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Insurance Loss Run Request

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Insurance Loss Run Request

Applicant / Insured Information

Contact Phone:

Email:

Individual    Corporation    LLC    Partnership    Other:

Policy / Coverage Details

Policy Number:

Agent / Broker:

Coverage Type (check all applicable):
General Liability    Commercial Auto    Property    Workers' Compensation    Professional Liability / E&O    Umbrella / Excess

Policy Limit:

Deductible/SIR:

Premium (if known):

Coverage Period Requested: From   to  

Requested Report Details

Request the insurer to provide a complete loss run for the insured and policy(ies) identified above. The loss run should include, at minimum, for each claim: claim number, date of loss, date reported, loss type/cause, status (open/closed), current reserves, total paid to date, indemnity expense allocation, defense expense allocation, and subrogation recoveries.

Provide loss run in the following format (select one):
Electronic (PDF or spreadsheet)    Hard copy via mail    Fax

Phone:

Email/Fax:

Inclusions / Exclusions

Include the following (check all that apply):
Open claims    Closed claims    Subrogation recoveries    Full reserve detail (case and IBNR)    Claims with zero activity

The insurer is requested to include any claim notes and file status comments that are part of the claim record. Do not exclude claim documentation that is necessary to understand claim status or payment history.

Authorization and Certification

By signing below, the undersigned hereby certifies that they are authorized to request loss history and claim information for the insured named in this request. The undersigned authorizes the insurer, its representatives, agents, and servicing companies to release the requested loss runs and related claim information to the designated recipient identified herein.

The undersigned understands that the release of claim information may include personal or sensitive data and agrees to indemnify and hold harmless the insurer and its agents from any claims arising from the release to the recipient listed on this form, provided the release is made pursuant to the authorization herein. This request does not waive any privilege beyond the scope of this release nor modify policy terms, coverages, or limits.

Additional Information / Notes

Requestor / Applicant Certification

I certify under penalty of perjury under the laws of the applicable jurisdiction that the information provided in this request is true and correct to the best of my knowledge. I acknowledge that this request is for informational purposes only and is not an admission of liability under any insurance policy.

Requestor Phone:

Requestor Email:

Printed Name:

Signature:

Date:

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What an Insurance Loss Run Request Is

An Insurance Loss Run Request is a formal written or electronic request submitted to an insurer or insurance agent asking for a policyholder’s claims history over a specified period. The document typically asks for dates of loss, claim numbers, reserves, payments, and cause codes for each claim. Brokers, underwriters, and insureds use loss runs for underwriting, renewal negotiations, premium audits, and claims management. The request may be sent during renewal, prior to quoting new coverage, or during due diligence for acquisitions and lending. Accurate, complete loss runs support proper risk assessment and pricing.

Why Loss Run Requests Matter

Loss run requests provide essential claims history that informs underwriting, pricing, and risk control decisions; they reduce surprise exposures at renewal and support accurate premium allocation during audits and transactions.

Why Loss Run Requests Matter

Typical Users and Their Roles

Brokers, risk managers, underwriters, and insured parties commonly request loss runs when assessing policy renewals or obtaining quotes.

  • Insurance brokers: collect loss runs to prepare comparative renewal submissions and negotiate coverage terms.
  • Risk managers: use historical claim details to implement loss-control measures and forecast reserve needs.
  • Underwriters: evaluate frequency and severity of claims to set rates, endorsements, and underwriting appetite.

Use appropriate internal controls for request authorization and preserve copies for compliance and audit trails.

Who Prepares and Reviews Loss Runs

Broker

Brokers or agents prepare loss run requests on behalf of insured clients to support renewal submissions, compare carrier responses, and negotiate terms; they must ensure the policyholder authorizes disclosure and verify completeness before submitting to prospective carriers or auditors.

Underwriter

Underwriters analyze loss run details — dates, reserves, paid amounts, and causes — to assess risk classification, determine pricing, set policy terms, and identify potential exclusions; accurate historical data informs reserve adjustments and future premium calculations.

Security and Compliance Essentials

Encryption in transit: TLS 1.2/1.3, AES-256 at rest.
Access Controls: Role-based permissions and audit trails.
HIPAA BAA: BAA available for covered entities.
Audit Trail: Time-stamped actions, IP address.
Certifications & Standards: SOC 2 Type II, ISO 27001.
Record Retention: Secure storage with version history.

