Individual Professional Liability Request


Current Status  

**This field is primarily for practitioners who hold active licensure in multiple states. For example, if a practitioner is licensed in 6 states and holds contracts with facilities or entities located in 5 of those states, they might complete this field as follows:

Georgia 7
Florida 4
Virginia 15
Utah 8
Calfornia 6
This would indicate that, on average, the practicitioner practices 7 hours/week tied to a contract held in Georgia, 4 hours/week to a contract in Florida, and so on.

If you are inquiring on behalf of a business entity or large group practice, please leave this field blank. A HUB representative will contact you if additional information is needed in order to calculate your premium indication.