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(This is an application for a claims made policy

(This is an application for a claims made policy 2026

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180 votes

The document is an application form for Insurance Broker's Professional Liability Insurance, specifically designed for newly recruited SIAA members. It outlines the necessary information required from applicants, including agency details, ownership structure, revenue projections, and office procedures. The application emphasizes the importance of complete and accurate responses to avoid rejection and highlights that coverage is subject to the terms of a claims-made policy.

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How to Use or Fill Out This Application for a Claims Made Policy

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Click 'Get Form' to open it in the editor.
Begin by entering the Legal Name of your Agency and any DBA (Doing Business As) names. Ensure all information is complete and legible.
Fill in your agency's address, including city, county, state, and zip code. Provide a contact name along with phone and fax numbers.
Indicate the type of applicant (Individual, Partnership, Corporation/LLC) and provide the establishment date along with years of experience.
List the total number of partners, staff, and office brokers. If applicable, indicate if you want to cover 1099 independent contractors under this policy.
Complete sections regarding ownership percentages and business placements. Ensure that totals equal 100% where required.
Provide revenue estimates for both the last 12 months and projections for the next year. Include details about current E&O carrier limits and deductibles.
Review all questions carefully, especially those regarding past claims or disciplinary actions. Provide detailed explanations on separate sheets if necessary.
Finally, sign the application as an owner or authorized representative to confirm that all information is accurate before submission.

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What triggers an insurance policy?

Under an occurrence policy, the occurrence of injury or damage is the trigger; liability will be covered under that policy if the injury or damage occurred during the policy period.

What is the claims made trigger in commercial general liability policies based on?

Unlike occurrence-based policies, which cover events that happen during the policy period, claims-made policies require both the alleged incident and the claim to occur within the policys timeframe. These policies often have a retroactive date. Claims arising from incidents before this date may not be covered.

What is the term for the process of making a claim under an insurance policy?

An insurance claim is a formal request from the policyholder to their insurance company asking for payment after a covered incident, such as a hospital stay, a natural disaster, theft, and more.

What does it mean to have a claims-made policy?

What is a claims-made policy? With a claims-made policy, your coverage only kicks in when you file a claim during the policy period. As long as an insurable event happened after the policys retroactive date, your insurer should provide coverage. A claims-made policy covers claims filed while your insurance is active.

What triggers an insurance claim?

The occurrence of the loss, such as a fire, theft, or natural disaster, triggers the coverage under the policy.

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What triggers a claims-made policy?

A claims-made coverage trigger obligates an insurer to defend and/or pay a claim on an insureds behalf if the claim is first made against the insured during the period in which the policy is in force.

What is the trigger of a claims-made policy?

The Claims-Made Trigger is the effective date of the insurance policy and is typically the date that the policy was issued, renewed or amended. The Claims-Made Trigger is usually expressed as the policys retroactive date.

Why are some policy claims-made?

The occurrence form is the original contract created by the insurance industry. The claims-made form was devised later in response to long-tail claims such as asbestosis that can take 20-30 years to manifest itself. It protects the insurance company from claims reported decades after the policy has expired.

(This is an application for a claims made policy 2026

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How to Use or Fill Out This Application for a Claims Made Policy