Who can request a loss run?

Typically the policyholder, an authorized agent, or someone with written authorization can request a loss run. Carriers may require a signed release or proof of authority before producing claim details.

Are loss runs legally binding?

Loss runs are carrier records of claim activity and are used for underwriting and auditing. They are factual summaries but do not replace policy terms; discrepancies should be reconciled with carrier claim files.

Is notarization required?

Most carriers do not require notarization for loss runs, but certain lenders or legal processes may request notarized copies. Check recipient requirements and state rules for notarization or witness needs.

Can loss runs include PHI?

Loss runs may contain protected health information if medical claims are listed. When PHI is present, handle and transmit reports under HIPAA protections and ensure a BAA with any vendor handling the data.

What if a claim is missing or incorrect?

Contact the issuing carrier promptly with supporting documentation. Request a corrected loss run and retain written confirmation of the carrier's correction for underwriting and audit trails.

How long should I keep loss runs?

Retain loss runs per your document retention policy; generally keep them for the policy term plus at least three years and longer where federal or state rules require extended retention.

Electronic Signature
Templates
Insurance
Insurance Loss Run Form

Insurance Loss Run Form

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

INSURANCE LOSS RUN REQUEST

Applicant / Insured Information

Insured Name Insured Address

Date of Birth

Tax ID / FEIN

Primary Contact

Phone

Email

Policy Information

Insurer / Carrier Name

Policy Number

Policy Type

Coverage Limit

Deductible

Annual Premium

Policy Period From

Policy Period To

Coverage Types (select all that apply)

General Liability
Property
Automobile
Workers' Compensation
Professional Liability / E&O
Other (describe below)

If Other, describe

Loss Run Period Requested

From: To:

Claim History — Provide all claims within requested period

Complete the table below for each claim known to the insured. If additional space is required, attach supplemental pages.

Claim #	Date of Loss	Date Reported	Claimant / Injured Party	Cause / Nature	Paid / Reserves

If additional claims, attach supplemental sheet

Attachments Checklist

Indicate which documents accompany this request:
Original loss notices
Photographs / diagrams
Repair estimates / invoices
Police reports / legal filings
Supplemental claim history (attached)

Exclusions and Limitations

Requestor understands that the loss run provided is limited to the carrier's policy records and may not reflect litigation outcomes or settlements not recorded in carrier files. The carrier is not required to give legal opinions, underwriting recommendations, or privileged claims notes. Loss runs typically show claim numbers, dates of loss, reported dates, paid loss amounts, and current reserves; other data may not be available.

Certification and Authorization

I certify that the information provided on this request is true, accurate and complete to the best of my knowledge. I authorize the named insurer and its representatives to compile and release the loss run information requested to the party identified on this form. This authorization is limited to the release of loss history and related claim summary data for underwriting or placement purposes and does not waive any other privileges or confidentiality protections except as necessary for release of the requested loss history.

Requestor affirms that any information provided which is willfully false or intentionally omitted may affect coverage and may be relied upon by the recipient insurer in determining terms or eligibility for insurance. Requestor agrees to indemnify the carrier for any costs incurred in responding to this request where permitted by law.

Requestor / Company Authorized to Receive Loss Run Purpose of Request Additional Instructions / Notes

By signing below, the undersigned certifies authority to request and receive the requested loss run information and acknowledges that this request may be processed in accordance with the carrier's administrative procedures.

Applicant Name:

Signature:

Date:

Title / Capacity:

What the Insurance Loss Run Form Is

An Insurance Loss Run Form is a document provided by an insurer that summarizes a policyholder's claim history over a specified period. It lists claim dates, loss amounts, claim status, reserves, payments, and coverage lines associated with each loss. Brokers, underwriters, risk managers, and insureds use loss runs to assess prior loss activity when quoting coverage, underwriting renewals, or evaluating acquisitions. Because loss runs affect premium and eligibility, accuracy and clarity are essential; many underwriters require recent loss runs covering one to five years for risk evaluation and policy placement decisions.

Why the Insurance Loss Run Form Matters

Loss runs provide a factual, consolidated loss history that insurers and brokers use to price risk, verify claims activity, and identify trends. Accurate loss runs reduce underwriting delays, support renewal negotiations, and inform risk-mitigation planning.

