Advanced Practice Providers Professional Liability Insurance Application

Providers who desire to apply for professional liability insurance from Michigan Professional Insurance Exchange (MPIE) are required to fully complete, sign, and date the application along with submitting the following information.

In addition to the Application for Insurance, please enclose a copy of the following:

  • Current coverage verification (i.e., declaration page, certificate of insurance).
  • Loss runs from all prior insurance companies or explanation as to why they are not available. 
  • Copy of curriculum vitae. 
  • Current business letterhead.

Once complete, please submit the documents using one of the following methods:

Fax:  (616) 741-1980


Mail: Michigan Professional Insurance Exchange 
Attn: Underwriting Department
333 Bridge St NW
Suite 810
Grand Rapids, Michigan 49504

The information you provide is confidential and will not be reviewed by anyone other than the Exchange and its counsel and other advisers, unless a review is required by a governmental agency.