Cal North injury claims are submitted online. If you prefer to file by submitting a hard copy form, you will need to contact Debbie Alvarez at dalvarez@calnorth.org for the appropriate case report/claim form.

Claims Process Overview

Only authorized team officials can completes the online claim form. The team official will need the following information regarding the injured person:

  1. First and Last Name
  2. Complete Mailing Address
  3. Date of Birth (DOB)
  4. Gender
  5. Parent / Legal Guardian’s First and Last Name
  6. Parent / Legal Guardian’s Phone #
  7. Parent / Legal Guardian’s Email Address
  8. Cal North ID #
  9. District #
  10. League #
  11. League Name
  12. Team Name
  13. Type of Event Injured at
  14. Date of the Injury
  15. Description of Injury
  16. Name of Field / facility Where Injury Occurred
  17. City Name Where Injury Occurred

A confirmation email indicating the submission was received will be sent to the team official, the parent, and the state office (DAlvarez@calnorth.org). The emails will be sent from pullenins@pullenins.com.

The state office will review and either approve or deny the claim.

If approved, the parent will receive an email with the claim form and instructions attached as a PDF document. The parent will complete sections VI and VII and email, mail or fax the claim form and other documents to the insurer.

If denied, the parent will receive an email indicating the claim was denied and the reason for the denial.
The insurer will mail a letter to the parents acknowledging receipt of the claim form and will request additional information from the parent, if necessary.

File your injury claim online.