompt paymet of eligible claims. All sports accidets must be reported o the jury Report Form. A hospital or physicia's stadard claim form aloe is ot acceptable. Please dispose of all your outdated isurace booklets, claim forms ad LBC Officers Affidavits to esure that there is o misuderstadig or cofusio cocerig our curret participat sports accidet program. The followig is a brief descriptio of the surace Program. This is ot the isurace cotract. The master policy is the oly cotract uder which beefits are paid. The policy is kept at USA Boxig's Headquarters as the policyholder ad will ot be distributed. Please read carefully ATHLETE AND NONATHLETE (PARTCPANT) SPORTS ACCDENT NSURANCE PROGRAM USA Boxig provides excess participat sports accidet isurace through Federal surace, a member of the Chubb Group of Compaies that covers USA Boxig's registered athletes ad o-athletes, whose premium has bee paid ad whose ames are o file at USA Boxig's Headquarters Office. The coverage for both athletes ad o-athletes is the same. USA Boxig also provides AD&D (Accidetal Death ad Dismembermet) coverage for registered athletes ad o-athletes participatig i USA Boxig sactioed evets, to iclude atioal ad iteratioal boxig competitios. Eligibility All registered athletes ad o-athletes of USA Boxig are eligible for coverage. Sports Accidet coverage is also provided for coaches, maagers, traiers, chaperos, ad officials who are registered with USA Boxig while participatig i USA Boxig sactioed evets ad orgaized practices oly.
2 Defiitio of Orgaized Practice ad Sactioed Evet "Orgaized Practice" meas participatio i practice that is scheduled by USA Boxig, uder the direct supervisio ad direct sposorship of the coach or maager of USA Boxig. "Sactioed Evet" meas a club-sposored show, local, regioal, or atioal champioship, held i the Uited States that is sposored by USA Boxig. Effective date Coverage will ot be effective for ay perso util he/she is a registered member of USA Boxig. Descriptio of Coverage Coverage is excess ad provided for registered athletes ad o-athletes agaist accidets i the course of participatig i USA Boxig sactioed evets ad orgaized practices scheduled by the Policyholder, uder the direct supervisio ad direct sposorship of a coach or maager of the Policyholder. The beefits provided uder this pla are payable after ay other isurace, which may be i effect at the time of the accidet, has bee exhausted. Beefits will be payable up to the amout show below or to the ed of the 52-week period followig the date of the accidet, whichever occurs first. Beefits will be paid at the rate that is Reasoable ad Customary. Note: Care ad treatmet must start withi 30 days after the accidet happes. juries to the head ad face will be covered oly if the athlete was wearig a mouthpiece ad headgear at the time of the accidet. Sactioed Competitio surace Coverage order to comply with Article of USA Boxig's Official Rules, participat accidet isurace coverage up to $25,000 for medical, surgical ad hospital care is provided for all registered members participatig i local, club, local boxig committee (LBC), atioal ad iteratioal boxig sactioed competitios. Beefits o Practice ad Sactioed Evet Coverage: o Accidetal Death Beefit Amout -- $10,000 o Accidetal Dismembermet Beefit Amout -- up to $10,000 o Accidet Medical Expese Beefit Amout (Practice) -- up to $ 25,000 o Accidet Medical Expese Beefit Amout (Competitio) -- $25,000 o Accidet Medical/Detal Expese Deductible Amout dividual pays first $1,000 if they have primary medical isurace coverage ad $2,500 if they do ot have primary
3 medical isurace USA Boxig pays up to $10,000 out of pocket o Maximum Detal Limit (Soud Natural Tooth-Excess) icluded i maximum medical beefit NOTE: NOTE: This coverage is secodary to ay other medical coverage that the idividual has ad requires a $1, deductible payable by the ijured party who has primary medical coverage ad a $2, for those without primary medical isurace. This is ot a Workers Compesatio policy ad does ot pay loss of wages due to a boxig ijury Exclusios This policy does ot cover ay loss resultig from the causes listed below: 1. Assault & Battery. 2. Ay accidetal ijury ot sustaied i practice or competitio. 3. Expeses for which the isured perso is etitled to beefits uder ay worker s compesatio act, ay madatory o-fault automobile isurace cotract or madatory basic reparatios beefit of o-fault. 4. War, or ay act of war. 5. Pregacy, childbirth, miscarriage or complicatios arisig therefrom. 6. Suicide, itetioally self-iflicted ijury or volutary self-destructio or ay attempts thereat, while sae or isae. 7. Heria. 8. jury resultig from a pre-existig coditio (provided it was kow by the sured Perso). 