Basic Information:
The Culpeper Football Association provides coverage for injuries to all participants through K&K Insurance. If your child is injured, we are happy to assist in submitting an initial claim for you. 


Parent Information:

Please be advised that this coverage is subject to a $100 deductible and is excess/secondary to any other valid and collectible coverage available to the claimant.  This means that if there is other heal and/or accident coverage available, all charges must be submitted to them first on a primary basis.  Subject to terms and conditions of this policy, coverage will apply to the amount not covered by other insurance. I you have other coverage, the other carrier payment(s) will be used to satisfy the deductible under this policy.  If you have no other coverage, we will apply the $100 deductible to the charges received until the deductible has been satisfied.

You are responsible for completing the upper portion of the claim form.  Omission of any information incurred with 104 weeks from the date of the accident will be considered.

If you have coverage under a HMO plan, but do not seek treatment from a provider within that play, your benefits under this policy may be reduced by the amount that would have been paid had the services been provided by a provider within your HMO plan.  You would also be responsible for the deductible under this plan.

Attach all itemized charges along with the explanation of benefits from any other insurance showing what has, or has not been paid.  We will then process the outstanding portion of your claim in accordance with them terms and conditions of this policy.

Verify that the insurance coordinator has completed the lower portion of the claim form in its entirety.

2022-2023 CFA Insurance Claim Form.pdf