Who Completes and Uses Loss Run Forms

Multiple parties request, produce, or rely on loss runs at different stages of insurance placement and claims review.

Insurance carriers and claims departments prepare official loss runs for insureds and brokers to document claim histories for underwriting and audits.
Brokers and agents request loss runs to assemble submission packages and to compare carriers' loss interpretations during placement or renewal.
Commercial insureds and risk managers use loss runs internally for budgeting, safety programs, and to support disclosure in mergers or financing.

Knowing who needs the form helps determine format, level of detail, and any required authentication such as notarization or carrier letterhead.

Essential Sections of a Professional Loss Run Form

A professional loss run is structured, dated, and signed by an authorized carrier representative. It should be on carrier letterhead, include policy identifiers, and present each claim consistently.

Carrier Info

Name, NAIC number, address, and contact for the claims department or issuing agent on carrier letterhead.

Policy Details

Policy number, policy period (MM/DD/YYYY–MM/DD/YYYY), policy type, and insured name exactly as listed on the policy.

Claim Summary

For each claim, list date of loss, claim number, cause of loss, status (open/closed), reserves, payments, and indemnity details.

Financials

Separate paid amounts, reserves, and outstanding case reserves; list defense costs if applicable.

Issuer Attestation

Signature, printed name, title, and date from an authorized carrier representative or claims officer.

Formatting Notes

Clear columns, consistent date format, and a statement indicating whether the report covers all claims for the period.

Step-by-Step: Requesting and Delivering a Loss Run

Follow a clear sequence to obtain an accurate loss run from the issuing carrier and deliver it to the requesting party.

01

Prepare Request: Gather insured name, policy number, and authorization letter if required.
02

Submit to Carrier: Send request by carrier-preferred channel (email, portal, or agent request).
03

Carrier Response: Carrier generates loss run and returns via secure email or portal download.
04

Review & Forward: Check completeness, then provide the loss run to underwriter or broker in PDF form.

Configuring an Online Loss Run Request Workflow

Set fields and authentication to match carrier requirements and to protect sensitive claim data.

Field	Configuration
Authentication Level	Email plus optional SMS code for recipient verification.
Date Format	MM/DD/YYYY required to match carrier systems.
Conditional Fields	Show carrier authorization only when third-party release selected.
Template Save	Save a reusable template for renewals and bulk requests.

Delivery and Integration Options for Loss Runs

Loss runs are typically shared via secure PDF and integrated into broker or carrier systems for underwriting and archival.

Email Delivery: Secure PDF via carrier-approved address.
Portal Upload: Carrier portals or broker platforms accept structured PDF files.
System Integrations: Integrate with CRM or AMS for automated filing.

Ensure the chosen channel preserves audit logs, access controls, and the ability to reproduce the record for regulatory or audit purposes.

Typical Routing for a Loss Run Request

A standard routing pattern ensures accountability and preserves the audit trail from request to delivery.

Request: Broker or insured sends a formal, dated request.
Carrier Processing: Claims department locates records and prepares the report.
Quality Review: Carrier verifies totals, dates, and signatures.
Delivery: PDF delivered to requester with audit metadata.

Typical Timing and Response Expectations

Timing varies by carrier, but common benchmarks help set expectations for requesters and underwriters.

Request Acknowledgement:

Carrier typically acknowledges within 1–3 business days of receipt.

Standard Preparation Time:

Most carriers deliver loss runs within 7–14 business days after receiving full authorization.

Expedited Requests:

Some carriers offer expedited handling for an additional fee; timeframe may be 24–72 hours.

Policy Renewal Deadlines:

Request loss runs at least 15–30 days before renewal submissions to avoid placement delays.

Retention After Delivery:

Keep copies in broker and insured files per retention policies and regulatory requirements.

Key Processing Milestones

Track these stages to manage expectations and to escalate when a milestone slips.

01

Request Submitted

Requester files authorization and policy data with the carrier for processing.

02

Carrier Processing

Claims verifies records, compiles claim entries, and prepares report.

03

Internal Review

Requester reviews loss run for completeness and flags discrepancies.

04

Final Delivery

Carrier sends signed PDF and audit metadata to requester for distribution.

