Mlmic application 2026

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4.8 out of 5

171 votes

The document is an application for Employee Professional Liability Insurance Coverage specifically for Allied Healthcare Providers, detailing eligibility requirements, application instructions, and necessary information to be provided by the applicant. It outlines the coverage limits, conditions for insurance issuance, and the need for a primary employer designation. The document also includes sections for personal information, professional training, insurance history, and authorization for information release.

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Click ‘Get Form’ to open the mlmic application in the editor.
Begin by filling in your personal information in Section 1. Include your last name, first name, middle name, home address, social security number, date of birth, and contact numbers.
In Section 2, specify the desired effective date for your insurance coverage. Ensure this is at least one day after submitting your application.
Proceed to Section 3 to provide details about your primary employer. Fill in their mailing address and select the type of practice they operate.
Complete Section 4 by selecting your professional capacity from the list provided. If applicable, add any additional titles.
In Sections 5 through 10, provide information regarding your professional training, licensing status, and any previous insurance history as required.
Finally, review all entries for accuracy before signing and dating the application at the end. Ensure that both you and your employer sign where indicated.

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Versions	Form popularity	Fillable & printable
2022	4.9 Satisfied (49 Votes)
2021	4.8 Satisfied (45 Votes)
2021	4.8 Satisfied (39 Votes)
2021	4.8 Satisfied (34 Votes)
2020	4.3 Satisfied (61 Votes)
2020	4.1 Satisfied (43 Votes)
2020	4.8 Satisfied (149 Votes)
2020	4.8 Satisfied (151 Votes)
2020	4.4 Satisfied (20 Votes)
2019	4.3 Satisfied (55 Votes)
2019	4.9 Satisfied (57 Votes)
2019	4.8 Satisfied (147 Votes)
2018	4.8 Satisfied (134 Votes)
2018	4.8 Satisfied (91 Votes)
2018	4.3 Satisfied (41 Votes)

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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 is the mission statement of the MLMIC?

Fax to: (212) 300-9388.

How do I report a claim to MLMIC?

Our mission: MLMICs mission is to provide Service Like No Other. As a proud member of the Berkshire Hathaway family, MLMIC is the leading medical liability insurer in New York. Weve earned this distinction by pairing the highest quality insurance products with long-term stability.

What does Mlmic stand for?

MEDICAL LIABILITY MUTUAL INSURANCE COMPANY.

What does MLMIC stand for?

Call (800) ASK-MLMIC. Claims or incidents may be reported to any of our Claim Offices. A representative will personally speak with you and obtain the pertinent information. Our representative will direct you to the correct Claim Office and advise you of the claims personnel assigned to your case.