How do I request a run?

Submit a written request to the insurer or administrator including the policyholder name, policy number, date range, and the purpose of the request; allow typical processing times and specify if certification or notarization is required.

Is an electronic run valid?

Yes. Under the ESIGN Act (15 U.S.C. ch. 96) and UETA (adopted in most states), electronic records and signatures are legally enforceable provided intent, consent, attribution, and retention are satisfied.

What if a claim is missing or incorrect?

Identify the discrepancy in writing, provide supporting documentation, and request a corrected run; insurers usually have dispute processes and timeframes for correction.

Do I need a notarized run?

Most routine underwriting uses uncertified electronic runs; notarization or a signed certification is only required if a receiving party specifically requests it or for legal proceedings.

Can I attach medical or third-party reports?

Yes, but ensure HIPAA and privacy requirements are met for protected health information; use redact or secure transfer methods when necessary.

Who verifies authenticity?

The insurer or issuing vendor should provide contact information and an audit trail; recipients may verify via a named contact or portal authentication mechanisms.

Electronic Signature
Templates
Insurance
Insurance Claim History Run

Insurance Claim History Run

This template is fully customizable. Edit the text, fill out the fields, and send it for signature. Give it a try!

INSURANCE CLAIM HISTORY RUN

Applicant / Insured Information

Please provide the full identifying information for the individual or entity for whom claim history is requested. Incomplete information may prevent retrieval of complete claim records.

Applicant Name Date of Birth Policyholder / Entity Name Address

Contact Phone

Contact Email

Last 4 of SSN or Tax ID (if applicable)

Policy Details

Policy Number

Carrier / Insurer Name

Policy Type (select all that apply)

Auto Homeowners Commercial Property General Liability Workers' Compensation Umbrella/Excess

Coverage Limit

Deductible

Annual Premium

Policy Period - From

Policy Period - To

Claim History Request Details

This form authorizes the release and retrieval of claims and loss history records for the applicant/insured named above from insurers, claims databases, loss run providers, and other third-party administrators. The requester certifies that the information supplied is accurate and complete for the purpose stated below.

Requesting Party Purpose of Request

History Date From

History Date To

Search Parameters (select all required)

Include open/active claims Include closed claims Include reserves and current estimate Include payments and indemnity amounts Include subrogation and recovery activity Include vehicle VIN and year/make/model Include property address for property claims

Preferred Delivery Method

Email Paper Mail Secure Transfer (third-party provider)

If Email Selected, Provide Delivery Email

Known Losses to Include (Optional)

Provide details of any known losses you specifically request to be included in the report. Inclusion of these items assists in accurate retrieval.

Date of Loss (1) Claim Number (1) Estimated Damage (1) Description (1) Date of Loss (2) Claim Number (2) Estimated Damage (2) Description (2) Date of Loss (3) Claim Number (3) Estimated Damage (3) Description (3)

Documentation Checklist

Indicate any supporting documentation being provided with this request. Attach copies as required by retrieval procedures.

Police report Photos Repair estimate/invoice Medical records Proof of loss

Beneficiary Information (If Applicable)

Provide beneficiary details if this request relates to claims involving life, death, or benefits payable to a beneficiary.

Beneficiary Name

Relationship

Percentage of Benefit

Exclusions, Limitations, and Privacy Notice

The requester acknowledges and agrees that: (a) records produced by insurers, claims administrators, or third-party data providers may contain personal, medical, and financial information related to the applicant and are provided solely for legitimate underwriting, renewal, claims handling, or compliance purposes; (b) the provider and data sources may rely on information supplied herein and are not responsible for inaccuracies in the supplied identifiers; (c) this request does not alter, waive, or expand coverage under any policy and does not constitute an admission of liability; and (d) data providers and insurers furnishing records are released from liability for disclosures made in good faith pursuant to this authorization, except as prohibited by applicable law.

Certification and Authorization

I certify under penalty of perjury that the information provided in this form is true and correct to the best of my knowledge. I authorize any insurer, claims administrator, third-party data vendor, and their representatives to disclose and transmit the requested claim and loss history information to the requesting party named on this form and its representatives. I understand that the information obtained may be used for underwriting, policy issuance, renewal decisions, claims handling, or risk assessment. I further acknowledge that duplication and redistribution of the received records may be governed by contractual restrictions imposed by the data provider.

