Malpractice Insurance | Professional Liability Quote

Contact Name
First Last
Full Legal Name of Applicant Firm
Mailing Address
Street Address Address Line 2 City State ZIP Code
Do you have a seperate physical address
Physical Address
Street Address Address Line 2 City State ZIP Code
Phone
Email
Date Firm Established
MM slash DD slash YYYY
Applicant Firm is a (an)
Describe Other
Indentify the attorney who handles your cases in your absense.
Please include Name, City/State, and Phone Number
Are you engaged in the full-time, private practice of law?
Other than Yellow Page Listings, does the your Firm advertise?
Please indicate in which of the following media
- Fliers
- Internet
- Newspapers
- Periodicals
- Radio
- Television
- Yellow Pages Ad

AREAS OF PRACTICE
Based on the Applicant Firm’s gross revenue for the last fiscal year, indicate the percentage of revenue derived from the following areas of practice.
Please select Area's of Practice
Administrative
Admiralty/Maritime – Defense
Admiralty/Maritime – Plaintiff
Antitrust/Trade Regulation
Arbitration/Mediation
Aviation
Banking/Financial Institutions
Bankruptcy
BI/PI – Defense
BI/PI – Plaintiff
Civil Rights/Discrimination
Collection/Repossession/Foreclosures
Communication/FCC
Copyright/Trademark (Not Patent)
Corporate – Formation/Alteration
Corporate – General
Criminal
Family Law
Eminent Domain
Employee Benefit Plans/ERISA
Entertainment/Sports
Environmental – General
Environmental – Litigation
Foreign (Non-U.S. Law)/International
Healthcare
Immigration
Insurance
Investment Counseling/Money Management
Loans
Labor Law – Management
Labor Law – Union
Labor Litigation- Defense
Labor Litigation – Plaintiff
Litigation – Commercial – Defense
Litigation – Commercial – Plaintiff
Mergers and Acquisitions
Municipal/Governmental – Zoning & Planning
Municipal/Governmental – Other (Not Bonds)
Oil/Gas/Minerals
Patent
Public Utilities
Real Estate
School Law
Securities/Bonds/Secured Transactions
Social Security/Elder Law
Taxation
Water Rights
Wills/Estate Planning/Probate/Trusts
Workers Compensation – Defense
Workers Compensation – Plaintiff
Other

Please describe and list percentage.

INSURANCE COVERAGE HISTORY
List the Lawyers Professional Liability Insurance coverage carried by the Applicant Firm or predecessor firms during the past five (5) years, including any periods without coverage. If no past coverage, indicate NONE.
Please list effective date, expiration date, insurance company, limit of liability, deductible, and the number of attorneys
Provide the date of the Applicant Firm’s first claims made policy (maintained without interruption to date)
MM slash DD slash YYYY

Can be found on your Declarations page as a retroactive date.
Does the Applicant Firm’s current policy contain a prior acts limitation or retroactive date applicable to the Applicant Firm or any individual attorney?
Does the Applicant Firm’s current policy have any endorsements or exclusions or coverage limitations tailored specifically to the Applicant Firm?
Has the Applicant Firm or any attorney for whom coverage is sought ever purchased an extended reporting period endorsement?
In the past five (5) years, has the Applicant Firm or any of its attorneys ever had professional liability insurance or similar insurance declined, cancelled or non-renewed?
In the past five (5) years, has any professional liability claim or suit ever been made against the Applicant Firm or any predecessor firm or any current or former attorney of the Applicant Firm or predecessor firm?
Does any attorney for whom coverage is sought know of any incident, act, error or omission that could result in a claim or suit against the Applicant Firm or any predecessor firm or any of the current or former attorneys of the Applicant Firm?
Has any attorney for whom coverage is sought been refused admission to practice, disbarred, suspended, reprimanded, sanctioned, or held in contempt by any court, administrative agency or regulatory body or been the subject of a disciplinary complaint made to any of the aforementioned entities?

Lawyers Malpractice Insurance

Lawyers Malpractice Insurance Quote

Step 1 of 7

Provide the total number of non-attorney employees utilized by the Applicant Firm as:

Indicate gross annual revenue for the Applicant Firm:

ATTORNEY INFORMATION

AREAS OF PRACTICE

SYSTEMS AND PROCEDURES

INSURANCE COVERAGE HISTORY

Administrative
Admiralty/Maritime – Defense
Admiralty/Maritime – Plaintiff
Antitrust/Trade Regulation
Arbitration/Mediation
Aviation
Banking/Financial Institutions
Bankruptcy
BI/PI – Defense
BI/PI – Plaintiff
Civil Rights/Discrimination
Collection/Repossession/Foreclosures
Communication/FCC
Copyright/Trademark (Not Patent)
Corporate – Formation/Alteration
Corporate – General
Criminal
Family Law
Eminent Domain
Employee Benefit Plans/ERISA
Entertainment/Sports
Environmental – General
Environmental – Litigation
Foreign (Non-U.S. Law)/International
Healthcare
Immigration
Insurance
Investment Counseling/Money Management
Loans
Labor Law – Management
Labor Law – Union
Labor Litigation- Defense
Labor Litigation – Plaintiff
Litigation – Commercial – Defense
Litigation – Commercial – Plaintiff
Mergers and Acquisitions
Municipal/Governmental – Zoning & Planning
Municipal/Governmental – Other (Not Bonds)
Oil/Gas/Minerals
Patent
Public Utilities
Real Estate
School Law
Securities/Bonds/Secured Transactions
Social Security/Elder Law
Taxation
Water Rights
Wills/Estate Planning/Probate/Trusts
Workers Compensation – Defense
Workers Compensation – Plaintiff
Other