9. A accidet occurrig elsewhere tha the premises locatio desigated or ay other time except durig a Covered Evet.*) 10. Treatmet to the teeth, except as a result of a accidetal ijury to soud atural teeth. 11. Services or treatmet redered by a physicia, urse, relative or ay other perso employed or retaied by the Policyholder. 12. Replacemet of eyeglasses, eye examiatio for the correctio of visio or fittig of eyeglasses. 13. Property damage of sured Perso s persoal article such as glasses, cotact leses, detures, uiforms, helmets ad the like. 14. Pre-existig coditios. 15. lless, disease, medical or surgical treatmet thereof, bodily ifirmity or ay bacterial ifectio other tha bacterial ifectio occurrig i cosequece of a accidetal cut or woud. 16. Defiitio of Covered Evet: The usual activities ad covered travel to ad from such covered activities which ca iclude sactioed competitio, practice, which costitute a usual covered activity for which a isurace premium has bee paid.
4 17. Covered Travel meas orgaized, supervised group travel as authorized by the Policy holder directly to ad from a covered evet. teratioal Club/Group Member Exchages side the U.S. Whe ivitig a foreig team to the U.S. to participate i a club/group member exchage, it is madatory that the foreig delegatio be covered with adequate medical ad travel isurace. Policies ad Procedures for teratioal Club/Group Member exchages are listed i the appedix of this brochure ad ca also be foud i USA Boxig s Official Rules. The policies ad procedures explai how to obtai coverage for foreig teams uder USA Boxig s Foreig Athlete Policy. The local club team will have the madatory participat accidet coverage uder the sactioed competitio isurace whe competig i the U.S. Outside the U.S. Whe takig a local club team to a foreig coutry, excess medical ad travel isurace must be provided for the team. Additioal formatio Notices pertiet to USA Boxig's isurace program ad sample forms ca be foud i the appedix sectio of this brochure. Claim ad Claim Reportig Procedures Geeral formatio A supply of jury Report forms has bee distributed to each LBC. There will be o favorable actio o a claim util the isurace compay receives all the ecessary iformatio. USA Boxig's isurace carrier is Federal surace, a member of the Chubb Group of surace Compaies. Procedure for Reportig Claims 1. Claims must be filed withi 30 days from the date of ijury or as soo as is reasoably possible. This does ot mea that all of the medical bills must be submitted withi that time frame. 2. Whe completig the form, give a accurate descriptio of the ijury ad how it occurred. For example, "right shoulder" is ot eough. A descriptio such as "fell ad fractured right
5 shoulder i third roud" is much better. The date of the accidet must always be give. The athlete or o-athlete s membership umber ad social security umber must always be give. 3. Submit all bills (itemized superbills) to the USA Boxig. Be sure to keep all bills pertaiig to a particular idividual stapled together. 4. f ay portio of the medical bills is ot paid by the athlete's persoal isurace, a claim ca be filed with USA Boxig s surace carrier. Attach the Explaatio of Beefits from the other isurace, showig exactly what amouts were paid ad the upaid balace. The claims filig procedure described i this sectio must be followed. 5. Each jury Report must be siged by a official who was witess to the ijury. MPORTANT NOTE: Care ad treatmet must start withi 30 days after the accidet happes. 6. Paymet will be made directly to the provider of service (i.e., doctor, hospital etc.). Remember: the policy has a $1,000 deductible if you have primary medical isurace ad a $2,500 deductible i the absece of primary medical isurace ad the ijured party must pay this. 7. Be sure to submit itemized medical bills, ot statemets that oly show a balace due. The isurace compay must kow what services it is payig for. 8. Be sure the athlete sigs the claim ad, if the athlete is uder 18, a paret or legal guardia must sig it. 9. The jury Report must be filled out completely, alog with the Claim Form. Claim forms may be obtaied by callig USA Boxig. All requested iformatio must be provided, icludig exact date of ijury ad complete descriptio. (i.e., fell ad fractured right arm i third roud of bout). The idividual that ca verify the boxig ijury must sig the ijury report. 11. All bills for this accidet should be stapled to the form. Oce the claim form has bee completely filled out, the mail claim ad bills to USA Boxig s headquarters. 10. USA Boxig will file the claim with the isurace carrier. 11. A cidet Report must be filled out for each ijury that occurs i competitio or practice ad kept i the LBC files, ad a copy must be forwarded to USA Boxig s headquarters.
