What exactly are loss runs?

Loss runs are carrier-produced reports summarizing a policyholder's claims history, usually listing claim dates, reserves, payments, and status. They are used by underwriters and brokers to evaluate past loss activity and inform pricing and coverage decisions.

Who can sign an authorization?

An insured (individual or an authorized corporate officer) or a person with written authority may sign. If a broker signs on behalf of an insured, carriers commonly require evidence of that authority to accept the release.

Can an authorization be e-signed?

Yes, where permitted by law and the carrier's policy. Electronic signatures that meet the ESIGN Act (15 U.S.C. §7001) and relevant state UETA requirements are generally enforceable for these authorizations.

Are there privacy concerns with releasing loss runs?

Yes. If records include protected health information or other regulated data, you must comply with HIPAA and applicable privacy laws; include required HIPAA authorization language and ensure any platform handling PHI has a BAA.

How long does it take to receive loss runs?

Times vary by carrier and request complexity; many responses arrive within 10–30 business days, though expedited services may be available for a fee. Allow extra time near renewal deadlines to avoid coverage gaps.

How do I revoke or correct an authorization?

Revocation typically requires a signed written notice to the carrier and recipient. For consumer-facing electronic records, ESIGN rules require that consent procedures allow withdrawal; consult carrier policy and legal counsel for precise steps.

Electronic Signature
Templates
Miscellaneous
Insurance Loss Runs Authorization

Insurance Loss Runs Authorization

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

Insurance Loss Runs Authorization

RECITALS

WHEREAS, the Insured Name: is or was insured under one or more policies issued by Carrier Name: ;

WHEREAS, Requestor Name: , acting on behalf of Claimant/Representative: , requires historical loss activity information (loss runs) for underwriting, claims handling, or risk assessment purposes;

WHEREAS, the undersigned Insured and Requestor desire to document authorization for release of loss run records to the Requestor for the limited purposes and time period set forth in this Authorization.

AUTHORIZATION

The Insured hereby authorizes Carrier identified above and any agent, broker, or administrator of Carrier to disclose and provide to the Requestor and its authorized representatives complete loss runs and related claim activity reports for the Policy Number: covering the period from: Month Day Year to Month Day Year .

SCOPE OF RECORDS REQUESTED

Describe records and scope

REQUESTOR CONTACT

Requestor Company Requestor Address

Contact Phone

Contact Email

PAYMENT TERMS

The Requestor agrees to pay an authorization and processing fee for retrieval and delivery of loss runs in the amount of $ payable as follows:

Payment schedule / terms

Late payments shall incur a late fee of on any unpaid balance after the due date.

TERM AND TERMINATION

This Authorization is effective as of Start Date: Month Day Year and shall remain in effect until End Date: Month Day Year unless earlier terminated as provided below.

Either party may terminate this Authorization upon written notice to the other party with at least days' prior notice. Termination shall not affect obligations accrued prior to termination.

CONFIDENTIALITY

All information received pursuant to this Authorization, including but not limited to policy information, claim details, and loss runs, shall be used solely for the stated purposes and shall be treated as confidential by the Requestor and its representatives. Requestor shall restrict access to such information to those employees, agents, or contractors with a legitimate need to know and shall not disclose such information to any third party except as required by law or with the prior written consent of the Insured.

Acknowledgment of confidentiality obligations: I acknowledge and agree to comply with the confidentiality provisions above.

GOVERNING LAW

This Authorization shall be governed by and construed in accordance with the laws of the State of without regard to its choice of law principles.

ENTIRE AGREEMENT

This Authorization constitutes the entire agreement between the parties with respect to the subject matter herein and supersedes all prior and contemporaneous oral or written agreements, understandings, and communications. Any amendment to this Authorization must be in writing and signed by both parties.

REPRESENTATIONS AND SIGNATURES

The undersigned represent and warrant that they are authorized to execute this Authorization on behalf of the party they represent. The Insured further warrants that this Authorization does not violate any policy provisions, court order, or statutory restriction.

