Get Individual Application - Tmic.biz

This guide provides a clear and supportive walkthrough for completing the Individual Application for professional liability insurance through Tmic.biz. Each section of the form is detailed to ensure users understand what information is required.

Follow the steps to successfully complete your application.

1. Press the ‘Get Form’ button to access the necessary form online and open it in your preferred editor.
2. Begin with Section I: General Information. Fill in your contact information, including your name, home address, and preferred mailing address. Make sure to provide your telephone numbers accurately.
3. For the insurance coverage section, specify the date you would like your coverage to commence and select your desired professional liability coverage type and limits.
4. In the Insurance History section, provide details of your current insurance, including the insurer's name, policy number, and expiration date. Indicate the basis of your present policy and answer questions regarding any claims or incidents.
5. Move to the Underwriting and Rating Information section. Provide information about your chiropractic education, training, and practice history. Be thorough, listing all relevant details.
6. Complete the Practice Structure and Personnel sections by specifying your practice's organization structure and any licensed chiropractors you employ or supervise.
7. In the Patients section, give estimates of the average number of patients seen per week and the source of patient services. Be open about your practice mix.
8. For any claims, suspensions, or relevant incidents, use the Additional Information section to detail your responses where necessary. Ensure full transparency.
9. Carefully review the Authorization and Representation Statement, ensuring that all information is accurate before signing and dating the application.
10. Once you have completed the application, you can save your changes, download a copy, and choose to print or share the completed form as required.

Complete your Individual Application online today to ensure you have the coverage you need.