6 Termiatio of Coverage The isurace of ay covered perso shall immediately termiate o the earliest of the followig dates: 1. O the date the master policy is termiated; 2. O the date the covered perso ceases to be a eligible member of the policyholder for isurace, uder the master policy. Followig these istructios will expedite the hadlig of claims ad isure prompt paymet of eligible claims. A claim is ormally paid withi 45 days after the isurace compay receives complete iformatio. f the isurace compay writes to the athlete, askig for additioal iformatio, please respod promptly. The claim will ot be cosidered util complete iformatio is received. Claims should be filed as soo as a ijury occurs, but ot later tha 30 days after the date of ijury or as soo as reasoably possible. To follow up o a claim or if you have questios regardig the claims filig procedure, you may phoe or write to: Lyette Smith USA Boxig 1 Olympic Plaza Colorado Sprigs, CO Phoe: FAX:
7 USA Boxig s Geeral Liability Policy USA Boxig provides its membership with geeral liability coverage for bodily ijury ad property damage claims arisig directly from its operatio as the Natioal Goverig Body for amateur boxig. All LBCs, member clubs, registered athletes, officials, coaches ad admiistrators are afforded coverage while actig for or o behalf of USA Boxig. t is importat to ote that the isurace applies to USA Boxig sactioed competitios ad orgaized practices at which a coach, maager or traier is physically preset. f a idividual club has its ow facilities or participates outside of USA Boxig sactioed matches, it is importat that they obtai separate liability isurace coverage. (See page 3 for defiitio of sactioed evet ad orgaized practices.) All participats (athletes, coaches, officials MUST be registered with USA Boxig.) Below is a descriptio of USA Boxig s geeral liability policy. LABLTY NSURANCE SUMMARY surace Carrier: Philadelphia demity surace Compay Policy Period: October 1 September 30 Who is covered: Uited States Amateur Boxig c. (USA Boxig); USA Boxig Local Boxig Committees; USA Boxig registered clubs, USA Boxig Group Member Orgaizatios, registered athletes ad o-athletes. Coverage starts o the day of registratio ad expires whe the policy expires (September 30). Limits of surace: Geeral Aggregate Limit (Per Evet) $5,000,000* (Other tha Products-Completed Operatio) Products Completed Operatios Aggregate $1,000,000 Persoal ad Advertisig jury Limit $1,000,000 Each Occurrece Limit $1,000,000 Participat Legal Liability $1,000,000
8 Damages to Premises $ 100,000 Excess Liability per occurrece $1,000,000 Excess Liability Aggregate $1,000,000 Medical Expese Limit (ay oe perso) Excluded *) There is a $5,000,000 policy geeral aggregate. This meas that the isurace compay would be liable for up to $5,000,000 i collective claims i oe year. Deductible: Noe Defiitio of Participat: The term participat shall iclude all persoel who have bee grated proper authorizatio to eter ay restricted area(s). Restricted area(s) shall iclude those areas which are occupied by participats ad to which access by the geeral public is restricted or prohibited. What are the Beefits: Potetial Liability Claims Arisig out of the followig: 1. All sactioed ad supervised activities ecessary or icidetal to coduct of practice ad competitio. 2. The owership, maiteace or use of facility or veue. 1. Products liability, i.e. cosumptio or use of food, equipmet ad other products. 2. Year roud sactioed ad supervised activities such as fud raisig, meetigs ad award baquets. 3. Liability assumed uder cotracts. 4. Libel, slader, defamatio of character, wrogful evictio; ad ivasio of privacy (as log as the club is ot a for profit etity) 5. Host Liquor Liability. 6. Advertisig ijury. 7. Fire Legal Liability. 8. cidetal Malpractice Liability. 9. Additioal sured, whe requested.
