Physicians Insurance, A Mutual Company
The premier provider of medical professional liability insurance for physicians,
other medical professionals, clinics, and hospitals in Washington, Oregon, and Idaho.

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Employment Practices Liability - Quote Request
Please complete the form below.

(* indicates a required field)



Contact name: *
Phone: *
Fax:  
E-Mail: *
 
Name of Organization: *
Business type:  
 
Address: *
City: *
State: *
Zip code: *
 
Number of employees:
Full time *
Part time *
Seasonal/Temporary *
 
Desired limits:    $300,000
 $500,000
 $1,000,000
 
Requested effective date  
 
Has the organization experienced any employment-related claims/incidents? *  Yes
 No
 
Has the number of employees decreased by more than 25% over the last 24 months? *  Yes
 No
 
Have any senior management been terminated within the last 18 months? *  Yes
 No
 
Does the organization comply with all mandatory federal & state postings? *  Yes
 No
 
Comments:
 



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