I pay the malpractice insurance premium for my associate. If he or she leaves my practice, will I get a refund?

To be eligible to receive the refund in this situation, you must be listed as the delegation holder of certain policy rights. As the delegation holder, you would receive any dividend checks, be able to cancel the policy and get a refund, or remove your name and get a refund when the employment agreement terminates. To be listed as the delegation holder, complete and return this form. Both you and your associate will need to sign the form.

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The NCMIC Malpractice Insurance Plan is underwritten by NCMIC Insurance Company. In the states of Florida and New York, the NCMIC Malpractice Insurance Plan is issued by NCMIC Risk Retention Group, Inc.

The terms and conditions of NCMIC's Malpractice Insurance Plan are fully explained in the policy. Policy features vary by state and may be subject to underwriting approval.