Common Errors and Obstacles to Avoid

Incomplete authorizations: missing insured signature or incorrect insured name often prevents carriers from releasing loss runs and delays underwriting.
Mismatched policy identifiers: incorrect policy numbers or periods can cause claims to be omitted from the report and distort loss history.
Unclear loss descriptions: vague causes or inconsistent date formats impede underwriters’ ability to evaluate frequency and severity accurately.
Delivery method issues: insecure email, missing audit trail, or non-searchable PDFs hinder compliance and future retrieval during audits.

Security and Compliance Considerations

Encryption: TLS 1.2/1.3; AES-256 at rest

Access Controls: Role-based permissions and audit logs

Authentication: Email, SMS, or stronger multifactor options

Audit Trail: Timestamps, IP, and signer attribution

HIPAA Considerations: BAA required when PHI present

Retention: Secure archival with reproduce capability

Risks and Consequences of Incorrect Loss Runs

Claim Denial: Incorrect facts can lead to claim disputes

Underwriting Delays: Incomplete reports slow placement processes

Regulatory Risk: Failing to preserve records may invite scrutiny

Financial Exposure: Undisclosed losses affect premium accuracy

Data Breach: Poor handling of reports risks PHI exposure

Reputational Harm: Repeated errors damage carrier-broker trust

How Loss Run eSignature and Delivery Options Compare

Compare common delivery features and authentication options to choose the right balance of security and convenience for loss runs.

Criteria	Platform A	Platform B
In-person signing	optional	optional
Remote notarization	available	limited
Bulk requests		limited
Audit metadata	full	partial

eSignature Pricing and Feature Comparison Relevant to Loss Runs

Compare starting prices and common feature considerations across major providers to evaluate cost and compliance suitability for loss run workflows.

	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	No	No	Yes, limited	Yes, limited
Bulk Send	Yes (Premium)	Yes	Yes	Yes	No
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes	Yes	Yes	No	No

Practical Tips for Accurate and Efficient Loss Runs

Apply these practical measures to reduce errors, preserve compliance, and speed underwriting decisions.

Standardize Request Templates

Use a consistent request template that includes insured name, policy number, policy period, and a carrier authorization signature line to eliminate back-and-forth clarifications and speed processing across multiple carriers.

Validate Identifiers

Double-check policy numbers and insured legal names against the policy declarations page before submitting the request; even small discrepancies can cause carriers to return incomplete reports or omit claims.

Secure Transmission

Send loss runs as secured PDFs with password protection or via carrier portals; ensure any third-party platform used provides audit logs and encrypts data in transit and at rest.

Review Immediately

Review the returned loss run promptly for missing entries, mismatched dates, or incorrect amounts and request corrections within the carrier’s stated response window to avoid renewal or placement delays.

Example Scenarios Where Loss Runs Influence Decisions

Real-world scenarios show how accurate loss runs affect pricing, placement, and risk mitigation.

Acquisition Due Diligence

A buyer requests three years of loss runs to evaluate liability exposure

Reviews frequency and severity across policies
Clear, carrier-signed loss runs enabled accurate reserve estimates and informed purchase price adjustments for the deal.

Renewal Negotiation

A broker submits updated loss runs during renewal negotiations

Highlights closed claims and reduced severity
The underwriter adjusted terms and deductible options after confirming the most recent reserves and payments.

Frequently Asked Questions About Loss Run Forms

Answers to common questions about requesting, validating, and delivering insurance loss run forms.

Need help? Contact support

Who can request a loss run?
Typically the policyholder, an authorized agent, or someone with written authorization can request a loss run. Carriers may require a signed release or proof of authority before producing claim details.
Are loss runs legally binding?
Loss runs are carrier records of claim activity and are used for underwriting and auditing. They are factual summaries but do not replace policy terms; discrepancies should be reconciled with carrier claim files.
Is notarization required?
Most carriers do not require notarization for loss runs, but certain lenders or legal processes may request notarized copies. Check recipient requirements and state rules for notarization or witness needs.
Can loss runs include PHI?
Loss runs may contain protected health information if medical claims are listed. When PHI is present, handle and transmit reports under HIPAA protections and ensure a BAA with any vendor handling the data.
What if a claim is missing or incorrect?
Contact the issuing carrier promptly with supporting documentation. Request a corrected loss run and retain written confirmation of the carrier's correction for underwriting and audit trails.
How long should I keep loss runs?
Retain loss runs per your document retention policy; generally keep them for the policy term plus at least three years and longer where federal or state rules require extended retention.

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