DigniCARE Applications & Forms for Senior Living

We want to facilitate the submission and application process for our brokers, which is why we have designated an on-line area for you to easily download the forms you need. Choose from the applications below. If you are unsure which application to use from the following list, or if you have any questions, please contact the underwriter in your region.

Some of our markets require company-specific supplemental applications in order to bind. However, all of our GLPL markets will quote using the DigniCARE program applications. We recommend that you use the DigniCARE applications for all senior living facility submissions to enable broader market access.

File Name

FORMAT

DOWNLOAD

DigniCARE Facility Supplemental

DigniCARE Main Application

Monoline Property and Auto

• Acord Property and Commercial Insurance Applications
• Acord Auto Application (if needed)
• Statement of Values
• BI Worksheets
• Five years currently valued loss runs

File Name

FORMAT

DOWNLOAD

CNA HealthPro BI Worksheet

Workers’ Compensation

• Completed ACORD Workers’ Comp application with all prior carrier and applicable payroll information
•  Completed ACORD Property application or similar source of property characteristics data
• Completed Supplemental application
• Five years currently valued loss runs Experience Mod worksheet
• Detail on all losses in excess of $50,000
• Financials on larger risks

File Name

FORMAT

DOWNLOAD

Workers’ Compensation

Eligible Class Codes