Apply for Coverage
Click on the appropriate application to download, print out the application, complete it and provide the appropriate documentation. Mail the completed application and requested information to:
West Virginia Mutual Insurance Company
500 Virginia Street, East
Suite 1200
Charleston, WV 25301
Application for Healthcare Provider Professional Liability Insurance
Application for Ancillary Medical Professional Liability Insurance
Application for Corporation Professional Liability
Physician Office Risk Self Assessment Form
Emergency Self Assessment Form
Radiology Self Assessment Form