Incident Reporting Instructions
Please see the Contact page for the name and contact information of our Insurance Coordinator.
Whenever An Accident Occurs
An Incident Report form must be completed immediately after an accident occurs and mailed or faxed to American Specialty Insurance & Risk Services, Inc. or submitted via web form as indicated below. This holds true whether the person involved is a participant or a spectator, or whether or not you feel the incident will result in a claim.
Although you may not have sufficient information to initially answer all questions, it is important that the form be completed as fully as possible at the time of the accident. Do not delay sending in the report form; an incomplete form is better than none at all. Be certain to include your name and daytime telephone number where indicated on the form.
The form contains sections to capture information regarding injury to persons, damage to property, and accidents involving autos. If you have any questions or need assistance regarding the completion of the Incident Report form, please call American Specialty at (800) 566-7941.
Mail or fax the completed Incident Report to:American Specialty Insurance & Risk Services, Inc.
7609 W. Jefferson Blvd, Suite 150
Fort Wayne, Indiana 46804-4133
Fax: (260) 969-4729
and send a copy to the club either by email to email@example.com or postal mail to:Alan Forkosh
Grizzly Peak Cyclists
33 Moss Av, #204
Oakland, CA 94610
Get the Incident Report form in PDF format, or you can submit a report via the web. If you use the web form, please also print a copy and send it to the club address above. The URL for the web report appears to be unstable, so just go to the insurance company home page and follow the "Report an Incident" link under "Claims Management".
If you want more information about the club's insurance coverage, please see the insurance company home page.
In Case Of Serious Injury
IN ADDITION, IN CASE OF SERIOUS INJURY TO A PARTICIPANT OR A SPECTATOR, it is important that you immediately notify American Specialty by calling (800) 566-7941 (if after standard business hours, simply follow the automated instructions for emergency claims reporting). This hotline is active 24 hours a day.
Coverage for Members
Our insurance policy provides, for GPC members: "Accident Medical Coverage: $10,000 per person per accident excess of a $500 per claim deductible and excess of any other valid and collectible insurance." See our member benefits page for more discussion. If a member needs to use this coverage, the first step is to contact our Insurance Coordinator and report the incident as described above.