9 10. The protectio afforded icludes the legal liability for ijury or death of athletes Notable Exclusios: 1. Property i the care, custody ad cotrol of the isured, i.e. persoal property of the athletes, o-athletes. 2. jury or death of a employee. 3. Athlete vs. Athlete claims. 4. Amusemet Devices, such as duk taks, etc. 5. Fireworks. 6. Property damage to aimals. 7. tetioal acts. 8. Tough Ma, Kick Boxig ad Martial Arts related evets or practices. 9. All auto exposures 10. Medical o-fault paymets 11. Coverage is for egligece oly of the isured parties The above is oly a very geeral referece to what coverage(s) the isurace policy provides ad is ot iteded to attempt to describe all of the various details of the coverage. Claims ad Potetial Claims: Remember, our aual premium cost i the future for this coverage is goig to be directly related to our experiece record o liability claims/paymets. This is ot a accidet or health policy; it is a liability policy to protect the aforemetioed etities from liability claims i case of lawsuits or potetial egligece. t is importat that USA Boxig ad the isurace compay be made aware of ay potetial liability claims immediately. f somethig occurs at a sactioed evet, which might make ay of the covered etities liable for some type of damages, the you should report the facts ad circumstaces immediately. The sooer a icidet is reported, the better the chaces of prevetig it from becomig a law suit. Never admit ay liability to parties ivolved or give ay details o our coverage (limits, etc.).
10 the evet of a occurrece.. 1. Collect as much iformatio as possible with respect to time, place, circumstaces, ames ad addresses of the ijured ad witesses. 2. Report the icidet ad iformatio you were able to obtai to the isurace compay ad USA Boxig s Headquarters office immediately. 3. Do ot REPEAT do ot admit ay liability to ayoe. 4. Most importat -- do ot talk to ayoe about the icidet, except the authorized claims represetative of OUR isurace compay ad the Headquarters office. What to Report: 1. OCCURRENCES ivolvig athletes o Uexpected results from medical maagemet of ijury or illess prologed ucosciousess o Severe ijury or disfiguremet o Athlete or family ager with ijury-producig situatios 2. OCCURRENCES ivolvig o-athletes o Ay ijury or property damage associated with sactioed evet or activity o Ay ager with o-ijury "isult" (e.g., ivasio of privacy, defamatio of character, etc.) 3. CLAMS o Ay demad for compesatio o Ay cotact by a attorey o Ay threat of retaiig a attorey structios for Reportig Occurreces 5. SUTS o Ay legal otice served o the orgaizatio or perso associated with the orgaizatio.
