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July 4, 2008 Brokers Only Search Site Map Links Employment Contact Us Home Insureds Only
If you are a chiropractor, podiatrist or healthcare facility and would like a premium estimate, please contact our Sales Department at
800/717-5333, or .
 
Premium Estimate Request
    Professional Liability Coverage
    Established Solo Physicians & Oral/Maxillofacial Surgeons

Note: At this time, we are only providing professional liability premium estimates in California and Delaware.

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Medical License #
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Check One
I have never had a claim filed against me.
I have had a claim filed against me.
 
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If you belong to a group practice, select the Group Size and
enter the Group Name.
Group Size
Group Name
Practice Location
Same as Mailing Address
City
State
 
Effective Date / /
Limits of Insurance
Part-Time/Full-Time
Medical Specialty
Secondary Specialty
(if applicable)
 
Retroactive (“Nose”) coverage provides protection for claims first made against you after the effective date of coverage with The SCPIE Companies arising out of your acts or omissions prior to the effective date and after the retroactive date of such coverage. If you do not obtain “Nose” coverage, you will have no coverage from The SCPIE Companies for claims arising out of these acts or omissions. If you do not want retroactive coverage, simply mark the checkbox below.
I do not want retroactive coverage.
Retroactive Date / /
 
If you completed your training program within the last 3 years,
tell us the date you started seeing patients.
Practice Start Date / /
 
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