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Colleges & Universities Students & Participants Liability Programs
Intercollegiate Sports
Claims

Download, print, and complete the appropriate form below to submit an Intercollegiate Sports claim.

Mail completed forms to:
Summit America Insurance Services, Inc
Attn: Claims Division
PO Box 25936
Overland Park, KS 66225

Or fax to:
913-327-7520

A representative of our staff will respond to your request promptly.

Mutual of Omaha Sports Claim Form -
Kansas City Office
(312K PDF)*
• download now
Mutual of Omaha Sports Claim Form -
Salt Lake City Office
(237K PDF)*
• download now
Generic Sports Claim Form -
Kansas City Office
(149K PDF)*
• download now
Generic Sports Claim Form -
Salt Lake City Office
(148K PDF)*
• download now
Aetna Sports Claim Form -
Kansas City Office
(146K PDF)*
• download now
Aetna Sports Claim Form -
Salt Lake City Office
(135K PDF)*
• download now
Authorization to Release Information
(24K PDF)*
• download now
Mutual of Omaha Sports Claim Form - Spanish
(57K PDF)*
• download now
Submit a Claims question
* PDFs require Adobe Reader v.6.0 or later