• RNAO NurseInsure Program

    Insurance Application 2026-2027

  • NOTE: In order to be eligible for the RNAO NurseInsure Business Insurance Program, each company owner of the business who is an RN or RN(EC) is required to purchase Errors & Omissions insurance under the NurseInsure Malpractice E&O Program. In addition, if applicable, the company must purchase Business Entity Errors & Omissions coverage.

  • Format: (000) 000-0000.
  • Do you hold an active RNAO membership?*

  • Warning: You must have an active RNAO membership in order to be eligible for coverage under the NurseInsure program.

  • Do you hold a valid certificate of registration from the the College of Nurses of Ontario (CNO)?*

  • Warning: You must have a valid certificate of registration from the College of Nurses of Ontario in order to be eligible for coverage under the NurseInsure program.

  • What is your registration status with CNO?*
  • Date of initial registration with CNO?*
     - -
    4 digit year, 2 digit month, 2 digit day

  • Section A - Malpractice Liability - Individual

  • Are you licensed in any other province or territory in Canada?*
  • Do you offer services outside of Canada? (note: the USA is considered outside of Canada)*

  • Professional Services Covered:

    Professional Services means the provision of healthcare, medical, surgical, nursing, dental, or other clinical services, treatment, advice, diagnosis, prescription, or care provided by the Insured, or by any person for whose acts, errors, or omissions the Insured is legally liable, in the course of the Insured’s practice as a duly licensed, registered, or accredited healthcare professional.

    Professional Services does not include Activities outside the scope of the Insured's professional qualifications, license, or accreditation; and Administrative, managerial, or financial services not involving patient diagnosis, care, or treatment.

  • Do you offer services outside of this scope?*
  • Do you operate a recruitment and/or staffing agency?*
  • Do you offer midwifery services?*
  • Are you involved in the teaching/coaching of Nursing students?*
  • Do you offer laser treatment?*
  • Is the laser treatment done by a certified esthetician/laser technician?*
  • Are signed waivers and consent to treat forms obtained that detail the client's understanding & acceptance of the risks associated with the service(s) provided?*
  • If the client is under 16 years of age, is parental consent obtained?
  • Do you operate as a medi-spa?*
  • Does the business have contracts with physicians to provide services outside the nurse's scope?*
  • Please provide the annual revenue, if any, from the following services:
    Rows
  • Are signed waivers and consent to treat forms obtained that detail the client's understanding & acceptance of the risks associated with the service(s) provided?*

  • Definitions for the following question:

    Employee: Works for an employer.

    Sole Proprietor: Self-employed individual who operates independently.

    Personal Corporation (with no employees): An incorporated entity owned by an individual, with no staff other than the owner.

    Personal Corporation (with self-insured independent contractors): An incorporated entity owned by a single individual, with no employees other than the owner and independent contractors who maintain their own insurance coverage and do not require coverage under the corporation's policy.

    Personal Corporation (with employees and/or independent contractors): An incorporated entity owned by an individual that employs one or more staff members, including independent contractors who do/do not carry their own insurance.

    Shareholder in Corporation: An individual who owns shares in a corporation and may or may not be actively involved in its operations.

    Partnership: An arrangement involving two or more partners working together under a partnership agreement.

  • What is your current employment status?*
  • Is this your first time purchasing Individual malpractice insurance?*
  • What is the date from when you first maintained continuous malpractice insurance coverage without any gaps:*
     - -
    4 digit year, 2 digit month, 2 digit day
  • Are you aware of any facts, circumstances or situations which may reasonably give rise to a claim for Professional Malpractice?*
  • In the past five years, have you ever been the recipient of any allegations of professional negligence either in writing or verbally?*
  • Has your Individual Malpractice insurance coverage ever been declined, cancelled or refused?*

  • Please review your answers carefully to ensure they are correct before you continue.

  • Malpractice Liability - Individual - Limit Selection

  • Warning: To be eligible for additional NurseInsure program products, including Business Entity Malpractice and Business (CGL & Property) insurance, you must first hold an Individual Malpractice policy.

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  • Please select your limit for Malpractice Liability - Individual. Premiums will be calculated in accordance with the tables above.*

  • Personal Corporation

    If you are incorporated, this section is applicable if you have a Personal Corporation (AKA an entity solely owned by yourself) AND do not have any employees. The Individual NurseInsure Malpractice Insurance coverage automatically extends to cover your sole proprietorship or Personal Corporation at no additional premium. This is subject to the terms and conditions of the policy.
  • Do you have a personal corporation?*
  • Is the personal corporation solely owned by the applicant?*
  • Does your personal corporation have any employees? (do not include yourself as an employee)*
  • Does your personal corporation hire independent contractors?*
  • Do all your independent contractors carry their own insurance coverage?*
  • Do you employ Personal Support Workers (PSWs) and/or any other non-regulated healthcare providers?*
  • Do these Personal Support Workers (PSWs) and/or other non-regulated healthcare providers require coverage under your policy?*
  • Do you require your personal corporation's name added to the policy?*

  • NOTE: Corporations with multiple owners, employees, or independent contractors requiring coverage while providing services on behalf of the corporation cannot be added to an individual NuresInsure Malpractice Insurance policy. Please complete Section B: Business Entity – Medical Malpractice.

  • Section B - Malpractice Liability - Business Entity

  • This section is applicable if you:

    • Are a sole proprietor with employees;
    • Are in a partnership;
    • Own a corporation with other shareholders;
    • Own a corporation which has employees
    • Own a corporation which has non-regulated employees or independent contractors who do not carry their own insurance coverage

    A separate Malpractice (Professional Liability) Business Entity Insurance policy is recommended. Limit options and applicable premiums are outlined below. This policy will provide coverage for the business and for all non-professional employees, subject to the terms of the policy.

    All professional employees, such as RNs or RN(EC)s, will continue to be required to purchase the Individual NurseInsure Malpractice insurance coverage.

  • Do you require Business Entity malpractice coverage?*
  • Please provide the name(s) of all owner(s) of the Business Entity:*
  • Does the Business Entity hire independent contractors?
  • Are any Personal Support Workers and/or non-regulated healthcare providers included in the total number of employees?
  • Do any company owners or employees hold professional licenses other than an RN or RN(EC)/Nurse Practitioner license?*
  • Please list the number of employees and independent contractors employed/hired offering each service for the Business Entity:*
    Rows
  • Do all these professionals carry their own malpractice (professional liability) coverage?
  • Does the Business Entity offer services outside of Canada? (note: the USA is considered outside of Canada)*

  • Professional Services Covered:

    Professional Services means the provision of healthcare, medical, surgical, nursing, dental, or other clinical services, treatment, advice, diagnosis, prescription, or care provided by the Insured, or by any person for whose acts, errors, or omissions the Insured is legally liable, in the course of the Insured’s practice as a duly licensed, registered, or accredited healthcare professional.

    Professional Services does not include Activities outside the scope of the Insured's professional qualifications, license, or accreditation; and Administrative, managerial, or financial services not involving patient diagnosis, care, or treatment.

  • Does the Business Entity offer services outside of this scope?*
  • Does the Business Entity operate a recruitment and/or staffing agency?*
  • Does the Business Entity offer midwifery services?*
  • Is the Business Entity involved in the teaching/coaching of Nursing students?*
  • Does the Business Entity offer laser treatment?*
  • Is the laser treatment done by a certified esthetician/laser technician?*
  • Are signed waivers and consent to treat forms obtained that detail the client's understanding & acceptance of the risks associated with the service(s) provided?*
  • If the client is under 16 years of age, is parental consent obtained?*
  • Does the Business Entity operate as a medi-spa?*
  • Does the business have contracts with physicians to provide services outside the nurse's scope?*
  • Please provide the annual revenue, if any, from the following services:
    Rows
  • Are signed waivers and consent to treat forms obtained that detail the client's understanding & acceptance of the risks associated with the service(s) provided?*
  • Is this your first time purchasing Business Entity malpractice insurance?*
  • What is the date from when you first maintained continuous malpractice insurance coverage without any gaps:*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Are you aware of any facts, circumstances or situations which may reasonably give rise to a claim for Business Entity Professional Malpractice?*
  • In the past five years, have any owners or employees of the Business Entity ever been the recipient of any allegations of professional negligence either in writing or verbally?*
  • Has your Business Entity malpractice insurance coverage ever been declined, cancelled or refused?*

  • Please review your answers carefully to ensure they are correct before you continue.

