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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

Class Code
Class Description
8051
Skilled Nursing Care Facilities
8052
Intermediate Care Facilities
8059
Nursing & Personal Care Facilities Not Elsewhere Classified
8804
Social Rehabilitation Facilities for Adults
8810
Medical Billing or HMO services
8823
Residential Care Facilities for Children
8824
Retirement Living Centers: Health Care Employees
8825
Retirement Living Centers: Food Service Employees
8826
Retirement Living Centers: All Other Employees, Salespersons and Drivers
8829
Convalescent Homes\Nursing Homes
8834
Physicians
8839
Dentists and Dental Surgeons
8851
Congregate Living facilities for the Elderly
8868
Adult Day Care – only
9070
Residential Care Facilities – Elderly
9085
Residential Care Facilities – Developmentally Disabled
Kbunderwriters
  • "K&B has a model that backs up their binders with services that help providers care for residents. They understand the business, including the challenge of reimbursement reductions enabling them to engage best-in-class service providers… This level of knowledge and responsiveness really helps agents ‘brand’ themselves.... "

    Erik Halvorsen
    Peachtree Special Risk Brokers

  • "Thank you K&B for your DigniCARE product. Our firm works with a variety of senior living facilities and we consider the DigniCARE Program to be one of the best in the industry. Your team delivers professional and friendly service to your policyholders and your agency partners. You are a rock... "

    Pam Muzzilla
    McGowan Private Client Group

  • "The staff at K&B understood everything. In fact, I almost felt that they knew what I needed before I asked. K&B got things accomplished in such a short time frame! We sent a new submission on a large account and got quotes back in less than 8 days! I wouldn’t... "

    Vickie Fortner
    Bowersox Insurance Agency

  • "I could have gone to the same carrier through a different broker, but I liked the staff at K&B and liked working with them. K&B wanted the business, were aggressive, and turned it around very quickly. I am very pleased with the work... "

    Robin Walker
    Expert Underwriters, Inc

  • "We rely on the experience of K&B that we may not get by going straight to the company. I believe this relationship is an important and necessary one in dealing with the insurance underwriters. Actually, K&B was the only brokerage we went through. It was all or nothing! Our deadlines... "

    Barry Layman
    The Colony Group, CIC

  • "The staff at K&B was instrumental in helping me! I had a policy that needed to be written at the 11th hour and with your staff at K&B, we wrote the policy. We have other policies coming up in the future and K&B is the trustworthy choice for us.... "

    Mark Kuhr
    Talbot/Hub Agency

  • "It’s the staff at K&B that I want to work with – you’re the ones who know what you’re doing!! K&B is straightforward in working with me and can tell me ‘yes’ or ‘no’ to my questions right away, which is great and what I need! The flow with K&B... "

    Mike Kram
    MD Kram Insurance Brokerage

  • "Your staff is persistent. Since I’m persistent too, I like that! K&B’s service is great because of the small things. A big thing we contend with is having an underwriter simply pick up the phone to take a call from us. Your staff will do that and it means a... "

    Sean Crayton
    Nixon & Lindstrom Insurance

 
Kbunderwriters
Kbunderwriters
  • "K&B has a model that backs up their binders with services that help providers care for residents. They understand the business, including the challenge of reimbursement reductions enabling them to engage best-in-class service providers… This level of knowledge and responsiveness really helps agents ‘brand’ themselves.... "

    Erik Halvorsen
    Peachtree Special Risk Brokers

  • "Thank you K&B for your DigniCARE product. Our firm works with a variety of senior living facilities and we consider the DigniCARE Program to be one of the best in the industry. Your team delivers professional and friendly service to your policyholders and your agency partners. You are a rock... "

    Pam Muzzilla
    McGowan Private Client Group

  • "The staff at K&B understood everything. In fact, I almost felt that they knew what I needed before I asked. K&B got things accomplished in such a short time frame! We sent a new submission on a large account and got quotes back in less than 8 days! I wouldn’t... "

    Vickie Fortner
    Bowersox Insurance Agency

  • "I could have gone to the same carrier through a different broker, but I liked the staff at K&B and liked working with them. K&B wanted the business, were aggressive, and turned it around very quickly. I am very pleased with the work... "

    Robin Walker
    Expert Underwriters, Inc

  • "We rely on the experience of K&B that we may not get by going straight to the company. I believe this relationship is an important and necessary one in dealing with the insurance underwriters. Actually, K&B was the only brokerage we went through. It was all or nothing! Our deadlines... "

    Barry Layman
    The Colony Group, CIC

  • "The staff at K&B was instrumental in helping me! I had a policy that needed to be written at the 11th hour and with your staff at K&B, we wrote the policy. We have other policies coming up in the future and K&B is the trustworthy choice for us.... "

    Mark Kuhr
    Talbot/Hub Agency

  • "It’s the staff at K&B that I want to work with – you’re the ones who know what you’re doing!! K&B is straightforward in working with me and can tell me ‘yes’ or ‘no’ to my questions right away, which is great and what I need! The flow with K&B... "

    Mike Kram
    MD Kram Insurance Brokerage

  • "Your staff is persistent. Since I’m persistent too, I like that! K&B’s service is great because of the small things. A big thing we contend with is having an underwriter simply pick up the phone to take a call from us. Your staff will do that and it means a... "

    Sean Crayton
    Nixon & Lindstrom Insurance

 
Kbunderwriters
Kbunderwriters
  • "K&B has a model that backs up their binders with services that help providers care for residents. They understand the business, including the challenge of reimbursement reductions enabling them to engage best-in-class service providers… This level of knowledge and responsiveness really helps agents ‘brand’ themselves.... "

    Erik Halvorsen
    Peachtree Special Risk Brokers

  • "Thank you K&B for your DigniCARE product. Our firm works with a variety of senior living facilities and we consider the DigniCARE Program to be one of the best in the industry. Your team delivers professional and friendly service to your policyholders and your agency partners. You are a rock... "

    Pam Muzzilla
    McGowan Private Client Group

  • "The staff at K&B understood everything. In fact, I almost felt that they knew what I needed before I asked. K&B got things accomplished in such a short time frame! We sent a new submission on a large account and got quotes back in less than 8 days! I wouldn’t... "

    Vickie Fortner
    Bowersox Insurance Agency

  • "I could have gone to the same carrier through a different broker, but I liked the staff at K&B and liked working with them. K&B wanted the business, were aggressive, and turned it around very quickly. I am very pleased with the work... "

    Robin Walker
    Expert Underwriters, Inc

  • "We rely on the experience of K&B that we may not get by going straight to the company. I believe this relationship is an important and necessary one in dealing with the insurance underwriters. Actually, K&B was the only brokerage we went through. It was all or nothing! Our deadlines... "

    Barry Layman
    The Colony Group, CIC

  • "The staff at K&B was instrumental in helping me! I had a policy that needed to be written at the 11th hour and with your staff at K&B, we wrote the policy. We have other policies coming up in the future and K&B is the trustworthy choice for us.... "

    Mark Kuhr
    Talbot/Hub Agency

  • "It’s the staff at K&B that I want to work with – you’re the ones who know what you’re doing!! K&B is straightforward in working with me and can tell me ‘yes’ or ‘no’ to my questions right away, which is great and what I need! The flow with K&B... "

    Mike Kram
    MD Kram Insurance Brokerage

  • "Your staff is persistent. Since I’m persistent too, I like that! K&B’s service is great because of the small things. A big thing we contend with is having an underwriter simply pick up the phone to take a call from us. Your staff will do that and it means a... "

    Sean Crayton
    Nixon & Lindstrom Insurance