Online Application

Paper Application

Online Application

Complete the online application, and upon completion, the application will return you to a page where you can upload any supplementary documents needed.


Apply for Coverage

There are two different ways that you can apply for medical malpractice insurance with MedMal Direct. The first way is with an online application that you can fill out, and you will be able to upload any relevant documents requested to complete the process. The other way is through our paper application which gives you the option to print, fill out by hand, and scan and return via e-mail, fax, or mail. We want this process to be as easy as possible for you, so if you have any questions, please do not hesitate to give us a call so we can walk you through the process.

Paper Application

Click the PDF application which will open on your computer, where you can complete it. Print it, Sign it and choose:

Email it:

Send it via email to

Fax it:

Fax your forms to (844) 877-5939

Mail it:

Mail forms to
MedMal Direct Insurance Company
76 South Laura Street, Suite 900
Jacksonville, FL 32202

If there are supplementary documents that need to be sent, simply UPLOAD YOUR FILES ONLINE directly to MedMal Direct. You may also submit the documents via E-mail, Fax or U.S. Mail as well.