11 Whe to Report MMEDATELY! f a typical occurrece, sed completed form by mail. f a severe occurrece, claim, or suit, call first ad the mail the iformatio. ALWAYS cosult with USA Boxig's Headquarters before ay cotact with a claimat's attorey. Where to Report Uited States Amateur Boxig, c. Att: Lyette Smith 1 Olympic Plaza Colorado Sprigs, CO Phoe: FAX: Supervise all activities 2. Have writte procedures that are commoly kow by all participats (review the USA Boxig Risk Maagemet Guide) 3. Develop a safety checklist for evets. Appoit a safety ispector. f your LBC does ot have a safety committee, you may wat to cosider formig oe. Have o had ad refer to USA Boxig s Risk Maagemet Guide. 4. Have ay idividual, who is trasportig athletes or members of the team, fill out ad sig a Driver formatio Form, providig iformatio o his drivig record, curret drivers licese, etc. (Sample form ca be foud i the back sectio of this brochure). 5. spect equipmet ad facilities regularly. Make repairs immediately. 6. struct your athletes that they should report ay symptoms of ijury or other distress. 7. Keep writte records of complaits. 8. Treat everyoe with digity. 9. Be reasoably sure you have doe everythig you could have to avoid a situatio that may lead to a lawsuit. 10. FOLLOW THE RULES
12 Most Commoly asked Questios Q. f do ot have a certificate, is my club still covered? A: Yes, liability coverage is i place from the day you register your club. Of course you must reew your club membership aually. Q: Whe do request a third party certificate? A: Whe the facility ower or sposor of your club or a evet you are holdig wats to see writte proof that your club has liability isurace coverage. Your club s ame will be show o the certificate i the descriptio sectio as the isured ad USA Boxig is show as the Named sured. Q: What is the differece betwee a secod party ad a third party certificate? A: First Party is USA Boxig. USA Boxig is the policyholder; Secod Party is members such as clubs, athletes ad o-athletes; Third Party or additioal isureds are o-members who wish to be amed as additioal isureds o the certificate of liability ad by beig amed additioal isureds have the same coverage as the member. Q: Our club ows a va. t is covered? A: No, your club must obtai its ow car isurace. Q: Are spectators covered? A: Yes, spectators at evets ad i the gym are covered, but oly for icidets that arise from egligece durig boxig related activities. Example: A spectator receives a ijury by trippig ad fallig over a cable that is strug across the floor to the aoucer s table without beig taped dow or secured. Securig the cable was boxig s resposibility ad the claim would be covered by USA Boxig s liability policy. The ijury was caused due to boxig s possible egligece. t would ot be covered uder the participat sports accidet policy. The sports accidet policy covers ijuries sustaied by members while participatig i the sport of boxig. Example: f the floor i the facility is defective ad a spectator trips ad receives a ijury as a result of it, this ijury is ot covered by USA Boxig s policy. The coditio of the facility is the facility ower s resposibility ad would be covered uder the facility s liability policy.
13 Certificates of surace Applicatios must be submitted to USA Boxig. Certificates will ot be issued uless the Natioal Goverig Body has approved them first. Sposors of sactioed evets, that are registered members of USA Boxig such as clubs, are automatically covered uder USA Boxig's geeral liability policy. Thus, the ONLY group that a certificate of isurace should be requested for is a o-member third party, such as the facility ower, etc., oe who is ot a official sposor of the evet or gym. Oly request a certificate if a third party requires oe. o Do ot assume that certificates will be reewed automatically. o Always fill out a request form ad mail it to USA Boxig. o The club membership applicatio must be o file at USA Boxig s Headquarters office. deally, certificate requests should be submitted 30 days prior to the evet. However, situatios may arise where this i ot possible. FAX service is available. A space is provided o the certificate request form for the fax umber. The preferable method for delivery of certificates is via , so please provide a address to deliver your Certificate(s) of surace. O third party certificates, o-members, such as sposors, the area, auditorium, high school or facility are amed as a Additioal isured. For secod party certificates of liability for USA Boxig sactioed evets ad traiig facilities oly the member club is listed as the isured. To isure that your certificate request is processed without delay, all requested iformatio must be give. Please fill out the form completely. Please be sure the certificate request has bee siged by a LBC officer ad icludes the sactio umber, if applicable. t is madatory that the locatio, where the evet takes place ad the relatioship of the third party to the sposor club be give. A sample applicatio form ca be foud i the appedix of this brochure. Sice liability isurace coverage is automatically available to member clubs, curret membership iformatio must have bee reported ad be o file at USA Boxig's Headquarters Office for the certificate to be valid.
