New Insurance Application


 


Requested Policy Effective Date
 
Policy Effective date must be greater than the current date and within 60 days of the current date.
Policy Expiration date defaults to (1) year following effective date.

Policy Coverage - $1,000,000 per claim / $3,000,000 aggregate limit


IMPORTANT: This application is intended for individuals only. Businesses with more than one coach should contact Customer Service for assistance.   This application is not intended for Fitness Instructors.   Separate coverage for fitness modalities is available at http://www.ideafit.com/fitness-insurance.

Underwriting Criteria
 

 
Applicant is engaged in the profession of life/career coaching and is seeking insurance for liability arising from errors and omissions in the conduct of this profession.
 
Applicant is NOT a clergyman/clergywoman, pastoral counselor, mental health counselor, nutrition counselor, social worker, master of social work, licensed professional counselor, rehabilitation counselor, school counselor, case manager, certified hypnotist, clinical counselor, drug/alcohol counselor, marriage/family counselor or psychologist. (applicants from these professions are advised to apply for insurance at www.cphins.com)
 
Applicant does not provide professional services to professional athletes whose total annual income is $25,000 or greater.
 
Applicant does not provide professional services in or on the premises of any long-term care facility.
 
Applicant does not provide any type of youth-focused overnight professional programs such as Outward-Bound, boot camps, or similar.
 
Applicant has never been convicted of a felony.



Associate Certified Coach / ACC
Master Certified Coach / MCC
Professional Certified Coach / PCC
Other  

3.  Is licensure for coaches required in your state?
   If yes, are you licensed?

 

 

 
Name of Insurer: Limit of Liability: $
Policy Period from:  To: Retro-active date on current policy:

Note:  If currently uninsured, then retro date will become the effective date of the policy, or extend to the next day.  If currently insured, application will not be accepted prior to 90 days of policy expiration date.


 
If yes, please explain:    


 
If yes, please explain:    

With regard to questions 7. and 8., it is understood and agreed that if any such claim, act, error, omission, dispute or circumstance exists, then such claim and/or claims arising from such act, error, omission, dispute or circumstance is excluded from coverage that may be provided under this proposed insurance and, further, failure to disclose such claim, act, error, omission, dispute or circumstance may result in the proposed insurance being void, and/or subject to rescission.

Location information (No PO Boxes)
 
 
 

 

Personal information
 
 
 
 

Please ensure the email address you are entering is valid. All policy communication such as renewal notification and policy delivery will be handled via email. Your policy will not be delivered by mail.

- -  
- - (optional)  
- - (optional)  
(optional)
  Home address is the same as location address
 
 
 
 

Mailing address is the same as home address

Purchase Information
Please review the purchase information below.



Additional Insured
Does the facility where you conduct business require you to list them as an Additional Insured on your policy and provide them with a Certificate of Insurance (COI)?



Credit Card Information
 
Billing address is the same as home address
(Do not include spaces or dashes)  
 
 

*All rates are subject to underwriter approval
**General Liability coverage is written through the Fitness & Wellness Risk
  Purchasing Group and a fully earned and non-refundable fee of $50.00 is required
  to join this Risk Purchasing Group



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After verifying your address you will be navigated back to this screen where you can submit your application
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Fraud Notice
Notice to applicants:
Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information, or conceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent insurance act which is a crime and may subject such person to criminal and civil penalties.

*Note: The above proposal may not account for local taxes mandated by the State in which you/your business operate(s). The final policy will include a description of how local taxes, if applicable, have been allocated as determined by the risk location. Please contact a PHLY representative if you have any questions.

The Insurer may not be subject to all of the insurance laws and regulations of your resident state.