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Insurance Loss Run Release

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Insurance Loss Run Release

This Insurance Loss Run Release (the Release) is executed to authorize the disclosure of claims and loss history records. Applicant Name: Recipient Name:

Applicant / Insured Information

Date of Birth:

Policy Details

Policy Period From:   To: 

Requested Scope of Loss Runs

Coverage Types to be released (check all that apply):

Prior Carriers / Additional Instructions

Authorization, Representations and Release

Applicant hereby authorizes all current and former insurance companies, agents, adjusters, administrators, and their representatives to furnish loss runs, claim registers, claim notes, reserve and payment history, subrogation and recovery information and related documents (collectively Loss Run Records) to Recipient Name:

Applicant represents and warrants that Applicant has authority to request the release of Loss Run Records for the policies identified herein and that the information requested is for the legitimate business purpose selected below. Applicant releases and holds harmless any releasing party from liability for furnishing Loss Run Records in accordance with this Release to the extent permitted by law.

Applicant agrees to indemnify and hold harmless any releasing insurer, its agents and employees from and against any claims, liabilities or damages arising from the release or use of Loss Run Records by Recipient, except to the extent caused by the gross negligence or willful misconduct of the releasing party.

Exclusions and Limitations

This Release does not authorize the disclosure of records that are privileged or required to be withheld by law. Applicant understands that certain personal information may be included in Loss Run Records and authorizes disclosure to Recipient to the extent permitted by applicable law.

Duration of Release

This Release is effective upon signature and shall remain in effect for months unless revoked in writing. Applicant acknowledges that revocation will not affect disclosures made prior to receipt of written revocation.

Certification

By signing below, Applicant certifies under penalty of perjury that the information provided in this Release is true and correct, that Applicant is authorized to request disclosure of the Loss Run Records described herein, and that Applicant understands and accepts the terms, limitations and indemnities contained in this Release.

Applicant Name:

Signature:

Date:

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What an Insurance Loss Run Release Is and When it’s Used

An Insurance Loss Run Release is a signed authorization that lets an insurer or third party disclose a policyholder’s loss history, including reported claims, dates, and paid or reserved amounts. Brokers, agents, underwriters, and insureds use this document when shopping coverage, underwriting renewals, or evaluating risk. It typically identifies the insured, policy number, coverage period, and the party authorized to receive loss run reports. The release may be required in original or notarized form by some carriers and is often exchanged with renewal applications, audits, or claims investigations.

Why an Insurance Loss Run Release Matters

A clear, properly executed release speeds underwriting, ensures accurate risk assessment, and avoids delays in quoting or binding coverage while providing an auditable consent record for disclosure.

Why an Insurance Loss Run Release Matters

Who Typically Completes or Receives a Loss Run Release

Roles vary by transaction; confirm the required signer and form format with the carrier before sending.

  • Insurance broker — Requests loss runs to compare carriers and prepare renewal submissions quickly.
  • Commercial insured — Signs to permit disclosure for renewal or sale due diligence.
  • Underwriter/insurer — Receives release to pull complete claims history for pricing decisions.

Filling Out an Insurance Loss Run Release — Step by Step

Follow these steps to complete the release accurately and reduce processing delays.

  • 01
    1. Identify Parties: Enter insured and recipient names exactly.
  • 02
    2. Specify Coverage: List policy numbers and policy periods precisely.
  • 03
    3. Define Scope: State which claims and date ranges are authorized.
  • 04
    4. Sign and Date: Sign, date, and include notary if required.

How to Configure a Digital Release Workflow

Set up fields and authentication before sending to ensure carriers accept the digital copy.

Field Configuration
Full Legal Name Field Required text field; validate against policy records
Policy Number Field Required text field with pattern checks
Date Fields MM/DD/YYYY format with date pickers
Signature Field eSignature required; optional notarization flag

Typical Routing and Submission Flow

A standard routing sequence ensures each party receives the release and the signed record is retained.

  • Prepare Document: Populate required fields and attach supporting info.
  • Send to Signer: Deliver via email or secure link for signature.
  • Carrier Request: Broker or insured forwards signed release to carrier.
  • Carrier Response: Insurer provides loss run report to authorized recipient.

Digital Submission: Platform and Format Considerations

If the insurer requires an original wet signature or notarization, follow their specific submission instructions rather than relying on a digital-only copy.

  • Accepted Formats: PDF or PDF/A preferred
  • Authentication: Email or SMS OTP commonly accepted
  • Integrations: Connect with CRM or AMS systems

Core Elements to Include in a Professional Release

A well-structured release reduces carrier questions and creates a reliable audit trail for underwriting and claims purposes.

