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Group Name
Contact Information
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Tile
Phone
Email
Professional Website
Decision Maker Information
Name
Title
Phone
Email
Primary Practice Location
Address
Address2
City
State
LSA provides coverage outside of Texas.
Click here for the TMLT group quote form.
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Alabama
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Zip Code
Practice county
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Anderson
Andrews
Angelina
Aransas
Archer
Armstrong
Atascosa
Austin
Bailey
Bandera
Bastrop
Baylor
Bee
Bell
Bexar
Blanco
Borden
Bosque
Bowie
Brazoria
Brazos
Brewster
Briscoe
Brooks
Brown
Burleson
Burnet
Caldwell
Calhoun
Callahan
Cameron
Camp
Carson
Cass
Castro
Chambers
Cheroke
Childress
Clay
Cochran
Coke
Coleman
Collin
Collingsworth
Colorado
Comal
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Cooke
Coryell
Cottle
Crane
Crockett
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Culberson
Dallam
Dallas
Dawson
Deaf Smith
Delta
Denton
DeWitt
Dickens
Dimmit
Donley
Duval
Eastland
Ector
Edwards
Ellis
El Paso
Erath
Falls
Fannin
Fayette
Fisher
Floyd
Foard
Fort Bend
Franklin
Freestone
Frio
Gaines
Galveston
Garza
Gillespie
Glasscock
Goliad
Gonzales
Gray
Grayson
Gregg
Grimes
Guadalupe
Hale
Hall
Hamilton
Hansford
Hardeman
Hardin
Harris
Harrison
Hartley
Haskell
Hays
Hemphill
Henderson
Hidalgo
Hill
Hockley
Hood
Hopkins
Houston
Howard
Hudspeth
Hunt
Hutchinson
Irion
Jack
Jackson
Jasper
Jeff Davis
Jefferson
Jim Hogg
Jim Wells
Johnson
Jones
Karnes
Kaufman
Kendall
Kenedy
Kent
Kerr
Kimble
King
Kinney
Kleberg
Knox
Lamar
Lamb
Lampasas
La Salle
Lavaca
Lee
Leon
Liberty
Limestone
Lipscomb
Live Oak
Llano
Loving
Lubbock
Lynn
Madison
Marion
Martin
Mason
Matagorda
Maverick
McCulloch
McLennan
McMullen
Medina
Menard
Midland
Milam
Mills
Mitchell
Montague
Montgomery
Moore
Morris
Motley
Nacogdoches
Navarro
Newton
Nolan
Nueces
Ochiltree
Oldham
Orange
Palo Pinto
Panola
Parker
Parmer
Pecos
Polk
Potter
Presidio
Rains
Randall
Reagan
Real
Red River
Reeves
Refugio
Roberts
Robertson
Rockwall
Runnels
Rusk
Sabine
San Augustine
San Jacinto
San Patricio
San Saba
Schleicher
Scurry
Shackelford
Shelby
Sherman
Smith
Somervell
Starr
Stephens
Sterling
Stonewall
Sutton
Swisher
Tarrant
Taylor
Terrell
Terry
Throckmorton
Titus
Tom Green
Travis
Trinity
Tyler
Upshur
Upton
Uvalde
Val Verde
Van Zandt
Victoria
Walker
Waller
Ward
Washington
Webb
Wharton
Wheeler
Wichita
Wilbarger
Willacy
Williamson
Wilson
Winkler
Wise
Wood
Yoakum
Young
Zapata
Zavala
Are there multiple practice locations?
Yes
No
If so, please list
Policy Information
Total Number of Physicians in Group
Total number of allied health care professionals in the group
Current carrier
Select one...
Academics
Accord
Admiral
Advocate MD
Agent
American Healthcare Indemnity
American Professional Agency Inc.
APA
APAC
API
Applied Medico-Legal Solutions
Arch Insurance Group
Ascension
Aspen
Banc Insure
Bare
Caitlin
Canadian Medical Protective Association
Capitol Specialty Insurance
Capson
Care
Centurion
CHUBB
Clarendon
CNA
COPIC
Coverys
Darwin
Dentist Advantage
Doctors and Surgeons National RRG, Inc.
Doctors Company
Doctors Direct Insurance (ddi)
Doctors First, Inc.
