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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
Applications
- Application for Healthcare Provider Professional Liability Insurance
- Renewal Application
- 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