Coverage Applications—Nebraska

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

Nebraska—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

Nebraska—Hospital or Medical Facility

1) Please select one of the following:

Nebraska—Medical Group Practices

1) Nebraska Entity Professional Liability 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.

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?