Rocky Mountain District Hockey

Kelly Grover
1188 Lampton Road
South Jordan, UT 84095
801-455-7153 Cell
kgrover@rockymountainhockey.com

For help with filing an insurance claim, obtaining a certificate of insurance or if you have a question concerning any risk management issue, please contact your affiliate's Associate Risk Manager.  

Standard insurance claims are filed directly with K & K (800) 237-2917, prompt 2. The coverage is for excess medical and you have one year to file your claim.  

To obtain a certificate of insurance for ice usage please complete the attached form and submit it with a copy of your ice rental contract(s) to your Associate Risk Manager for initial review and approval. These requests may take up to 30 days to process depending on the number of requests that are being submitted from all over the country.

All serious injuries should be reported immediately to either your Associate Risk Manager or Kelly Grover, Rocky Mountain District Risk Manager.
2011-12 Summary of Insurance Coverages
2011-12 Request For Certificate Of Insurance
Special Events Sanction 

To file an insurance claim: 

1. Obtain a USA Hockey Case Report/Accident Medial Insurance Claim Form from your local association registrar. 
2. Do NOT take the Case Report/Insurance Claim Form to your medical provider for completion: YOU MUST FILL IT OUT. 
3. You and your Coach/Program Administrator MUST SIGN the form. 
4. You must include a copy of your online registration confirmation page, IMR (Individual Membership Registration) form, or USA Hockey Roster to process your claim.USA Hockey Insurance is an excess policy and may carry a DEDUCTIBLE. 
5. Mail your completed form and proof of current USA Hockey membership to:  

USA Hockey
c/o K&K Insurance Group - Claims Dept.
1712 Magnavox Way
P.O. Box 2338
Fort Wayne, IN  46801-2338  

For more information, please contact your affiliate's Associate Risk Manager above.

A Special Events Sanction can be obtained for association activities not covered under "on-ice" sanctioning. Please refer to the Summary of Insurance Coverages for Members, FAQ.  Special Events Sanctions are approved by Kelly Grover, Rocky Mountain District Risk Manager.

Special Events Sanction Form