What it does
PR DS 04 is the declarations form used with the ISO PR 00 07 (occurrence) and PR 00 08 (claims-made) coverage forms. It records the named insured, policy period, limits of insurance and premium, and, for claims-made coverage, the retroactive date that controls which earlier incidents are covered.
Program context
ISO's medical professional liability (PR) program provides separate coverage forms for physicians, surgeons and dentists; hospitals; allied health care providers; blood banks; diagnostic testing laboratories; optometrists; and veterinarians, each in an occurrence version and a claims-made version, with matching declarations (PR DS 01 to PR DS 07) and shared endorsements. Forms lists show the 09 08 edition as current. ISO has filed this as its Simplified Medical Professional Liability program.
Who needs it
Every policy written on the matching PR coverage form.
Quoting and selling notes
- Check the limits (each claim or occurrence and aggregate) against hospital privileges, contracts and state requirements.
- On claims-made policies confirm the retroactive date matches prior coverage.
- Carriers frequently print their own declarations in place of the ISO form.