  • Business Entity - Limit Selection

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  • Please select your limit for Malpractice Liability - Business Entity. Premiums will be calculated in accordance with the tables above.*

  • NOTE: In order to be eligible for the RNAO NurseInsure Business Insurance Program, each company owner of the business who is an RN or RN(EC) is required to purchase Errors & Omissions insurance under the NurseInsure Malpractice E&O Program. In addition, if applicable, the company must purchase Business Entity Errors & Omissions coverage.

  • Business Insurance - Property & Commercial General Liability

    NurseInsure Business Insurance (Property & CGL) provides protection for your business contents and income, along with third party liability coverage as a result of negligence.

  • NOTE: In order to be eligible for the RNAO NurseInsure Business Insurance Program, each company owner of the business who is an RN or RN(EC) or Nurse Practitioner is required to purchase Individual Malpractice Errors & Omissions insurance under the NurseInsure Malpractice E&O Program. In addition, if applicable, the company must purchase Business Entity Malpractice Errors & Omissions coverage.

  • Do you currently have Commercial General Liability and/or Property Insurance via the RNAO NurseInsure program?*

  • Commercial General Liability

    Commercial General Liability (CGL) insurance protects a business against claims by third parties for bodily injury, property damage, and personal/advertising injury arising from the business's operations, products, or premises.
  • Do you require Commercial General Liability (CGL) insurance?*
  • How does your business operate?*
  • Number of physical locations:*
  • Has your business incurred a liability claim in the last 5 years?*

  • Commercial General Liability - Limit Selection

  • Please select your Commercial General Liability limit:
  • Please select your Commercial General Liability limit:
  • Please select your Commercial General Liability limit:
  • Please select your Commercial General Liability limit:
  • Please select your Commercial General Liability limit:

  • Please note: if applicable, an additional premium of $50 will apply for each physical location, starting with the 2nd location.

  • Property Insurance

  • Do you require property insurance?*
  • How many locations do require property insurance for?*
  • Use of Premises - Location 1*
  • If Home Office, do you receive clients in your home?*
  • Is the Applicant (business entity) the owner of the building at this location?*
  • Do you require Building coverage?*
  • Is this Building a condo?*
  • Have the Plumbing, Roof, Electrical and Heating systems at this location ALL been updated within the last 25 years?*
  • Please check off all Protection measures in place: (location 1)*
  • Do you have a centrally monitored burglar alarm? (location 1)*
  • Construction Type: (location 1)*
  • Do you have any high-valued (any one item over $20,000) medical or precision equipment at location 1?*
  • Please select Business Contents limit required for location 1:*
  • Use of Premises - Location 2*
  • If Home Office, do you receive clients in your home?*
  • Is the Applicant (business entity) the owner of the building at this location?*
  • Do you require Building coverage?*
  • Is this Building a condo?*
  • Have the Plumbing, Roof, Electrical and Heating systems at this location ALL been updated within the last 25 years?*
  • Please check off all Protection measures in place: (location 2)*
  • Do you have a centrally monitored burglar alarm? (location 2)*
  • Construction Type: (location 2)*
  • Do you have any high-valued (any one item over $20,000) medical or precision equipment at location 2?*
  • Please select Business Contents limit required for location 2:*
  • Use of Premises - Location 3*
  • If Home Office, do you receive clients in your home?*
  • Is the Applicant (business entity) the owner of the building at this location?*
  • Do you require Building coverage?*
  • Is this Building a condo?*
  • Have the Plumbing, Roof, Electrical and Heating systems at this location ALL been updated within the last 25 years?*
  • Please check off all Protection measures in place: (location 3)*
  • Do you have a centrally monitored burglar alarm? (location 3)*
  • Construction Type: (location 3)*
  • Do you have any high-valued (any one item over $20,000) medical or precision equipment at location 3?*
  • Please select Business Contents limit required for location 3:*
  • Use of Premises - Location 4*
  • If Home Office, do you receive clients in your home?*
  • Is the Applicant (business entity) the owner of the building at this location?*
  • Do you require Building coverage?*
  • Is this Building a condo?*
  • Have the Plumbing, Roof, Electrical and Heating systems at this location ALL been updated within the last 25 years?*
  • Please check off all Protection measures in place: (location 4)*
  • Do you have a centrally monitored burglar alarm? (location 4)*
  • Construction Type: (location 4)*
  • Do you have any high-valued (any one item over $20,000) medical or precision equipment at location 4?*
  • Please select Business Contents limit required for location 4:*
  • Has your business incurred a property claim in the last 5 years?*
  • Has your Business Insurance (Commercial General Liability or Property insurance) ever been declined, cancelled or refused?*

