Workers' Compensation Quote Request | TDIC (The Dentists Insurance Company)

Workers' Compensation Insurance Quote Request

Complete this form for a free, no-obligation quote. After your request has been reviewed, your dedicated agent will then contact you to discuss.

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Physical Address (to be insured)






















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Employee & Payroll Information

Enter the number of full-time and part-time employees and payroll. Full-time is equal to 30+ hours per week. Payroll for included owners and officers cannot exceed 25 percent of total payroll.

















Please note: the information upon which quotes are based is on the information you have provided. As this information could be subject to error, TDIC Insurance Solutions cannot guarantee the correctness of the rates quoted.

This form is for proposal use only. An application is required for coverage, subject to insurance review.