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(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
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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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A. If your current or previous professional liability insurance was identified in Section 11 as Claims Made, please explain how tail coverage is provided forRead more
The policy may also be claims-made, meaning coverage depends heavily on when the claim is made and reported. A careful review should compare limits
Claims-made liability insurance means an insurance policy providing coverage for the insureds liability for injury, damage, or wrongful act