Named Parties

List the insured, insurer, and the authorized recipient by full legal name and provide company identification or NAIC number where applicable to avoid misrouting.

Policy Identifiers

Include each relevant policy number, line of business, and policy period so carriers can retrieve the exact accounts associated with requested loss runs.

Clear Scope

Specify whether the request covers reported, paid, closed, or reserved claims and define the date range to prevent partial or incomplete disclosures.

Signature and Date

Provide a dated signature block for the authorized signer and record the signing method to support legal validity and carrier acceptance.

Notary or Witness

Include notarization or witness lines only if the carrier or state requires them; specify requirements in an instruction note if applicable.

Retention Statement

State whether the recipient will retain and protect the loss run and reference any privacy obligations or data handling limits attached to the release.

Required Fields Checklist

Insured Name: Exact legal name
Policy Number: Full identifier
Policy Period: MM/DD/YYYY range
Authorized Recipient: Name and contact
Signature: Signer name and date
Notary: If required by carrier

Risks of an Incorrect or Incomplete Release

Delayed Underwriting: Prolonged quoting or bind delays
Incomplete Records: Partial loss runs hamper pricing
Claim Disputes: Ambiguous authorizations invite contest
Regulatory Noncompliance: Privacy breaches risk penalties
Tax Impacts: Incorrect data can affect reporting
Carrier Rejection: Insurer may refuse to honor request

Common Mistakes to Avoid When Preparing a Release

  • Using an informal recipient name instead of the authorized entity, which can prevent carriers from releasing records to the intended party and require reissuance of the form.
  • Entering an incorrect policy number or policy period, which commonly results in the insurer locating the wrong account or returning an incomplete loss run.
  • Failing to specify the scope of claims (reported, paid, reserves), leading to inconsistent or partial reports that are unusable for underwriting.
  • Assuming all carriers accept eSignatures; some require wet signatures, specific notarizations, or original documents before releasing sensitive claim histories.

Typical Timelines and Processing Expectations

Timing varies by carrier and state; plan ahead when requesting loss runs for renewals or transactions that are time-sensitive.

Standard Carrier Response:

Often 7–21 business days depending on workload

Renewal Requests:

Request loss runs 30–60 days before renewal deadlines

Broker Processing:

Allow 3–5 business days for broker review and redistribution

Notary or Original Requirement:

Adds additional days for in-person execution

Dispute Resolution:

Corrections or appeals may take several weeks

Example Scenarios Where a Release Is Used

Two practical examples show common use cases and expected outcomes when a release is properly completed.

Broker Renewal Submission

A broker needs current loss runs for a commercial package renewal

  • Broker specifies 5-year period and authorized recipient
  • With a complete release the carrier supplied consolidated loss runs within two weeks, enabling timely quotes and renewal placement.

M&A Due Diligence

A buyer requests historical claims before acquisition

  • Release names buyer as recipient and defines scope through the closing date
  • Clear scope and exact policy identifiers produced complete loss history, reducing post-close indemnity disputes.

Typical Signers and Their Authority

Claims Manager

A designated claims manager or authorized company officer who has authority to consent to disclosure on behalf of the insured. This signer should be prepared to verify identity and relationship to the insured.

Insurance Broker

A licensed broker or agent acting with written authorization from the insured to request loss runs. Brokers should retain a copy of the executed release to show authority when interacting with carriers.

eSignature Vendor Comparison for Executing a Loss Run Release

Compare common vendor pricing and capabilities relevant to signing and distributing Insurance Loss Run Releases; signNow is listed first for reference.

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 Yes, 7-day trial No No Yes, limited Yes, limited
Bulk Send Yes Yes Yes Yes No
Audit Trail Yes Yes Yes Yes Yes
HIPAA Compliant Yes Yes Yes No No

Practical Tips for Accurate and Rapid Completion

Follow these practical measures to reduce errors, speed carrier acceptance, and preserve an auditable record.

Verify Names and Numbers
Cross-check the insured name and policy number against the insurer’s policy declarations page or the insured’s policy documents before sending to avoid mismatches and rework.
Be Specific About Scope
State clearly what claim types and date ranges are authorized so the carrier returns a comprehensive and usable loss run without needing clarification.
Confirm Carrier Requirements
Ask the receiving insurer whether they accept electronic signatures, require notarization, or need an original document to ensure compliance and avoid delays.
Keep an Audit Trail
Retain the signed document, delivery receipts, and any verification logs to support audits and disputes; include consent language for third-party disclosures.

FAQs and Troubleshooting for Loss Run Releases

Answers to common questions about validity, signature methods, notarization, and retention for Insurance Loss Run Releases.


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