Federal Employee Risk Management Association Professional Liability Application

Worldwide Career Protector

Great for Managers/Supervisors

^$395_{/yr + $15 administration fee}

$2,000,000 Liability Limit

For civil lawsuits brought by external parties seeking damages for alleged violations of their rights.

Defense Coverage

$200,000 Administrative For investigations brought by the federal government. $200,000 Criminal For investigations or proceedings to review or prosecute charges of criminal misconduct. $200,000 Additional Employment Practices For employment practices-related proceedings, including: discrimination, wrongful termination, harassment, and retaliation charges.

Security Clearance Coverage Included

To assist with problems arising from issuance and defend against any administrative proceedings to revoke your clearance.

$500,000 LEOSA Liability

Provided to fill gaps relative to LEOSA, including acts of self-defense as well as state charges of unlawful carriage.

2 Hours Access to Pre-claim Counsel Line

Provides up to two hours of phone consultation with a legal professional to try to reduce your liability exposure before a claim is made.

Select Policy

Worldwide

Great for Law Enforcement

^$345_{/yr + $15 administration fee}

$2,000,000 Liability Limit

For civil lawsuits brought by external parties seeking damages for alleged violations of their rights.

Defense Coverage

$200,000 Administrative For investigations brought by the federal government. $200,000 Criminal For investigations or proceedings to review or prosecute charges of criminal misconduct.

Security Clearance Coverage Included

To assist with problems arising from issuance and defend against any administrative proceedings to revoke your clearance.

$500,000 LEOSA Liability

Provided to fill gaps relative to LEOSA, including acts of self-defense as well as state charges of unlawful carriage.

2 Hours Access to Pre-claim Counsel Line

Provides up to two hours of phone consultation with a legal professional to try to reduce your liability exposure before a claim is made.

Save up to 20-40% of comparable policies!

Select Policy

Basic

Great for any Federal Employee

^$290_{/yr + $15 administration fee}

$1,000,000 Liability Limit

For civil lawsuits brought by external parties seeking damages for alleged violations of their rights.

Defense Coverage

$200,000 Administrative For investigations brought by the federal government. $100,000 Criminal For investigations or proceedings to review or prosecute charges of criminal misconduct.

2 Hours Access to Pre-claim Counsel Line

Provides up to two hours of phone consultation with a legal professional to try to reduce your liability exposure before a claim is made.

Select Policy

Start Here - Required Information

First Name

Middle Initial

Last Name

Male Female

Date of Birth

Work Email

Home Email

Mobile Phone Is Mobile Phone International?

Work Phone
Is Work Phone International?

Home Phone Is Home Phone International?

Address 1

Address 2

City

State

Zip Code

Employment Agency

Reference

Has any professional liability claim(s), civil suit(s) or internal administrative/disciplinary actions been made against the applicant over the past five years or have any knowledge or information of any circumstance that might reasonable give rise to a claim?

Yes No

If Yes, Please Explain:

Do you currently have Federal Employee Professional Liability Insurance with another carrier?

Yes No

The applicant warrants that the statements and responses to the questions on this application are true and complete. This application does not bind the applicant or the company, nor does it obligate the company to issue a policy. Such policy may be cancelled by the company from inception upon discovery that the policy was obtained through a fraudulent statement, omission, or concealment of the facts mertial to the acceptance of the risk or hazard assumed.

Note: Any matter arising out of any claim or any acts, errors, or omissions that have been disclosed or should have been disclosed in response to this application are excluded under the policy issued in response to this application. The policy is fully earned at inception.

Accept Reject

Please note we accept credit card and EFT payments for annual premiums.

For other premiums, payment is by electronic funds transer or payroll deduction.

How would you like to be billed - select one:

Payment Type - Select One:

Billing Address is Different than above

Please use member info address from above

Card Type

Card Number

Expire Month

Expire Year

Frequency

Go Paperless

Please enter your market code here

Any Questions? We're happy to assist: support@wrightusa.com

To begin, set up payroll allotments though your federal agency with the following steps:

Sign in to your agency online account (i.e. EPP, Employee Express, NFC, My Pay, etc)
Select to start a new financial allotment
Enter the Starr Wright USA Routing and Account number:
1. Enter 022000046 as the Bank Routing Number
2. Enter 9873540471 as the Bank Account Number
Select Checking as the type of account
Enter as the allotment amount
Send your confirmation to support@wrightusa.com
1. Email the confirmation from your online account, or
2. Print the confirmation and fax it to 302-483-0230

Upon receipt of your first payment your account will be effective and you will receive a confirmation notice with directions on how to print your new certificate of insurance.

For assistance please contact Starr Wright USA at support@wrightusa.com or 800-424-9801.
Please mention your Member ID:

Your policy will not be effective until the first allotment of your premium is received.

Change Payment Type Proceed to Print Instructions

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What’s holding you back?

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Enter your contact information below, and you will hear from a Customer Service Representative shortly.

Name

Email Address

Phone Number

Best Time To Contact

Protect your career longer... for less

Select a policy - secure your coverage in just minutes

Worldwide Career Protector

Great for Managers/Supervisors

Worldwide

Great for Law Enforcement

Basic

Great for any Federal Employee

Enroll Now

Start Here - Required Information

Payment Information - multiple payment methods to fit your budget

All Done! - just one click away from career coverage

Select a policy - secure your coverage in just minutes

Worldwide Career Protector

Great for Managers/Supervisors

Worldwide

Great for Law Enforcement

Basic

Great for any Federal Employee

Enroll Now

Start Here - Required Information

Payment Information - multiple payment methods to fit your budget

All Done! - just one click away from career coverage

Thank you for choosing Starr Wright USA!

You have selected the bi-weekly payroll deduction option for per pay period.This amount reflects your policy premium, surplus lines, tax and administrative fee for your payroll deduction amount.

Your policy will not be effective until the first allotment of your premium is received.

Would you like to upgrade your liability limit to $2 Million for JUST $2 more per pay?

Would you like to add 2 hours access to legal expertise (up to $600 value) for JUST $2 more per pay?

Sorry to see you go! What’s holding you back?

We’re happy to help. Enter your contact information below, and you will hear from a Customer Service Representative shortly.

You have selected the bi-weekly payroll deduction option for per pay period.
This amount reflects your policy premium, surplus lines, tax and administrative fee for your payroll deduction amount.

Sorry to see you go!
What’s holding you back?

We’re happy to help.
Enter your contact information below, and you will hear from a Customer Service Representative shortly.