Get Professional Liability Insurance Application For - Lockton Medical ...

Filling out the Professional Liability Insurance Application is an essential step for healthcare professionals seeking coverage. This guide will provide you with clear and detailed instructions to complete the application seamlessly online.

Follow the steps to complete the Professional Liability Insurance Application.

1. Press the ‘Get Form’ button to retrieve the application form and open it in your preferred online editor.
2. In Section I, provide your applicant information. Fill in the allied health occupation you are applying for, ensuring to attach any required licenses or certificates if applicable.
3. Complete your personal details including your name, mailing address, city, state, zip code, email address, and both daytime and evening phone numbers. Include your date of birth.
4. Section II requires you to indicate your employment information. Specify your years of relevant experience and whether you are employed, self-employed full-time or part-time, or a student.
5. Answer questions regarding your professional status, including ownership stakes or equity positions related to your employer.
6. List your highest degree and graduation date. Indicate whether your education qualifies you for the occupation for which you are seeking coverage.
7. Continue filling out the professional limits and coverage in Section III. Choose the limits of liability you wish to apply for.
8. In Section IV, select the individual activities for which you are requesting coverage from the provided options.
9. Use Section V to describe any additional insured parties, including their business relationship to you.
10. Answer the warranty questions in Section VI regarding any past licensing issues or malpractice claims.
11. Finally, in Section VII, read through the declaration, sign, and date the application. Provide your method of payment at the end.
12. Once all sections are completed, save any changes made to the application, and proceed to download, print, or share as necessary.

Complete your Professional Liability Insurance Application online to ensure your coverage needs are met.