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Physicians and Surgeons Application for Claims - KAMMCO

Physicians and Surgeons Application for Claims - KAMMCO 2026

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4.8 out of 5

177 votes

The document is an application form for Non-Physician Healthcare Professionals seeking Claims-Made Professional Liability Insurance from KAMMCO. It includes instructions for completing the application, required information about the applicant's professional background, coverage requests, and underwriting questions. Specific sections address Kansas state requirements for certain healthcare providers regarding participation in the Kansas Health Care Stabilization Fund. The document also contains a claim information worksheet and supplemental questionnaires for telemedicine practices.

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Click ‘Get Form’ to open the Physicians and Surgeons Application for Claims - KAMMCO in our platform.
Begin by filling out Section A: Applicant Information. Enter your full name, gender, employer details, and contact information accurately.
Proceed to Section B: Professional Coverage. Specify your professional occupation from the provided list and ensure you include any required certifications.
In Section C: Requested Coverage, indicate your existing form of insurance and provide details about your coverage for the past five years.
Complete Section E: Education / Training / Work Experience by detailing your highest level of education, licensure status, and work history over the last five years.
Review Sections F through H carefully, answering all underwriting questions truthfully. Use the Comments section if additional space is needed.
Finally, sign and date the application in the designated area before submitting it via email or fax as instructed.

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Versions	Form popularity	Fillable & printable
2020	4.8 Satisfied (177 Votes)
2018	4.4 Satisfied (69 Votes)

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What does kammco stand for?

KAMMCO is a Kansas domestic mutual insurance company formed in 1989 by the Kansas Medical Society to insure its members for medical professional liability and related lines of insurance.

How much does malpractice insurance cost on average?

How to Get Malpractice Insurance If its your first time purchasing malpractice insurance, follow these steps to find the right coverage for your needs: Identify Your Coverage Needs with Proliability. Select Your Profession and Coverage Options. Get a Free Quote. Compare Coverage Options. Submit an Application.

What are the two types of malpractice insurance?

The cost of medical malpractice insurance varies depending on your specialty, the state in which you practice, and the amount of coverage you need. Average annual malpractice insurance premiums range from $4k to $12k, though surgeons in some states pay as high as $50k and OB/GYNS may pay in excess of $200,000.

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How to obtain malpractice insurance?

Depending on the location and nature of your practice, you can purchase an individual or group policy from a traditional private insurer, obtain a policy through a medical risk retention group (RRG), or obtain coverage provided as part of a policy held by an employer such as a hospital.

Physicians and Surgeons Application for Claims - KAMMCO 2026

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