Application
Download Application

Completing the application and forwarding to the address below will provide us with the information needed to apply for coverage. Through Fort Wayne Medical Surety Company, you can select an either occurrence or claims made policy and if you are a group practice, FWMSC allow you the option to choose a mix among your physicians. If your group currently has a claims made policy and would need to purchase a tail, FWMCS can provide you with tail coverage at a substantial savings compared to the commercial market.

The underwriting operations are professionally provided by FWMSC. They will process your application and determine your eligibility and then provide you with a premium quote for both occurrence and claims made policies.

Please send your completed application to:

Fort Wayne Medical Surety Company, RRG
Lana Lowe
Chief Operations Officer
6619 Brotherhood Way
Fort Wayne, IN 46825
P: 260-426-1321
F: 260-426-0270

lana@fwmsc.com

If you have questions in regards to becoming a shareholder, please direct your questions to:

Fort Wayne Medical Surety Company, RRG
Lana Lowe
Chief Operations Officer
6619 Brotherhood Way         
Fort Wayne, IN 46825
P: 260-426-1321
F: 260-426-0270

lana@fwmsc.com