Requestor (Printed Name):

By:

Date:

Insured / Policyholder (Printed Name):

By:

Date:

What an Insurance Loss Runs Authorization Is

An Insurance Loss Runs Authorization is a signed document that permits an insurer or claims administrator to disclose a policyholder's claims history (loss runs) to a named third party, such as a broker, underwriter, or prospective carrier. The form identifies the insured, policy numbers, coverage period, and the scope of records requested. It is commonly used for renewal, quoting, and underwriting reviews. When executed electronically, the authorization must satisfy applicable electronic signature and privacy laws to ensure the release is valid and protected.

Why a Clear Authorization Matters

A complete authorization speeds underwriting, reduces follow-up requests, and ensures the receiving party has the precise claims data needed for pricing and risk assessment. Clear scope and dates prevent disputes over omitted claims and shorten renewal cycles.

Who Typically Prepares and Uses This Authorization

Common participants include brokers, insureds, and underwriting or risk teams who need verified claims history for decision-making.

Insurance brokers and agents requesting loss runs for competitive quotes and placement decisions.
Commercial and individual insureds authorizing release of their claims records to brokers or carriers.
Underwriters and risk managers verifying claim frequency and severity for underwriting and pricing.

Identifying the correct requester and recipient up front prevents processing delays and helps carriers match records without manual reconciliation.

Step-by-step: Completing an Insurance Loss Runs Authorization

Use these steps to prepare, sign, and submit a clear authorization so carriers can process requests without unnecessary delay.

01

Gather Policy Details: Collect policy numbers, carrier names, and coverage dates.
02

Specify Records Period: Define start and end dates for the requested loss runs.
03

Authorize Recipient: Name the broker, insurer, or third party receiving records.
04

Sign and Submit: Sign, date, and send via a secure channel to the carrier.

Configuring an Online Authorization Workflow

Set up a secure e-signing workflow that captures identity and preserves an audit trail for compliance and carrier acceptance.

Field	Configuration
Authentication Method	Email link or SMS code
Date Field Format	MM/DD/YYYY enforced
Attachments	Allow PDF and DOCX uploads
Audit Trail	Capture IP, timestamp, and signer email

Platform Features to Support Secure Submission

Choose a platform that enforces signer authentication, creates tamper-evident signed PDFs, and retains a detailed audit trail for compliance and carrier review.

File Formats: PDF, DOCX accepted
Authentication: Email, SMS, or stronger
Audit Trail: IP, timestamp, events

Where to Send a Completed Authorization

Common destinations, submission methods, and recipient responsibilities for a signed loss runs authorization are listed below.

Send to Carrier: Submit to carrier underwriting or claims via secure portal or email per carrier policy.
Send to Broker: Provide a copy to your broker to request loss runs on your behalf.
Send to Prospective Insurer: Include with a quote request to the new insurer for underwriting review.
Retain a Copy: Keep a signed copy in your records for audit and renewal.

Timing Expectations for Requests and Responses

Processing times vary by carrier, request volume, and whether the request is expedited; plan ahead for renewals and quote deadlines.

Carrier Acknowledgment:

Typically within 3–5 business days of receipt.

Carrier Processing:

Often 10–30 business days to compile complete loss runs.

Expedited Requests:

Some carriers provide 24–72 hour turnaround for a fee.

Renewal Deadlines:

Request at least 30–45 days before renewal effective date.

Third-party Follow-up:

Allow extra time for brokers to reconcile received records.

Key Milestones from Request to Receipt

A simple milestone sequence helps track status and identify bottlenecks during processing.

01

Submit Request

Signed authorization transmitted to carrier or agent.

02

Carrier Intake

Carrier logs request and confirms receipt to requester.

03

Compilation

Claims files are searched and loss runs are generated.

04

Delivery

Carrier delivers records to the authorized recipient; verify completeness.