Name of Person Making Request (Printed) Title / Relationship to Insured Requestor Contact Phone

Applicant / Insured:

Signature:

Date:

What an Insurance Claim History Run Is

An Insurance Claim History Run is a compiled record from an insurer or third-party administrator that lists prior claims for a policyholder or insured entity over a specified period. It typically includes claim dates, loss types, paid amounts, reserves, claim status, and adjuster notes. Insurers, underwriters, brokers, and risk managers use the run to evaluate prior loss experience when pricing coverage, underwriting risk, or investigating coverage issues. Accurate runs support proper reserves, subrogation, and claims-handling decisions.

Why Requesting a Claim History Run Matters

A clear claim history run improves underwriting accuracy, speeds claim reviews, and reduces downstream disputes by putting prior loss data in one place; it also aids in fraud detection and trend analysis.

Who Typically Requests or Prepares a Claim History Run

Different parties request or prepare runs depending on purpose, from underwriting to litigation support.

Underwriters assessing new or renewal exposures for pricing and terms.
Claims examiners verifying prior payments, reserves, and subrogation opportunities.
Brokers and agents compiling loss histories for client placement.
Attorneys and risk managers using runs for litigation, audits, or regulatory reviews.

Access and accuracy expectations vary by role; who requests the run should specify period, policy numbers, and any exclusions.

Core Elements Included in a Professional Claim History Run

A professional run standardizes key data points so recipients can compare exposures across applicants and periods without manual reconciliation.

Policy Identifier

Policy number, effective and expiration dates, and insurer name to link claims to coverage.

Claim Identifier

Unique claim number and loss date for chronological tracking and cross-reference.

Loss Type

Classification (e.g., liability, property, workers' comp) and brief loss description for underwriting context.

Payment Details

Amounts paid, payment dates, and reserve changes to show financial impact.

Claim Status

Open, closed, litigated, or subrogation status to indicate ongoing exposure.

Adjuster Notes

Concise narrative of key findings, coverage positions, or investigative actions.

Essential Data Fields at a Glance

Claimant Name: Full name as on policy

Policy Number: Insurer policy ID

Claim Number: Insurer claim reference

Date of Loss: MM/DD/YYYY

Loss Type: Standard category

Paid / Reserved: Amounts in USD

Step-by-Step: Preparing or Requesting a Claim History Run

Follow these four steps to obtain a usable run whether you request it from an insurer or generate it internally.

01

Define Scope: Specify insured, policy numbers, and date range.
02

Request or Extract: Submit insurer request or query claims system for matching records.
03

Validate Entries: Confirm claim numbers, dates, and amounts match source files.
04

Deliver with Notes: Include a legend and adjuster notes for context.

Customize an Online Workflow to Produce the Run

Set up a repeatable digital workflow that captures data, triggers quality checks, and exports standardized runs.

Field	Configuration
Claim Search	Auto-populate by policy number
Validation Rule	Require loss date and claim number
Export Format	CSV and PDF summary
Access Control	Role-based view and download

Digital Signing and eSubmission Considerations

For electronic runs, confirm platform capabilities for secure export, audit trails, and signer authentication before eSubmission.

File Formats: PDF/A, CSV and DOCX supported
Integrations: Salesforce, NetSuite, Google Workspace
Authentication: Email, SMS code, or KBA available

Choose a solution that provides an unalterable PDF export and an audit trail that documents who accessed or attested to the run.

Where to Send or File an Insurance Claim History Run

Routes depend on the requestor: underwriters, reinsurers, regulators, or claim handlers each have different submission targets and access needs.

To Underwriters: Send via secure portal or SFTP
To Brokers/Clients: Provide PDF with cover letter
To Reinsurers: Send schedule and detailed files
To Regulators: File per agency submission rules

How to Download, Save, and Package the Run

Use standardized exports and secure formats to maintain integrity and make the run usable for analysis or regulatory submission.

PDF Export

Create a locked PDF summary with an attached CSV for line-item detail; include an audit trail page.

CSV / Spreadsheet

Export raw claim rows with header fields for data ingestion and trend analysis.

