Coverage Applications-North Dakota

Below are medical professional liability insurance applications by coverage type. Please complete the applications listed in the appropriate section and then submit them to COPIC:

  • Email:
  • Fax: 877.263.6665
  • Mail: Attn: COPIC Sales Department, 7351 E. Lowry Blvd., Ste. 400, Denver, CO 80230

North Dakota—Individual Physicians or Allied Health Professionals

1) Please select one of the following:

PLEASE NOTE: Additional supplemental applications may be required based on your specialty. Our staff will contact you about this information. To see a list of the allied health professionals that require an application, please click on the "read more" button.

Allied health professionals who are required to submit an application for coverage:

  • Acupuncturist
  • Advanced Practice Nurse
  • Aesthetician
  • Child Health Associate
  • Clinical Nurse-Specialist
  • CRNA/Nurse Anesthetist
  • Cytotechnologist
  • Electrologist
  • Embryologist
  • Emergency Medical Technician
  • Endermologist
  • Laser Technician
  • Microdermabrasionist
  • Nurse Clinician
  • Nurse Midwife
  • Nurse Practitioner
  • Optometrist
  • Orthopaedic Physician Assistant
  • Perfusionist
  • Pharmacist
  • Physician Assistant
  • Physicist
  • Physiologist
  • Psychologist
  • Psychotherapist
  • Radiology Practitioner Assistant
  • Surgical Assistant
  • Surgical Technician

North Dakota—Medical Group Practices

1) Please use following application:

2) In addition to the above application, please refer to the requirements in the Individual Physicians or Allied Health Professionals section above for each physician/allied health professional that will be included in your coverage.

North Dakota—Hospital or Medical Facility

1) Please select one of the following:

2) In addition, please use the following application for each individual you would like to cover under your policy:

Contact Us

Contact our staff with questions or to get started. Looking for an agent? We can help with that too.
800.421.1834, ext. 6186 or 720.858.6186

Confused About Coverage Options?