Common Preparation Errors to Avoid

Incomplete policy numbers or misspelled insured names that force manual carrier searches and delay delivery.
Vague scope language such as 'all claims' without date limits, causing disagreement about what to include.
Missing evidence of signer authority when a third-party signs for an organization, which can void the release.
Submitting unsigned or undated forms or using initials where a full signature is required by carrier policy.

Risks and Potential Consequences

Privacy Exposure: Regulatory fines possible

Invalid Release: Carrier may refuse disclosure

Renewal Delay: Pricing and coverage gaps

Incomplete Records: Underwriting relies on missing data

HIPAA Concern: Civil penalties apply

Unauthorized Access: Potential liability for misrouting

eSignature Vendor Pricing and Core Features

Basic pricing and feature availability for common eSignature providers, focusing on capabilities relevant to signing and transmitting Loss Runs Authorizations.

	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	Yes	Yes	Yes	No
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes	Yes	Yes	No	No
Envelope Cap	No cap	100 envelopes/user/year	Varies by plan	Varies by plan	Varies by plan

Practical Tips for Accurate and Efficient Completion

Follow these best practices to reduce carrier rejections, speed processing, and preserve privacy when requesting loss runs.

Use Exact Policy Identifiers

Provide full policy numbers, named insured as shown on the policy, and the carrier's legal name. Exact identifiers avoid mismatches that trigger manual searches and delays and improve the likelihood of timely delivery.

Be Clear About the Scope

Specify start and end dates, whether closed claims are included, and whether sublimits or reserves should be disclosed. Clear scope prevents disputes over omitted claims and reduces follow-up questions from carriers.

Confirm Signer Authority

When an agent or corporate officer signs, include a brief authority statement or attach a letter of authorization. Carriers often require proof that the signer is permitted to release policyholder records.

Prefer Secure Electronic Channels

When carriers accept e-signatures, use platforms that provide tamper-evident PDFs and audit trails. Secure transmission reduces physical handling, speeds delivery, and simplifies recordkeeping for audits.

Security and Compliance Essentials

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

Audit Trail: IP, timestamps, event log

Legal Compliance: ESIGN and UETA compliant

HIPAA Support: BAA required for PHI

21 CFR Part 11: Support for FDA-regulated records

Certifications: SOC 2 Type II and ISO 27001

FAQs: Common Questions About Loss Runs Authorizations

Answers to frequent practical and legal questions about who can sign, whether e-signatures are valid, timing, and recordkeeping for loss runs requests.

Need help? Contact support

What exactly are loss runs?
Loss runs are carrier-produced reports summarizing a policyholder's claims history, usually listing claim dates, reserves, payments, and status. They are used by underwriters and brokers to evaluate past loss activity and inform pricing and coverage decisions.
Who can sign an authorization?
An insured (individual or an authorized corporate officer) or a person with written authority may sign. If a broker signs on behalf of an insured, carriers commonly require evidence of that authority to accept the release.
Can an authorization be e-signed?
Yes, where permitted by law and the carrier's policy. Electronic signatures that meet the ESIGN Act (15 U.S.C. §7001) and relevant state UETA requirements are generally enforceable for these authorizations.
Are there privacy concerns with releasing loss runs?
Yes. If records include protected health information or other regulated data, you must comply with HIPAA and applicable privacy laws; include required HIPAA authorization language and ensure any platform handling PHI has a BAA.
How long does it take to receive loss runs?
Times vary by carrier and request complexity; many responses arrive within 10–30 business days, though expedited services may be available for a fee. Allow extra time near renewal deadlines to avoid coverage gaps.
How do I revoke or correct an authorization?
Revocation typically requires a signed written notice to the carrier and recipient. For consumer-facing electronic records, ESIGN rules require that consent procedures allow withdrawal; consult carrier policy and legal counsel for precise steps.

be ready to get more

Join over 28 million airSlate SignNow users

Sign Now