Claims Information

• 1st Report of Injury Form
• Temporary Disability Form
• Supplemental Disability Form
• Accidential Death Form
• Dismemberment/Paralysis Form

How to File a Claim – English
How to File a Claim - Spanish

Procedures following an injury:

• Report your injury immediately to a racetrack representative
• Forms are available at the track; MOC Insurance Services; AIG Insurance or online at www.mocins.com
• A claim form must be completed and signed for all injuries.
• Be sure to include your current contact information as we must be able to contact you to process your claim. Your phone number with area code, mailing address and cell phone numbers are needed.
• Provide an accurate description of the injury and how it occurred and indicate if medical attention was necessary.

Send completed forms to:

MOC Insurance Service
44 Montgomery Street, 17th Floor
San Francisco, CA 94104

Or
Fax to: (415) 957-0577

All hospital, physicians, prescription, ambulance or rehabilitation bills should be mailed to the insurance carrier for payment:

AIG Claims
Attention: Accident and Health Claims Division
P.O. Box 15701
Wilmington, DE 19850-5701

*The policy number starts with SRG and can be found on the top of the claim form.

FAQ

• Temporary Disability payments may be available to you while you are unable to work due to the on-track injury. Temporary Disability payments have a 7 day waiting period following the date of your injury, and will continue until you are medically released to return to racing or up to 104 weeks.
• In order for AIG to process your disability payments, a completed Temporary Disability Form is required. The injured jockey fills out the first page and the doctor completes and signs the second page. The sooner the completed form is returned the sooner payments can start.
• If your disability continues for more than 4 weeks, you and your doctor need to complete a Supplemental Disability Form to provide us with an update on your work status. Otherwise, disability payments could be suspended.
• The disability forms as well as the claim forms can be provided by a racetrack representative, MOC Insurance Services, AIG Insurance or online at www.mocins.com

Will my medical bills be paid?

• Medical Expenses: All necessary treatments are covered, as long as you are a licensed Jockey injured during a covered activity. Make sure you provide your doctor or clinic with the insurance information: AIG Insurance billing address, phone number 1-800-551-0824 and Policy number (SRG#).
• Prescription Drugs: You can request reimbursement for prescription drugs prescribed by your doctor for treatment related to your on-track accident. Over the counter medications are not covered.
• When submitting copies of pharmacy receipts for reimbursement, you need to make sure you write your name, the date of the accident and the name of the racetrack on your receipt.
• If you cannot afford your prescribed medication, please ask the pharmacy if they are willing to bill AIG Claims directly.

Contact Us

John Patrick Unick - President Thoroughbred Racing Division
Phone: (415) 357-9219
Fax: (415) 957-0577
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Sara Przemielewski - Manager
Phone: (415) 357-9234
Fax: (415) 957-0577
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Frankie Spitaleri - Account Executive
Phone: (415) 357-9229
Fax: (415) 957-0577
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Dilcia Giron - Claims Representative
Phone: (415) 357-9212
Fax: (415) 957-0577
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