Employment Practices Liability Insurance (EPLI)

Employment Practices Liability Insurance otherwise known as EPLI is insurance that helps protect you against claims from your employees that result from the general conduct of your business. Common examples of employee related claims include claims relating to:

• Discrimination
• Wrongful Discharge
• Sexual Harassment
• Hostile Working Environment
• Wrongful Termination
• Lack of Advancement

Employment Practices Liability (EPLI) Quote Request

Please take a moment to fill out the form below and one of our local insurance agents will contact you with a free, no-obligation quote. This information will be kept confidential and will be used for quote purposes only.

* Required fields.

General Information
Your Full Name: *
Your Company:
Address:
City:
State:	Zip:
Business Phone: *	Fax:
E-mail Address: *

Employee Information
No. of F-T Employees:
No. of P-T Employees:
No. of Employees within Salary Range:	$1-30,000   $30,001-50,000   $50,001-100,000   > $100,000

Prior/Pending Claims
Within the past 5 years, has any administrative hearing / claim been made or is now pending against the organization?	Yes   No
Is any person aware of any fact or circumstance that may give rise to a claim under this policy?	Yes   No

Operations/Procedures
Nature of Operations:
Does the insured have written policies/procedures on?	Hiring/Firing: Yes   No Sexual Harassment: Yes   No Discrimination: Yes   No
Is there a Human Resource Department?	Yes   No

Miscellaneous Information
Has there been, or is there anticipated to be any reduction in staff in the past / future 12 months? If YES, explain:
Does the Insured have an "Employment At Will" statement?	Yes   No
Does the handbook state that it is "not a contract"?	Yes   No
Is EPL coverage in place currently? If YES:	a) Inception date of first policy: b) Current Carrier:

Describe Any Claims You've Had in the Past 3 Years

Additional Comments or Questions

Enter Security Code:

Please click the "Submit Quote Request" button to send your quote request. No coverage is in effect until bound by an insurance carrier. This is a request for quotation only.