Submit for a Quote

For practices whose premiums are less than $25,000 annually, please submit the following information for a quote:

  • Declarations Pages of current policy(ies) to include: Name, Address(es), FEIN(s), Payroll, Class Code(s).

  • Are officers and owners included or excluded from coverage? Yes / No / Not Sure

For practices whose premiums are more than $25,000 annually, please submit the following information for a quote:

  • Declarations Pages of current policy(ies) to include: Name, Address(es), FEIN(s), Payroll, Class Code(s).

  • Are officers and owners included or excluded from coverage? Yes / No / Not Sure

  • Claims History, 3 years of Loss Runs.
  • Historical Payroll, 3 years of Year-end Payroll numbers.

Once we receive your submission, our underwriting team will be in touch with any additional questions!

We are here for you!