  • Note: Please review your answers carefully to ensure they are correct before you continue.

  • Miscellaneous Property Floater

  • Do you need Miscellaneous Property Floater coverage (a Miscellaneous Property Floater provides coverage for Business Contents that are portable and not typically kept at the insured premises)?*

  • Certificates of Insurance

  • Do you require Certificates of Insurance to be issued for any of the following: loss payee, lessor, mortgagee, landlord or additional insured?*
  • Please provide the following for each Certificate of Insurance required:

  • Privacy Consent, Acknowledgements & Declaration

  • The Client hereby acknowledges that Axis Insurance Managers Inc.. has been retained by the Client to acquire or renew a policy or policies of insurance or to provide Consulting and/or Risk Management Services for the Client, under which the individual Client, or named individuals in addition to the Client, or where the Client is a commercial or other entity, its employees, servants and representatives (hereafter collectively called “insured individuals”) may be insured. As part of the application for new or renewal insurance coverage(s), the Client hereby authorizes Axis Insurance Managers Inc. to collect, use and disclose personal information of such insured individuals as required and as permitted pursuant to relevant Canadian privacy laws or other relevant Canadian laws. The Client hereby expressly consents to Axis Insurance Managers Inc. collecting, using or disclosing personal information of such insured individuals, or providing such personal information to third parties, including the plan sponsor (RNAO) and insurance companies, as required by relevant Canadian laws or for the purpose of acquiring or renewing a policy or policies of insurance. Where there are insured individuals in addition to the Client, or where the Client is a commercial or other entity, the Client hereby covenants and warrants that the Client has obtained the appropriate consent from all of the insured individuals to disclose their personal information to Axis Insurance Managers Inc. for these purposes accordingly. Each of the parties further agrees to safeguard the security of such personal information in a manner appropriate to the sensitivity of that information and as required by relevant Canadian privacy laws. The Privacy Policy of Axis Insurance Mangers Inc. can be viewed at www.axisinsurance.ca or can be forwarded to the Client upon request.

    I hereby confirm my consent that the policy and any correspondence pertaining to this insurance be issued in the English language.

    I hereby confirm my request to have my policy documents through the RNAO program sent to me electronically. This arrangement will stay in effect until I issue instructions to the contrary. I acknowledge that email is not a secure medium of communication. Although unlikely, there is the possibility that confidentiality through this medium may be compromised.

    Your coverages will be placed with a program administered by Axis Insurance Managers Inc. Axis has engaged in a competitive marketing process to offer a competitive product. We have negotiated this Program on a group basis with insurers, but we have not acted as a broker for any individual participant.

  • The Insured represents that the information furnished in this application is complete, true and correct. Any misrepresentation, omission, concealment or incorrect statement of material fact, in the application or otherwise, shall be grounds for rescission of any policy issued in reliance upon such information.


    I hereby declare that to the best of my knowledge and belief, the above statements and particulars are true, that I have not suppressed or misstated any material facts and I agree that this declaration shall form the basis of the insurance contract prepared on my behalf by the Insurer.

  • Please note, submitting this appliciation does not bind coverage. Once submitted, an Axis Insurance representative will contact you to confirm binding and provide payment instructions. Once payment is received by Axis, your Certificate of Insurance evidencing coverage will be emailed to you.

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