We welcome the opportunity to speak with you about finding the right coverage for your unique situation. If you have questions, feel free to call 864.240.5449 or 866.893.6270, and we will gladly assess your risk and discuss your coverage options.
To apply for coverage, please download the appropriate form below and return it with all required materials, such as current declarations, curriculum vitae, a loss history report and other materials.
Unless otherwise requested, all JUA insured individual physicians, dentists and allied healthcare providers will receive renewal quotes based upon the information currently in our system.
Hospitals and other medical facilities are required to submit renewal applications each year.
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REGISTRATION FORM - New Physician Risk Management Seminar 12.2.11
Download, compete and submit this form to register for either the morning or afternoon sessions of the December 2, 2011 New Physician Risk Management Seminar.
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SCJUA Application - Allied Healthcare Professional
Application for Optometrists, Pharmacists, Physician Assistants, Registered Nurses, Nurse Practitioners, Nurse Anesthetists, and Nurse midwives.
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SCJUA Application - Dentist & Oral Surgeon
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SCJUA Application - Healthcare Facility - New
This is a NEW BUSINESS application for medical professional liability insurance from the SCJUA. It is intended for use by outpatient surgery centers, diagnostic centers, endoscopy centers, free/non-profit clinics and other facilities who are NOT currently insured by the SCJUA.
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SCJUA Application - Healthcare Facility - Renewal
This is a RENEWAL application for medical professional liability insurance from the SCJUA. It is intended for use by outpatient surgery centers, diagnostic centers, endoscopy centers, free/non-profit clinics and other facilities who are currently insured by the SCJUA.
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SCJUA Application - Locum Tenens Healthcare Provider
Written request for Locum Tenens coverage approval for a substitute healthcare provider must be made in advance using this application. Locum Tenens coverage cannot be provided on a retroactive basis if the request is made late. Every effort will be made to advise the applicant within 48 hours if they are eligible for Locum Tenens Coverage through the JUA. If a physician is determined to be eligible, his/her approved application will be in effect for one year.
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SCJUA Application - Part Time Credit
A Part Time Healthcare Provider Credit Application must be completed by the applicant every year for the purposes of determining whether the applicant is eligible for this type of coverage. The hours reported to the SCJUA are for rating purposes and are subject to audit at the SCJUA’s discretion.
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SCJUA Application - Physician
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SCJUA Application - Practice Entity - New
This is a NEW BUSINESS application for medical professional liability insurance from the SCJUA. It is intended for use by practice entities that are NOT currently insured by the SCJUA.
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SCJUA Application - Practice Entity - Renewal
This is a RENEWAL application for medical professional liability insurance from the SCJUA. It is intended for use by practice entities that are currently insured by the SCJUA. Practice entities are required to submit a renewal application annually.
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SCJUA Form - Authorization to Release Policy Information
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SCJUA Form - Broker Information
Required form for agent/brokers who place business with the SCJUA, or who are registering for a listing in "Find an Agent" on SCJUA.com
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SCJUA Form - Dentist & Oral Surgeon Procedures Request
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SCJUA Form - Entity Shared Limits Endorsement Request
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SCJUA Form - Insured Address Change Request
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SCJUA Form - Locum Tenens Coverage Request
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SCJUA Form - Loss Notice
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SCJUA Form - Midlevel Shared Limits Endorsement Request
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SCJUA Form - Occurrence to Claims Made Request
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SCJUA Form - Policy Cancellation Request
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SCJUA Form - Renewal Questionnaire for Cardiology Pathology and Radiology