Following are links to an application for the Dentists Professional Liability Trust of Colorado and related documents, which include a Supplemental Application, an Application for Retroactive Coverage, a Participation Agreement, a Trust Agreement, a HIPAA Business Associate Contract, and endorsement applications for both phases of implants.
This policy provides two million dollars of dental professional liability coverage, with a six million dollar aggregate. This coverage is only offered to the dentist who is (or becomes) a member of the Colorado Dental Association. This policy does NOT insure your office equipment, premises liability etc. These policies need to be purchased separately. Please contact our office for more information about these policies.
Retroactive coverage is available for dentists who have had claims-made polices in the past, with the dental practice being in the state of Colorado. Complete this page also to decline retroactive coverage.
The premium for this policy is determined by whether or not you do the surgical phase of implants or need retroactive coverage. Please call me for the premium applicable to your situation. The Trust offers three different premium payment options: you can pay the premium in full; pay the premium in three installments with a $50 administrative fee applied to the first payment; or you can have the premium deducted from your checking account on a monthly basis.
Thank you for your interest in Dentists Professional Liability Trust of Colorado. If you have any questions regarding the coverage provided, payment plans, or need assistance in completing the application, please do not hesitate to call.
Randy L. Kluender, DDS, MS
DENTISTS PROFESSIONAL LIABILITY TRUST OF COLORADO
|Download ENTIRE packet at once (Size 637 KB)||OR||Download EACH FORM individually (All must be completed)|
Download those of the following ADDITIONAL APPLICATIONS as appropriate for the nature of your practice.
Download, print and retain a copy for your records (BUT DO NOT MAIL TO US)|
Also, for your information, an article from the March/April 1987 edition of the Journal of the Colorado Dental Association regarding the formation of the Dentists Professional Liability Trust.|
|Mail completed application and related supporting documents to:|
|DENTISTS PROFESSIONAL LIABILITY TRUST OF COLORADO|
c/o Berkley Risk
7807 E. Peakview Ave
Centennial, CO 80111
NOTE: Coverage is only available through The Trust in Colorado. Should you have a practice with a satellite office outside of Colorado, the Trust cannot cover the satellite office. Please contact us with any questions you may have.
Policy rates are based on a five year progression with rates leveling out at the fifth year. There are discounts for new graduates. Please contact us for specific rates.