Program Applications

Streamlining the Submission Process

You will find specific applications here for Home Care, Allied Health and Human/Social Services organizations. We have also outlined the additional information that’s required for each submission.

Submission Requirements


  • Please include the following attachments with your submission:
    • Currently valued insurance company loss reports for the past three to five years
    • Most recent Experience Modification Worksheet (for Workers’ Compensation submissions)
    • Resumes of owner/operators (to verify management experience in health care), pro-forma financials and a business plan (if available) for firms that are new in business (less than two years)
    • Most current annual financial statement – audited or compiled (for D&O applicants)
    • Please note – Additional information may be requested by your underwriter once a submission is received and reviewed for eligibility
  • Send your completed application(s) and all required attachments to: or fax to 1-603-647-9716.
  • If you do not see a particular application or class code, contact us at

If you have already completed an application for another program, we can often provide review of eligibility and a premium indication from a competitor’s application. We would just ask for our program application to be signed and completed when you choose to bind coverage with us.

Partnering with Us:
We’re Dedicated to Insuring the Health Care Industry

Our experience and commitment to the home care industry goes back to 1976 when our President and CEO’s father, Warren L. Thompson, was the first in the insurance marketplace to design specialized insurance coverage for home health care organizations. Our commitment continues as we focus on serving the broader Home Care, Allied Health and Human/Social Services sector as a leading source of “all lines” insurance coverage. Our programs are exclusively offered through our broker partners, and provide unparalleled underwriting experience, excellent service and competitive pricing. For more information about our programs and becoming a broker partner with us, please call us at 855-972-9399.