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Professional Liability Insurance
NEW LIABILITY INSURANCE - ONLINE APPLICATION
HOME » APPLY
NEW! APPLY/RENEW ONLINE FOR INSURANCE
To apply/renew and pay for your insurance policy, please complete the form below.
Client Information
Business Name
Name:
Address
City
Province
​
Postal Code
Email
Phone Number
Fax
Business Website
I am applying for a new policy.


Modalities

Modalities
Please choose your main Modality (service you provide) from the drop down list, you can also choose other to add more modalities.
Do you have a training certificate for all the modalities you are practicing?
Do you sell any products?
Do you manufacture any products?
Please indicate your estimated gross annual income for the next 12 months:
What is the estimated value of the equipment used for your business?
Generally refers to all contents usual to your business, including furniture, machinery, tools, appliances. For example: computers, massage tables, laser machine, etc.
$
What is the estimated value of the stock used for your business?
Generally refers to all merchandise usual to your business. For example, massage oils, printing papers, advertising materials, etc
$
Are you a Commercial Clinic, Spa or studio owner?
Privacy Breach/Cyber Liability Coverage
If your routine business activities include handling or processing payments, storing client information, employee records, or other personal information defined by provincial or federal law you may purchase coverage for Privacy Breach/Cyber Liability. A privacy breach can include the loss, theft, unauthorized access to or use of personal customer or employee information. This data can include: Social Insurance Number; bank account number, credit or debit card information; driver’s licence number; medical diagnosis, patient history and medications; and, other personal information.
Please consider Privacy Breach/Cyber Liability Coverage
To add Privacy Breach Liability coverage, the additional premium is $120.00 annually and includes $25,000 in First-Party coverage for the following: Remediation expenses to cover various costs (such as notifying customers and employees; and, credit and fraud monitoring expenses); Business interruption to cover loss of income related to the breach, and necessary extra expenses; and, Legal expense coverage for certain legal fees and defence costs incurred as a result of a covered breach. Please select here to add this coverage to your policy.

Add Privacy Breach/Cyber Liability Coverage coverage to your policy, for an additional $120

*Higher limits of coverage are available. Please consult with a Complementary Health Account Manager to further discuss your needs.

Disclaimer

Has complimentary healthcare insurance ever been declined, cancelled or renewal thereof been refused by the insurer?

Have you had any losses / claims in the past three years?

Have you had any current or past circumstance that could result in you placing a claim or having a lawsuit being brought against you?*


Notice Concerning Personal Information
I hereby consent to BrokerLink to collect, use and disclose personal information required for the purposes of considering my application for insurance for new or renewal insurance coverage. The Broker is authorized to collect, use and disclose personal information and provide such personal information to third parties, as required, including insurance companies. The Broker may also be required to disclose such personal information pursuant to relevant laws or other laws. I authorize BrokerLink to communicate directly with the member association.


Warranty Statement
By submitting this application, you attest that the application has been completed accurately and honestly. No disciplinary action has been taken or is pending against you. You have never been the subject of any investigation, either civil or criminal, in connection with any sexual act, conduct, molestation, and/or assault. You understand that your insurance certificate will provide evidence that you have been added as an individual participant with respect to the coverage and limits of the Master Policy. You understand that the coverage provided by your insurance certificate is subject to all the terms, conditions and exclusions contained in the Master Policy. You further understand that the Insurance Company will rely on the information you have provided in the application. You are also able to provide a certificate of training for the modality you practice on your policy upon request. Failure to pay required premiums and/or false statements on this application or subsequent renewals shall void this application and render your insurance coverage null and void, and you may be subject to further legal action if making false statements.

Please indicate your agreement:*


Please review your answers before submitting, once your application/renewal is received a broker will review and contact you if further information is required, if all information is complete and your application/renewal is approved, your certificate of insurance will be emailed to the email provided, please make sure to check your spam/junk mail. Please Note this process can take 3-5 business days to complete.
Please note: Pricing is not guaranteed. Once application is submitted, it will be processed by the Brokerlink team