Affiliated members of the FC Mont Bruno soccer club, in association with the Quebec Soccer Federation, are covered by accident insurance during practices and / or soccer games (events sanctioned by the Federation). You will find the link for the forms at the bottom of the page.
ACCIDENT INSURANCE PROGRAM - STEPS TO FOLLOW FOR CLAIM (must be done within 30 days after incident)
1. Have the OFFICIAL form completed as soon as possible by a physician who confirms the injury.
2. Return the completed form to the FCMB.
3. The FCMB will send the form to the Federation
4. The Federation must approve and forward the form to the insurance company.
* Make sure you complete the form correctly within 30 days of the injury. Incomplete forms result in a delay in the refund process.
** It is important to specify whether you already have private insurance on line 8 of the form. *** The claim form MUST be filled in by a doctor. A FORM COMPLETED BY A PHYSIOTHERAPIST IS NOT VALID.
WHAT IS NOT COVERED
1. The insurance company will never reimburse more than 80% of the bill.
2. Reimbursement will not be granted for tendonitis or muscle strain.
3. If the claimant is injured during an activity not sanctioned by the Federation, the claim will be automatically refused.
POLICIES AND FORMS
Injury claim form: (have a practitioner fill in)
Dental accident claim form: (to be completed by a dentist)