Disability Income Insurance for Professionals

Disability Insurance can be a complicated product for those uneducated in the options, definitions, and policy structure.  By requesting a quote, we are assuming you are a Professional with a basic level of understanding about Disability Insurance and thus are requiring a Non-Cancelable & Guaranteed Renewable Policy with true Own Occupation coverage, COLA, Future Increase, and Residual Benefits.  With this as the Policy core, additional riders will be included in your quote for consideration and discussion prior to application and issue.

So that we can provide you with the most accurate quote possible, please include occupation specialty, avocations, and income details.  Your quote will include several riders that most professionals consider important - you may decide to reduce or remove these riders during the application process on your own or after consultation with our Disability Specialists.  Due to privacy laws, the details about your health history will be discussed via phone.

Disability Insurance Quote Request

All required fields are marked with a *. Due to the daily volume of requests, if you leave a required field blank your request will not be fulfilled.

First Name*
Last Name*
E-mail Address*
Phone Number*
State*	Select One.... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington DC West Virginia Wisconsin Wyoming
Age*
Sex*	select... Male Female
Annual Income*
Association Membership(s)?*
Occupation/Medical Specialty/Resident*
If Medical, Any Invasive Duties?*	select... N/A Yes No
Do you use Tobacco?*	select... Yes No
Health History	Due to privacy laws, we will discuss health history via phone; Counseling, Chiropractic, P/T, Surgery, & Prescriptions are all relevant
Current Disability Coverage	Indicate if coverage is Individual or Group, the Insurance Provider, and whether you personally pay the Premium for the coverage or not
Additional Information	eg. recent motor vehicle moving violations, avocations like piloting or rock climbing, adding to or replacing current coverage, requested discount via employer sponsored plan, etc
Please also contact me regarding:	Retirement Protection Plus Life Insurance Financial Strategies Business Overhead Expense Insurance
Details for items selected:	eg. For Retirement Protection Plus: indicate the Retirement plans in which you participate, how much You Contribute, and how much your Employer Contributes. For Life Insurance: indicate type and amount of coverage. For Financial Strategies: indicate your primary desires like (a) reduce taxes, (b) craft exit strategies from retirement plans, (c) buy your building, (d) optimize and coordinate assets, etc.
Would you like a Disability Specialist to call you to answer questions first?	Yes     No
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