Evanston
Everest
Executive Risk
Fairway
Farmers
FD Insurance
Fellow
Fireman's Fund/Interstate/Chicago
First Year
Fortress Insurance Company
FPIE-Florida Physician Ins Exchange
Freedom Specialty
Galen Insurance Company
General Star
Government/VA
Group Carrier Unknown
Hallmark Pro Medical Professional Liability
Hartford
Hudson
ICA
Ironshore Specialty Insurance Company
ISMIE Mutual Insurance
James River
JUA-Joint Underwriters Assoc
Kinsale
Lammico
Lancet Indemnity
Landmark
Lexington
Lloyds of London
MagMutual
MCIC Vermont
MD Advantage
Medical Assurance
Medical Insurance Exchange of California (MIEC)
Medical Liability Insurance Company of America
Medical Protective
Medicus
Med Mad Direct
MICA
MIIX
Military
Missouri Doctors Mutual Insurance Company
Missouri Professionals Mutual
Moonlighting
Mutual Assurance
National Casualty
National Fire and Marine Insurance Company
National Health
National Union Fire Ins Co of Pittsburgh
Norcal
Not Currently Working
Oceanus
OHA Insurance Solutions
OMIC
OneBeacon
Other
Out of State
PHICO
Physicians Casualty, RRG
Physicians Mutual
Physicians Professional Indemnity Association (PPIA)
PLICO
Podiatry Insurance Company of America (PICA)
Preferred Phys
Preferred Professional Insurance Company
Princeton (MedPro)
Pro Assurance
Professionals Advocate Insurance
Professional Solutions Insurance Company (PSIC)
Resident
Retired
Risk Retention Group
Self Insurance Program
St. Paul
Star
Start-up
State Volunteer Mutual Insurance Company (SVMIC)
Steadfast
TDC
The Doctors Company
The Hospital Insurance Exchange
THIE Zurich
TIG
TMIC
TMLT
Travellers
Truck Ins Exchange
United National
Unknown
Various
Western Indemnity
Other...
Is this a new start-up practice?
Yes
No
Policy Effective Date
Policy Type
Claims Made
Occurrence
Entity Retroactive Date for prior acts coverage?
Claims Made Limits (Amount Per Claim/Aggregate Per Year)
$100,000 / $300,000
$200,000 / $600,000
$500,000 / $1,000,000
$1,000,000 / $3,000,000
Occurrence Limits (Amount Per Claim/Aggregate Per Year)
$100,000 / $300,000
$200,000 / $600,000
$500,000 / $1,000,000
$1,000,000 / $3,000,000
Specialty
Select one...
Multispecialty
Allergy
Anesthesiology
Cardiology, Interventional
Cardiology, no surgery
Chiropractor
Colon & Rectal Surgery
Corporation/Partnership/Professional Association
Dermatology, minor surgery
Emergency Medicine, no major surgery
Endocrinology, major surgery
Endocrinology, no surgery
Family/General Medicine - Major Surgery
Family/General Medicine - Minor Surgery
Family/General Medicine - No Surgery
Family/General Medicine, with obstetrics
Gastroenterology, minor surgery
General Surgery
General Surgery, incl. Bariatrics
General Surgery, incl. Thoracic
General Surgery, incl. Vascular
Gynecology, major surgery
Hand Surgery
Hematology, no surgery
Hospitalist, no surgery
Infectious Diseases, no surgery
Internal Medicine, no surgery
Neonatology
Nephrology, no surgery
Neurology, no surgery
Neurosurgery
Nuclear Medicine, no surgery
Obstetrics & Gynecology
Occupational Medicine, no surgery
Oncology, no surgery
Ophthalmology - surgery
Orthopedics Surgery, No Spine
Orthopedics Surgery, w/ Spine
Otorhinolaryngology, major surgery
Pain Management
Pain Management (Interventional)
Pathology, no surgery
Pediatrics
Pediatrics, major surgery/PICU
Physical Medicine & Rehab, incl. Pain Management
Physical Medicine & Rehab, no surgery
Physician NOC - Minor Surgery
Physician NOC - No Surgery
Physician/Surgeon Assistant
Physicians Assistants - Supervised by Non-Invasive Specialists
Physicians Assistants - Supervised by Specialists Performing Major Surgery as Primary Surgeons
Physicians Assistants - Supervised by Specialists Performing Minor Surgery as Primary Surgeons
Plastic Surgery
Podiatrist
Psychiatry, no surgery
Pulmonary Disease, no surgery
RN – General Duty Employed
Radiation Oncology
Radiology, Diagnostic, no surgery
Radiology, Interventional, minor surgery
Rheumatology, no surgery
Urgent Care Medicine, no Hospital ER
Urology, major surgery
zzz - Nurse Practitioner - Employed
Do any physicians need Medical Director coverage for administrative or supervisory duties?
Yes
No
If so, who?
Are any physicians entering practice for the first time after graduate training, military, or academics?
Yes
No
If so, provide details
Are any physicians working part time?
Yes
No
If so, provide details, including who & average number of hours/week
Has the group had any claims in the past 5 years (loss runs will be required
Yes
No
Do you currently work with an agency/broker?
Yes
No
Agency
Broker's Name
Who are the owner partners?
Pricing Information
Expiring Premium
Renewal Premium
Additional Comments/Requests/Procedure Information
How did you hear about us?
Select Choice
LSA outreach
Trade show/LSA event/meeting
Reputation
Referral
Previous LSA insured client
Previous TMLT insured client
Online research
Other
Other
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