14 Followig this sectio, sample copies of Certificates of Liability surace ca be foud to illustrate what the actual certificate looks like whe it is issued by the isurace agets. Types of Certificates Evet Certificate: 1. Third Party is amed as a Additioal isured for a specific date of evet. 2. Club is amed as the isured for a specific date of evet. Traiig Facility Certificate: 1. Third Party (facility, etc.) is amed as a Additioal isured. Coverage is i effect from the date the certificate is requested through September 30 whe the policy expires. The dates o the certificate will be the date of issue through September Club oly is amed o the certificate as the isured. The dates o the certificate will be the date of issue through September 30.
15 Do s ad Do ts for Certificate Requests The do s ad do ts for requestig certificates came from our isurace agets, who issue the certificates. They may appear uaccommodatig, but keep i mid that they issue hudreds of certificates each day for over 30 Olympic sports. Please try to adhere to the requests. DO S o Do have Local Boxig Committee (LBC) represetative authorize all requests o Do allow 30 days for processig, if possible. o Do verify accuracy ad completeess of Additioal sured requests. o Do give full ames of evets, locatios, Additioal sureds, etc. o Do prit or write legibly, or type your request. o Do put chages (such as date of evet, addig aother third party) i writig. o Do give the correct address of the club. DON TS o Do t submit icomplete forms. o Do t expect automatic re-issuace of certificates upo policy reewal o Do t expect that rush requests ca be accommodated. At times requests are received late o a Friday for a weeked evet whe USA Boxig is already closed. o Do t request back-datig of certificates as this caot be doe. o Do t request alteratios or additios to certificates o Do t request certificates by telephoe. o Do t abbreviate iformatio. o Do t request Additioal sured s after a evet is over o Do t assume that you have woderful pemaship.
16 Recap of USA Boxig s surace Policies Participat Sports Accidet surace covers. juries sustaied by athletes ad o-athletes durig sactioed evets or supervised practice Geeral Liability surace covers.. Bodily jury: Persoal jury: Advertisig jury: Property Damage: juries sustaied as a result of egligece durig a covered activity cludes libel, slader ad defamatio of character jury resultig from ifrigemet of copyright, title or sloga; oral or writte material violatig a idividual s right of privacy; cludes damage to property that you do ot ow, ret, lease or occupy. Directors ad Officers Liability surace covers.. o Wrogful decisio; o Wrogful dismissal; o ssues surroudig athlete eligibility, i.e. challegig selectio process or ot followig selectio process; o Fiacial malfeasace, misappropriatio of fuds; o Not followig Bylaws, decisio makig.
17 NSTRUCTONS FOR REPORTNG NCDENTS 1. Begi the followig form immediately after learig of the occurrece ad mail it to Lyette Smith as directed withi seve (7) days of the occurrece. Note: f a serious or catastrophic ijury is ivolved, call immediately ad sed i the completed form later. Lyette Smith Director of Membership USA Boxig 1 Olympic Plaza Colorado Sprigs, CO (719) FAX: (719) f property damage is beig reported, check that item ad the describe the apparet damage uder "Apparet jury". 3. describig the occurrece, start with the situatio that preceded the ijury ad follow the steps sequetially throughout the icidet util the ijured perso received professioal first aid or medical attetio. Do ot add your opiio of what caused the ijury; describe the activity durig which the ijury occurred. 4. "Perso Reportig Occurrece" is perso withi your orgaizatio who is give the resposibility to report these matters whe they occur to Lyette Smith. Oly oe (1) perso should be give this resposibility, alog with a backup perso if the pricipal perso is to be away for a exteded period of time. 5. Use "Additioal iformatio for further descriptio of the occurrece of related iformatio that would help the isurace compay evaluates its potetiality as a claim.
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