Political Subdivision Workers Compensation Alliance

Provider Application

The Alliance is not accepting applications for new providers at this time. We will only process additions to existing contracts. If your practice is already contracted with the Alliance and you need to add a new provider to the contract, please complete the application below.

Tell us about the Applicant.

Location 1 (required)

Additional location

Provider 1

Additional provider

Practice Point of Contact

The Political Subdivision Workers' Compensation Alliance (the Alliance) is a 504 network serving 5 public entity risk pools: