Get a Quote

 

We are only able to offer insurance to Connecticut risk currently.

  
 
Home   Get A Quote   Contact Us
     
Name
Address 1
Address 2
City
County:
State
Zip Code
Email Address
Speciality
   
Do you perform surgery: Major Minor


Claims Made Occurrence
Retroactive Date


Board Certified: Eligible:

Type of Practice
If other, describe:
If practice is limited, breifly describe below:

Current Carrier
Requested effective date
Expiration Date

Limits of Liability Desired:  
Per Occurrence:
Aggregate:

Have you ever had a Medical Malpractice Claim? Yes No

 

If yes, give date of claim, a short description and settlement/reserve amount for each claim, if applicable.


Completing the questions above will result in an "indication" of premium. A complete application is required and must be accepted by underwriters before a final quotation can be provided or coverage can be initiated. Final premiums may be more or less than initially indicated based upon the information provided.

If you prefer, you may contact us by phone at (860) 450-7243.

 

 

Home | Get A Quote | Contact Us

Copyright © 2001 Stonehill Insurance Brokers, Inc.