Parsons & Associates. Inc. -- Insurance & Risk Management

Professional Protector Plan for Dentists
The painless estimate: Professional Protector Plan®
By answering these few questions, we can offer you a reliable
estimate of what coverage under the plan would cost. If you
decide to buy coverage, we'll need a complete application.


     This Online Application is on a Secure Server. Click on the seal on the left for more information on the certificate's authentication.

Privacy Statement: Any information provided by a consumer or customer via our online forms WILL be held in the strictest confidence. No information will be shared with others. Our goal is to respond to all submissions within two business days.

Netscape Communicator Attention Netscape Communicator users:
This form best viewed with a 12 point font setting

We only accept inquiries for insurance written in New York State

Professional Liability Coverage
For the most accurate proposal please provide copies of insurance policy cover pages
Name:
Mailing Address:
City:   State:    ZIP:
Practice Address:
City:   State:    ZIP:
Phone: ( ) -            Fax: ( ) -
Best time to call:   am  pm
Email:

Discounts
Your Graduation Date:                          
Have you attended a loss-control seminar within the last year?: Yes   No
Do you practice 16 hours a week or less?: Yes   No

Your Practice
Do you treat patients under: Conscious Sedation   Deep Sedation or General Anesthesia
Only in a hospital?: Yes   No
Are you an oral surgeon?: Yes   No

Insurance Background
Have you had any professional liability claims?: Yes No     Current Carrier:
Current Coverage Limits: $   Expiration Date:
Occurrence   Claims-made       Prior acts date:


Professional Protector Plan® Complete Practice Protection

Practice Income Interruption
Among the many things the plan does, its valued practice income protection pays you the daily income you select, for the number of days you select, with no requirement that you document your losses or that you reschedule patients.

Two hundred dollars a day is the minimum. How much money would you need to receive for each day you can't practice?
$

Thirty-two and a half days is the minimum time. How many days would you need coverage for?

Blanket Practice Property Protection
Imagine that tomorrow you had to replace everything: operations, tools, office equipment, x-rays, patient charts, records, furniture, decor, the personal property in the office; your accounts receivable that became uncollectible.

How much money would you need?
$

When does your current coverage expire?

Practice Contents and/or Building Coverage
What is your building's construction type?  

Do you own or rent?   Own   Rent

If you own, building value:   $

NYS Disability Benefits / Workers Compensation
# Employees:   Male Female         Payroll: $

Additional Comments:
Please give any additional comments about the coverage you desire:

 

The Professional Protector Plan® is a registered trademark of Poe & Brown Insurance, Inc., Tampa, Fl., and is underwritten by the following CNA Insurance companies: Continental Casualty Company, National Fire Insurance Company of Hartford and American Casualty Company of Reading, Pennsylvania. CNA is a registered service mark of CNA Financial Corporation.

Thank you for your time in submitting this proposal form. One of our representatives will respond to your submission as soon as possible!

Copyright 2000 - Parsons & Associates, Inc. -- All Rights Reserved