Safety

Hockey Canada Injury Form

This form must be completed for each case where an injury is sustained by a player, spectator or any other person at a sanctioned hockey activity, a Hockey Canada Injury Form must be completed an submitted to Hockey Canada.

In addition to providing additional medical insurance to players families, this form is also used by Hockey Canada to track injuries in minor hockey. All personal information is kept confidential but provides important statistics on what, where, when and at what ages injuries occur. This is useful information in the mitigation of player injuries.

• All injury claims must be submitted to the BC Hockey office within 90 days of the incident on a Hockey Canada Injury Report Form. If this form is not received, the claim will NOT be processed.

• Please note invoices and / or receipts can be submitted at a later date following the original claim – payment on the claim may be affected if the claim is received after the above mentioned 90 day period. Receipts and invoices can be submitted up to 52 weeks after the date of the injury.

• Coverage is not in effect for services or treatments that are insured services (BC Medical Services Plan, Extended Benefits, Dental Plans, etc.)

• Hockey Canada is a secondary insurer.  If a participant has Extended Benefits or other insurance, request for payment must be filed with the Extended Benefits or other insurance prior to any reimbursement being made from Hockey Canada. However, the injury claim form must still be submitted to the BC Hockey office within 90 days of the injury. Any coverage statements from the participant’s Extended Benefits or other insurance should be forwarded to the BC Hockey office along with the invoices and receipts.

• If the family does not have Extended Benefits or other insurance coverage and the participant is a resident of Canada with provincial coverage, then coverage is in place for services such as ambulance transportation, prescriptions, crutches, collars, and physiotherapy treatments after the provincial medical has been exhausted.

• Out of country players must purchase a separate primary insurance coverage plan in order for the Hockey Canada Insurance Program to be in effect.

• As with other insurance carriers, the Hockey Canada Insurance Program has coverage limits. For further information regarding coverage limits, please refer to the Safety Requires Teamwork booklet.

• Regardless of the severity of the injury, a Hockey Canada Injury Report Form must be completed and submitted. This applies to all situations, including those where no corresponding monetary claim will be submitted.

• Please keep copies of all documentation you forward to BC Hockey.

• Forms MUST be completed in full with the following information:

• Name and address including postal code and telephone number
• Date of birth
• Date of injury
• Type of injury and nature of condition
• Whether the injury took place at a Hockey Canada sanctioned activity
• Name of Association and team
• Description of accident
• Signature of team official
• Signature of parent / guardian (under 18 years of age) or signature of participant (18 years of age or older)
• Insurance information

• Incomplete forms will NOT be processed. They will be sent back to the team’s Risk Manager for additional information.

• Please attach additional physician’s and / or dentist’s statement and / or letter to the form if more space is required or more details of the injury need to be provided.

• All invoices and / or receipts attached or following the original claim must be itemized, so please check invoices and receipts carefully before sending them to the BC Hockey office.

• Please make sure the injured individual’s name is on all correspondence.