Allied Healthcare Professionals Application For Professional Liability Coverage

ENCLOSED ARE THE FORMS NECESSARY FOR

ALLIED HEALTHCARE PROFESSIONALS APPLICATION

Thank you for choosing to apply with TEXAS MEDICAL INSURANCE COMPANY (TMIC). We know that you have choices when purchasing liability insurance to protect your reputation and your medical practice. We appreciate the opportunity to earn your business.

When submitting your application, please:

Complete and sign the application.
Complete the Claim/Suit Information Addendum if a professional liability claim or suit has ever been brought against you.
Enclose the following:

A copy of your current declarations page

Drag files here or use the button below. Remove File

Select File

Current loss run(s) for a five-year period

Drag files here or use the button below. Remove File

Select File

A copy of active training certificates or licensures

Drag files here or use the button below. Remove File

Select Files

Any additional documentation requested in the application

Drag files here or use the button below. Remove File

Select Files

We want to make your application experience as simple as possible. If you have any questions during the process, we will be happy to assist you. Call 1-800-580-8658 and ask for Underwriting or visit our website at https://www.tmic.org

Receipt of application and/or premium payment does not constitute a binder or acceptance of coverage.