Standard Small Business/Medical Malpractice

• Clinics E&O (Medical-Public Health-Dental)
• Dentists and Oral Surgeons E&O
• Home Healthcare Supplemental Application
• Physicians-Surgeons E&O
• Specified Medical Professions E&O
• Supplemental Claim Information Form

New Business Application Submissions from your Agency Management System

1. Below is a list of options for submitting business to Arlington/Roe.

2. Look in your system. Are the Acord applications for current accounts fully profiled? Have you received download from a standard carrier, or filled up these screens on your own? All applications submitted must be completed fully.

3. You have three options:

   1. PRINT -You may print the Acord applications off of your agency management system and send them to us via the US mail.

   2. FAX - You can print and fax them to us, or fax from your P.C., if available. Our fax number is (317) 554- 8551 Please fax to the attention of: Small Business, Ryan Babb

   3. E-MAIL -You can send the application in an attachment, via e-mail, directly from your agency management system if you have this capability available on your system. This option is the most preferable.

E-Mail to rbabb@arlingtonroe.com

We have a team of dedicated I.T. and Business staff available to assist you in making the placement of business with us as easy as possible. We will work hand in hand with you to make the process of placing new business with us as quick and seamless as possible for you and your clients. If you have further questions or concerns and would like to discuss, please contact Ryan Babb at rbabb@arlingtonroe.com.

Need an application not listed?

Call us at 1-800-878-9891

or Email Ryan Babb

Fax all applications to (317) 554-8551