COVID-19: See how MLMIC is supporting the Medical community. . Vaccine Resources. Menu Search WHY MLMIC Apply Now Download an application as an Adobe PDF file that you can complete and return. Please refer to our Completion and Delivery Instructions prior to opening any of the applications on this page. Physicians and Surgeons: Application for Physicians and Surgeons Professional Liability Insurance Application for Legal Defense Costs Coverage Supplemental Application for Bariatric Surgeons Supplemental Application for Part Time Practice Policy Administrator Designation and/or Change Form Application for Excess Professional Liability Insurance Physicians/Surgeons Professional Entity: Application for Physicians/Surgeons Professional Entity – Professional Liability Insurance Physician Assistants, Specialist Assistants, Nurse Practitioners, Midwives and Nurse Anesthetists: Application for Employee Professional Liability Insurance Other Health Care Providers: Application for Employee Professional Liability Insurance Dentists: There are 3 easy ways to apply for MLMIC dental professional liability coverage. Online Start or complete an application at the MLMIC Insurance Company rapid application portal. APPLY ONLINE Mail (or Email/Fax) Download the Application for Dentists Professional Liability Insurance and return the completed application to MLMIC. Follow the Completion and Delivery Instructions for details on submitting your application. Part time practitioners must also submit a Supplemental Application for Part Time Practice. Phone Need help? Give us a call at 800-ASK-MLMIC (800-275-6564). Hospitals and Groups: Contact a MLMIC representative today. REQUEST A QUOTE About MLMIC Annual Report Ask a Specialist Careers Contact MLMIC Document Request Medical Malpractice Insurance Cost APPLY NOW MLMIC Home Page MLMIC Insider Payment Information Professional Societies & Associations Report a Claim Stress Resource Center Download the MLMIC Insurance Company mobile app today! RATED A+ BY A.M. BEST PROUDLY ENDORSED BY MORE THAN 70 STATE, COUNTY MEDICAL AND SPECIALTY SOCIETIES Copyright © 2021 MLMIC Insurance Company. All rights reserved. All references to MLMIC refer to MLMIC Insurance Company, Two Park Avenue, New York, NY 10016. Apple and the Apple Logo are registered trademarks of Apple Inc. Google Play and the Google Play logo are trademarks of Google LLC. Privacy Policy Terms & Conditions