Medical Professional Liability Resources

Loss Run Requests

Please submit your loss run requests to Liz Vatuna at lvatuna@rockbridgeins.com.

Credentialing

Please submit your credentialing via fax to 832-494-2349 or email to credentialing@rockbridgeins.com.

Applications

Listed below are links to download our applications. If you have questions about which application is appropriate for a given risk, please contact one of our underwriters for assistance.

Physician-Surgeon Application
Physician-Surgeon Renewal Application
Abortion Clinic Application
Corporate Application
Emergency Room/Ambulatory Care Application
Locum Tenens Application
Medical Spa Application
Multi-Practice Clinic or Large Group Practice Application
Surgery Center Application
Claim Supplement
Recovering Physicians Supplemental Application
Teleradiology Supplemental Application
Weight Control Supplemental Application

Policy Forms

Listed below are links to download our most commonly used policy forms. If you are looking for further customization of your insured's policy, please contact one of our underwriters. We look forward to discussing your client's needs.

Policies
Medical Professional Liability Insurance Policy (Scheduled Physicians)
Medical Professional Liability Insurance Policy (Physicians Included as Additional Named Insureds)

Declarations
Declarations Medical Professional Liability Policy

Endorsements
Administrative Hearing Coverage Endorsement
Amend Exclusion 6 Endorsement
Broadened Claim Definition Endorsement - 60 Days
Broadened Claim Definition Endorsement - 90 Days
Broadened Claim Definition Endorsement
Cancellation Amendatory Endorsement - 60 Days
Cancellation Amendatory Endorsement - 90 Days
Cancellation Endorsement
Claims Expense in Addition to Limits Amendatory Endorsement
Consent to Settle Endorsement
Consent to Settle Within the Deductible Endorsement
Course of Treatment Endorsement
Deductible Endorsement
Emergency Department Medical Directors Coverage Endorsement
Exercise Extended Reporting Period Endorsement
Extended Claim Definition Endorsement
Extended Reporting Period Endorsement
General Change Endorsement
Insurance Required for Others Endorsement
Limited Extended Reporting Period Endorsement
Limits of Liability Specified by Periods Endorsement
Locum Tenens Endorsement - Scheduled Persons
Locum Tenens Endorsement
Medical Director for the Named Insured and Scheduled Medical Director Coverage Endorsement
Medical Director for the Named Insured Coverage Endorsement
Premium Audit Endorsement
Professional Association - Professional Corporation Liability Endorsement
Scheduled Location Coverage Limitation Endorsement
Scheduled Medical Director Coverage Endorsement
Service of Suite Endorsement
State Specific Claims Expense in Addition to Limits Amendatory Endorsement

Exclusions
Exclusion of Specified Locations, Medical Specialists, Medical Professionals or Loss Events
Insurance Required by Contract Exclusion

Supplemental Forms
No Loss Warranty Letter
California Consent to Settle Waiver - Group
California Consent to Settle Waifer - Individual