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Occupational Therapist Liability Insurance

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Additional Insured Request Form

MyOT Additional Insured Request Form

Please fill out the form below to add an Additional Insured to your policy. Once completed, a member of our team will reach out to you.

IMPORTANT: A member of our team will contact you by phone to collect payment for adding additional insureds to your policy. Your request will not be fully processed until payment is received.

(This does not apply if you purchased the $30 Unlimited Additional Insureds package at checkout.)

Additional Insured FAQ’s

What is an additional insured?

An additional insured is a person, place, or organization added to your policy who can benefit from your coverage should a claim occur that also impacted them. By naming them as an additional insured, you are extending your coverage to them, it is not a policy of their own.

Who does not qualify as an additional insured?

Those who do not qualify as additional insureds on your MyOT policy include coworkers, employees, friends, or family.

How much does it cost to add an additional insured?

It costs $10 to add an additional insured to your policy. You can also add unlimited additional insureds to your policy for only $30.

How can I purchase an additional insured?

To purchase additional insureds, please fill out the form above and someone from our team will call you within 48 business hours to complete your purchase.

How will I be charged for an additional insured?

You will be charged to add additional insureds on the telephone with a member of our customer service team when they call you after you submit this form. No online purchases are available at this time.

What if I have the unlimited additional insureds package?

If you have the unlimited additional insureds package, you will be able to add unlimited additional insureds to your policy at no extra cost. Filling out this form does not charge you.

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Should you have any questions about an existing or new liability insurance policy with My OT Insurance,
call 800-993-0648 and speak with a live representative,
Monday – Friday, 8:30am to 5:30pm.

The Liability master policy is issued to the Healthcare Professionals Purchasing Group, LLC. The Identity Protection Plan is powered by Identity Fraud, Inc., Walnut Creek, CA, whose members include members of Healthcare Professionals Purchasing Group, LLC. Gallagher Affinity Insurance Services, Inc. is the insurance partner for Healthcare Professionals Purchasing Group, LLC. Gallagher Affinity Insurance Services, Inc., a 50-state licensed broker, is the broker for all coverage under Healthcare Professionals Purchasing Group, LLC. Gallagher Affinity Insurance Services, Inc. also serves as excess and surplus lines broker for Healthcare Professionals Purchasing Group, LLC. Professional Liability and Commercial General Liability coverage under Healthcare Professionals Purchasing Group, LLC is underwritten in the surplus lines market by an A rated (Excellent) insurance company, per A.M. Best Company. Persons insured by surplus lines companies are not eligible for recourse through any state guarantee fund for the obligations of an insolvent insurer. Healthcare Professionals Purchasing Group, LLC is for health, wellness and beauty professionals and students created for the purpose of providing valuable and important benefits and services to its members. Healthcare Professionals Purchasing Group, LLC is not an insurer. 8430 Enterprise Circle Suite 200, Lakewood Ranch, FL 34202.

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My OT Insurance Office

My OT Insurance

8430 Enterprise Circle Suite 200
Lakewood Ranch, FL 34202

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