Senior Living Submission Requirements

Choose from the supplemental 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. The following submission items are required for a proposal:

General and Professional Liability

• Completed & signed ACORD applications
• Completed & signed supplemental applications
• Five years currently valued loss runs
• Five years of premium history
• Most recent financial statements, including balance sheet, income and expense sheets
• State Inspection reports – last two years with any statement of deficiencies and plan of correction
• Resumes if business is less than 3 years old
• Licenses for each facility
• Brochures
• Resident Service Contract

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