Versioning

Label files with generation date and version; do not overwrite originals.

Secure Storage

Store in encrypted cloud or enterprise repository with role-based access.

Timelines, Deadlines, and Processing Expectations

Typical turnaround and retention expectations help set SLAs between requestors and insurers.

Request Acknowledgement:

Within 3 business days

Standard Delivery:

5–10 business days for typical runs

Expedited Requests:

1–3 business days if prioritized

Issuer Audits:

Additional 10–30 days for verification

Record Retention:

Retain original for at least 3 years

Key Milestones in Producing a Claim History Run

A typical production timeline has numbered milestones from request intake through final delivery and archival.

01

Intake and Verification

Confirm requestor, scope, and identity of insured.

02

Data Extraction

Pull matching claims from policy and claim systems.

03

Quality Review

Reconcile totals, check for duplicates, and confirm dates.

04

Delivery and Documentation

Deliver files with legend and audit trail.

Common Mistakes to Avoid When Preparing a Run

Providing incomplete policy identifiers that prevent record matching.
Using inconsistent loss type labels that skew trend analysis.
Failing to include paid versus reserved distinctions.
Delivering runs without an explanatory legend or adjuster notes.

Potential Risks and Consequences of Incorrect Runs

Claim Denial: Incorrect history can lead to disputed coverage

Delayed Settlement: Errors slow evaluation and payments

Regulatory Scrutiny: Incomplete records may prompt inquiries

Privacy Violation: Unauthorized disclosures risk HIPAA/CCPA issues

Financial Exposure: Understated reserves create solvency risk

Reputational Harm: Repeated errors reduce market trust

How a Claim History Run Differs from a Loss Run Summary

These documents overlap but serve different operational and analytical needs; the table highlights key distinctions.

Criteria	Insurance Claim History Run	Loss Run Summary
Purpose	detailed claim-level record	aggregated loss totals
Detail Level	high detail with notes	summary rows by period
Typical Users	claims/legal/underwriting	actuarial/underwriting
Delivery Format	pdf + csv with notes	spreadsheet summary

eSignature Vendor Pricing and Feature Snapshot

Compare basic pricing and common features across vendors; signNow is listed first per comparison conventions without time-stamping this data.

	signNow	DocuSign	Adobe Sign	PandaDoc	HelloSign
Starting Price	$8/user/mo	$15/user/mo	$14/user/mo	$19/user/mo	$15/user/mo
Free Trial	7-day free trial	Varies by vendor	Varies by vendor	Varies by vendor	Varies by vendor
Bulk Send	Yes (Premium tier)	Yes	Yes	Yes	Varies
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes	Yes	Yes	No	No

Who Can Legally Sign or Certify a Claim History Run

Authorized Signer

An insurer's authorized representative or claims manager should sign or certify the run. The signer must have documented authority within the insurer's delegation policy and be able to attest to the run's completeness and accuracy in writing.

Third-Party Provider

A vendor producing runs on behalf of an insurer may sign if contractually authorized; include a certification statement and contact for verification to avoid acceptance issues.

Frequently Asked Questions About Insurance Claim History Runs

Answers to common questions about obtaining, authenticating, and correcting claim history runs, with practical next steps.

Need help? Contact support

How do I request a run?
Submit a written request to the insurer or administrator including the policyholder name, policy number, date range, and the purpose of the request; allow typical processing times and specify if certification or notarization is required.
Is an electronic run valid?
Yes. Under the ESIGN Act (15 U.S.C. ch. 96) and UETA (adopted in most states), electronic records and signatures are legally enforceable provided intent, consent, attribution, and retention are satisfied.
What if a claim is missing or incorrect?
Identify the discrepancy in writing, provide supporting documentation, and request a corrected run; insurers usually have dispute processes and timeframes for correction.
Do I need a notarized run?
Most routine underwriting uses uncertified electronic runs; notarization or a signed certification is only required if a receiving party specifically requests it or for legal proceedings.
Can I attach medical or third-party reports?
Yes, but ensure HIPAA and privacy requirements are met for protected health information; use redact or secure transfer methods when necessary.
Who verifies authenticity?
The insurer or issuing vendor should provide contact information and an audit trail; recipients may verify via a named contact or portal authentication mechanisms.

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