⬡ Professional Liability Insurance

Medical Professionals
Need Protection Too

Comprehensive malpractice coverage designed specifically for your specialty. Get a quote in minutes.

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Physician's Assistant

Coverage for PA-C professionals

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Nurse Practitioner

APRN & NP liability plans

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CRNAs

Nurse Anesthetist coverage

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Medical Director

Director & oversight liability

Step 1 of 7

General Information

Tell us a bit about where and when you need coverage.

What state do you live in? *

Desired effective date *

/ /

Step 2 of 7

Coverage Specifics

Customize your coverage details.

Choose your coverage type *

Are you a member of a Professional Association?

Do you work more than 20 hours per week? *

Step 3 of 7

Specialty Selection

Please select all applicable specialties.

Non-Surgical Specialties

Surgical Specialties

Total Premium Amount

$2,170.00

Annual Premium · Based on your selections

💳 Pay in Full

$2,170.00

One-time credit card payment
No additional fees

📅 Pay with Financing

$187.58/mo

10 installments
$434.00 Down · $139.80 Finance Charge

Step 5 of 7

Personal Information

We need some details to complete your application.

First Name *

M.I.

Last Name *

Date of Birth *

Phone Number *

Street Address *

City *

State *

Zip Code *

Email Address *

State of Practice

Professional License # *

Graduation Year *

Step 6 of 7

Risk Assessment

Please answer the following questions honestly.

Have you ever been indicted for, or convicted of, any criminal act or violation of any law?

Please upload supporting documentation (PDF):

📎 Upload PDF

Have your hospital privileges or DEA license ever been refused, suspended, revoked, or voluntarily surrendered?

Please upload supporting documentation (PDF):

📎 Upload PDF

Has any previous insurance been declined, canceled, or non-renewed?

Please provide details:

Date

Explanation

Have you held professional liability insurance in the past?

Please provide your prior coverage details:

Insurance Carrier

Coverage Type

Policy Number

Limits

Effective Date

Retro Date

Step 7 of 7

Agreement & Payment

Review the agreement, sign, and complete your payment.

Subscriber Agreement

SUBSCRIBER AGREEMENT — Physicians Insurance Services

This Subscriber Agreement ("Agreement") is entered into between the Applicant ("Subscriber") and Physicians Insurance Services ("PIS"), acting as program administrator.

1. Coverage. PIS agrees to provide professional liability insurance coverage as described in the policy declarations, subject to all terms, conditions, and exclusions of the policy.

2. Premium Payment. The Subscriber agrees to pay all premiums when due. Failure to pay premiums may result in cancellation of coverage.

3. Duties of the Subscriber. The Subscriber agrees to: (a) provide truthful and complete information on this application; (b) promptly report any claims or potential claims; (c) cooperate fully with PIS and the insurance carrier in the investigation and defense of any claim.

4. Material Misrepresentation. Any material misrepresentation or omission in this application may void the policy and result in denial of coverage.

5. Cancellation. Either party may cancel this agreement with 30 days written notice. Earned premium is non-refundable.

6. Governing Law. This agreement shall be governed by the laws of the state in which the Subscriber practices.

7. Acknowledgment. By signing below, the Subscriber acknowledges that they have read and understood all terms of this agreement and that all information provided in this application is true and correct to the best of their knowledge.

E-Signature (Type Full Name) *

Today's Date

Payment Method

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Card Number *

Exp Date *

CVV *

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Application Submitted Successfully!

Congratulations on your policy. Your coverage details are below.

📋 Policy Summary

Carrier Kristen Allen Underwriting

Policy Holder —

Profession —

Coverage Type —

Effective Date —

State —

Premium Paid $2,170.00

Policy Number —

Medical ProfessionalsNeed Protection Too