Consequences of Incorrect or Late Requests

Late 1099 Filing: $60–$330 per form (IRC §6721)
Intentional Disregard: $660+ per form, no cap.
Missing TIN: Backup withholding 24%.
I-9 Violations: $281–$2,789 per violation.
Incorrect Loss Data: Underwriting denial or premium reclassification.
Delayed Response: Coverage gaps or renewal delays.

Common Preparation Challenges

  • Incomplete claim details hinder accurate underwriting and can lead to premium adjustments or coverage disputes during renewal or audit.
  • Data inconsistencies across carriers require manual reconciliation, increasing processing time and potential for overlooked claims.
  • Unauthorized requests without proper written consent or signatures may breach privacy rules and delay insurer responses.
  • Poorly formatted requests increase follow-up queries, prolong turnaround times, and impair timely underwriting risk decisions.

Step-by-Step: Prepare and Submit a Loss Run Request

Follow this step-by-step process to prepare and submit an Insurance Loss Run Request electronically or on paper.

  • 01
    Confirm Authorization: Obtain written permission from the policyholder.
  • 02
    Specify Period: State exact start and end dates in MM/DD/YYYY.
  • 03
    Detail Data Requested: List fields: claim number, date, reserves, payments.
  • 04
    Send to Carrier: Deliver via insurer portal, email, or certified mail.

Configuring a Digital Workflow for Requests

Configure digital workflows to capture, route, and archive loss run responses securely, with authentication and audit logging enabled.

Field Configuration
Signer Authentication Method and Strength Enable email links, SMS codes, or KBA.
Field Mapping and Validation Rules Map CSV columns to fields; validate dates and numerics.
Routing, Sequential Approvals, and Notifications Route responses to broker, underwriter, and compliance teams.
Storage, Retention, and Access Controls Securely store documents with version history and retention policies.

Technical Requirements and Integrations

Digital submission requires a platform that supports PDF/CSV uploads, audit trails, and secure authentication for signers and recipients.

  • Formats Supported: PDF, CSV, Excel supported.
  • Integrations: Salesforce, NetSuite, Google Workspace, Microsoft 365.
  • Authentication Options: Email link, SMS, KBA, SSO.

How the Request and Response Flow Typically Works

Typical routing: request generation, carrier delivery, carrier response, and archiving for underwriting and audit purposes.

  • Upload Request: Create request and attach required authorization.
  • Send to Carrier: Use insurer portal or secure email link.
  • Carrier Processes: Carrier locates records, compiles loss runs.
  • Receive & Review: Download structured file and verify completeness.

eSignature Pricing and Capability Comparison

Comparison of common eSignature plans and capabilities relevant to submitting and signing Insurance Loss Run Requests electronically.

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 trial Varies by vendor Varies by vendor Varies by vendor Varies by vendor
Bulk Send Yes Yes Yes Yes No
Audit Trail Yes Yes Yes Yes Yes
HIPAA Compliant Yes Yes Yes No No

Best Practices to Improve Accuracy and Speed

Follow these best practices to make loss run requests complete, auditable, and easy for carriers to fulfill.

Obtain written authorization from policyholder
Always secure a signed authorization that names the requesting party and specifies the data period; carriers will not release detailed claim files without explicit written consent, and missing authorization is a common cause of delays.
Specify exact fields and preferred file format
Provide a clear list of required fields and request CSV or Excel output when possible; structured exports reduce manual rekeying, minimize transcription errors, and speed integration with underwriting tools and loss runs analysis workflows.
Confirm identity and policy details before sending
Verify policy numbers, insured names, and effective dates against policy records or ID to avoid mismatches; inaccurate identifiers often produce incomplete or incorrect loss runs that require time-consuming follow-up and re-requests to carriers.
Request structured data when possible for analysis
Ask carriers to provide loss runs in CSV or Excel with consistent column headers and standardized date formats to enable automated import, reduce manual reconciliation, and facilitate quicker actuarial or underwriting assessment across multiple policies or entities.

Frequently Asked Questions About Insurance Loss Run Requests

Answers to frequent questions about preparing, submitting, and validating Insurance Loss Run Requests with electronic signatures and digital delivery.


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