How to Apply

Getting coverage in place isn't difficult or complicated.

Please have the following information available to complete your application.

  • Licensure Information – A copy of each active state license you hold.
  • Previous Insurance Information – A copy of your current Declarations Page (if you are currently insured).

Click below to select the application you need:

Applications

  1. Physicians and Surgeons Professional Liability Claims Made Application
  2. Corporation and Partnership Professional Liability Claims Made Application
  3. Physicians and Surgeons Part Time Credit Application
  4. Physicians and Surgeons Professional Liability Claims Made Bridge Application
  5. Plysicians and Surgeons Locum Tenens Application

Supplements

  1. Claim Information Form
  2. CRNA/AA Roster Addendum
  3. Bariatrics Supplemental Application
  4. Pain Management Supplemental Application
  5. Delegation of Certain Policy Rights (all states except KS)
  6. Delegation of Certain Policy Rights Removal (all states except KS)
  7. Physician Retainer Practices Supplemental Application
  8. Physician Home Health Care Supplemental Application
  9. Physician Telemedicine Telehealth Supplemental Application
  10. Nurse Practitioner Physician Assistant Supplemental Questionnaire
  11. Physician Roster Supplement (Iowa only)
  • Complete, print and sign the application.
  • Please follow the submission instructions found on the PSIC Physician application.
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