CT We Care LLC
Home Care Agency Insurance Intake — powered by Safeshield
Business Information
Tell us about your home care agency
Services & Operations
Underwriting needs to understand exactly what care you provide
Any prior claims or incidents in the last 5 years?
Commercial Auto Information
Vehicles used for the business and caregiver driving practices
Agency-Owned Vehicles
Employee Information
For Workers Comp, EPLI, and staffing exposure
Key Employees / Caregivers
General Liability Details
Standing GL exposure for the agency itself
GL Limits Needed
Any client injury, property damage, or abuse-related incidents / allegations?
Medical Malpractice / Professional Liability
Only matters if any clinical or medical care is provided
Desired / Current Malpractice Limits
Prior malpractice claims or allegations (dates + outcome)
Coverage Needs
Check every coverage you want us to quote
Upload Current Declarations Page (Optional)
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Upload your current declarations page
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When do you need coverage? *
How did you hear about us?
Anything else we should know?
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