IIA    

Office Information:
1620 Niles Cortland Road N.E.
Warren, Ohio 44484
Ph: (330) 609-5252
Fax: (330) 609-5254
Office Information:
1620 Niles Cortland Road N.E.
Warren, Ohio 44484
Ph: (330) 609-5252
Fax: (330) 609-5254

1620 Niles Cortland Road N.E.
Warren, Ohio 44484
Phone: (330) 609-5252
Fax: (330) 609-5254

Medical Malpractice

Medical malpractice insurance covers doctors and other professionals in the medical field for liability claims arising from their treatment of patients.

Please contact us or submit the form below to request a free indication. Our agents will work with you to identify your needs and pinpoint your areas of risk to make sure you have optimal coverage.

 

Policy Information Form

Physician/Group Name:
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Business Address:
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Zip:
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Phone:
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Fax:
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Email:
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Contact Person (i.e. office mgr.)
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Specialty:
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Years In Practice:
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Hours Worked Per Week:
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Expiration Date Of Policy:
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Current Carrier:
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Current Premium:
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Are You Currently Receiving Special Discounts?
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Type (teaching, part-time, ect.)
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Coverage From:
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Retroactive Date:
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Current Limits ($):
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each claim
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aggregate
Separate Corporation Limits:
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Do You Have Existing Claims?
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Please include information for all claims below. (whether settled, dismissed, or closed without payment, including 180 day letters)
Description Of Claims:
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Submit:

Policy Information Form

Physician/Group Name:
Invalid Input

Business Address:
Invalid Input

State:
Invalid Input

Zip:
Invalid Input

Phone:
Invalid Input

Fax:
Invalid Input

Email:
Invalid Input

Contact Person (i.e. office mgr.)
Invalid Input

Specialty:
Invalid Input

Years In Practice:
Invalid Input

Hours Worked Per Week:
Invalid Input

Expiration Date Of Policy:
Invalid Input

Current Carrier:
Invalid Input

Current Premium:
Invalid Input

Are You Currently Receiving Special Discounts?
Invalid Input

Type (teaching, part-time, ect.)
Invalid Input

Coverage From:
Invalid Input

Retroactive Date:
Invalid Input

Current Limits ($):
Invalid Input

each claim

Invalid Input

aggregate

Separate Corporation Limits:
Invalid Input

Do You Have Existing Claims?
Invalid Input

Please include information for all claims below. (whether settled, dismissed, or closed without payment, including 180 day letters)

Description Of Claims:
Invalid Input

CAPTCHA:(*)
CAPTCHA:   RefreshInvalid Input

Submit: