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Insurance Loss Runs Form

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INSURANCE LOSS RUNS FORM

1. Applicant / Insured Information

Date of Birth (if individual insured):   Tax ID / EIN (if business):

2. Policy / Coverage Details

Select coverage classes to include in the loss runs (check all that apply):

3. Requested Loss Run Period

Loss run requested from:   to:   Number of prior policy years requested:

4. Loss Run Report Requirements

Include the following data elements in the loss runs (check all requested):

Preferred delivery format: Additional instructions:

5. Claim / Loss History (Provide known claims for the requested period)

If there are more claims than provided rows, attach additional pages with the same fields.

Date of Loss:   Claim Number:   Type:   Reported:

Reserve:   Paid:   Status:

Date of Loss:   Claim Number:   Type:   Reported:

Reserve:   Paid:   Status:

Date of Loss:   Claim Number:   Type:   Reported:

Reserve:   Paid:   Status:

Date of Loss:   Claim Number:   Type:   Reported:

Reserve:   Paid:   Status:

Date of Loss:   Claim Number:   Type:   Reported:

Reserve:   Paid:   Status:

6. Documentation Checklist







7. Exclusions and Redactions

The insurer may redact or withhold information that is protected by privilege or by law, including attorney-client communications, privileged claim reserving memoranda, medical records, or other confidential third-party information. If redactions are made, provide a redaction log identifying the category of information withheld and the reason for withholding. This request does not constitute a waiver of the insurer's legal rights or privileges.



8. Beneficiary / Authorized Recipient (if different from insured)

9. Authorization, Certification and Release

By signing below, the undersigned Insured authorizes and directs the insurer (and its authorized representatives) to produce and release complete loss run information for the policy(ies) and period(s) identified herein. The Insured represents that the information provided on this form is true and correct to the best of the Insured's knowledge. The Insured further represents that the signer has authority to request and receive the requested loss information.

The Insured agrees to indemnify and hold harmless the insurer and its representatives from any liability arising from disclosure in accordance with this request, except to the extent resulting from the insurer's willful misconduct. The insurer may charge a reasonable retrieval or processing fee for assembling historical loss information; any such fee should be communicated in advance. This request does not alter policy terms, limits, coverage, or defenses under the policy.

Printed Name:

Signature:

Date:

Title / Capacity:

Phone / Email:

Enter text✕
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What the Insurance Loss Runs Form Is and when it’s used

The Insurance Loss Runs Form is a standardized record that summarizes a policyholder’s claim activity over a specified period. Typical entries include loss dates, claim numbers, reserves, payments, cause of loss, and claim status. Brokers, underwriters, and risk managers use the document to assess frequency and severity of claims when underwriting, pricing, or renewing coverage. Insurers generally produce loss runs on request; accurate, complete loss runs speed underwriting evaluations, reduce follow-up questions, and provide objective data for premium and deductible decisions.

Why accurate loss runs matter to underwriting and renewals

An Insurance Loss Runs Form provides a concise claims history that helps underwriters, brokers, and risk managers evaluate exposure, price coverage, and negotiate terms. Clear loss runs reduce back-and-forth, shorten renewal cycles, and support objective assessment of risk trends and retention strategies.

Why accurate loss runs matter to underwriting and renewals

Who typically requests and relies on loss runs

Typical users of the Insurance Loss Runs Form include carriers, agents, brokers, and corporate risk teams during placement, renewal, or due diligence.

  • Insurance carriers: underwriters and claims teams that verify reserves, payments, and exposure for pricing decisions.
  • Brokers and agents: assemble loss runs to support renewal submissions and negotiate coverage terms with carriers.
  • Policyholders: companies request loss runs for audits, acquisitions, or to compare insurer offers during shopping.

Knowing which party owns the request helps ensure the insurer releases the correct records and that any required authorization accompanies the request.

Primary requestors and their responsibilities

Authorized Signer

A company officer or risk manager authorized to request loss runs; must provide company name, policy numbers, and evidence of authority. Insurers may require a signed release or written authorization; unsupported requests can be delayed or declined.

Broker / Producer

A licensed broker acting on behalf of the insured; should supply agency contact data, client authorization when needed, and precise date ranges. Brokers often use templates to speed insurer responses and reduce follow-up inquiries.

Key security and compliance controls to expect

Encryption in transit: TLS 1.2/1.3 for communications
Encryption at rest: AES-256 encrypted storage
Certification posture: SOC 2 Type II, ISO 27001
Privacy compliance: GDPR and CCPA controls
Healthcare protections: HIPAA compliance (BAA required)
Audit capabilities: Detailed timestamped audit trail

Principal risks of incorrect or incomplete loss runs

Underwriting delays: Incomplete data triggers follow-up and renewal delays
Pricing errors: Missing claims can lead to incorrect premiums
Coverage gaps: Unverified losses may produce coverage disputes
Regulatory exposure: Privacy breaches can invoke HIPAA or state penalties
Contract disputes: Misstated reserves may affect settlement obligations
Reputational harm: Repeated inaccuracies reduce broker and carrier trust

Common pitfalls when preparing or requesting loss runs

  • Omitting precise policy numbers or effective dates, which forces insurers to search multiple accounts and delays delivery by days or weeks.
  • Submitting vague date ranges such as 'last few years' rather than exact MM/DD/YYYY start and end dates required by carriers.
  • Failing to include a signed authorization when the request is on behalf of another legal entity, prompting denials or redaction.
  • Requesting loss runs without specifying the claim details needed (reserves, payments, status), resulting in incomplete or unusable reports.

Step-by-step: Requesting and obtaining loss runs

Follow these steps to request the Insurance Loss Runs Form from the insurer or through your broker to ensure a timely, complete response.

  • 01
    Prepare request: Gather legal name, policy number, date range, and authorization.
  • 02
    Submit request: Send request via insurer portal, email, or agent platform.
  • 03
    Confirm receipt: Ask for an acknowledgment and estimated delivery timeframe.
  • 04
    Review delivery: Verify claim fields, totals, and any redactions immediately.

Typical processing workflow for a loss runs request

A clear workflow speeds delivery and reduces follow-up: request, authorization check, retrieval, verification, and secure delivery.

  • Request intake: Insurer logs the request and verifies authorization.
  • Records lookup: Claims system retrieves matching loss records.
  • Quality check: Claims team confirms accuracy and redactions if necessary.
  • Delivery: Insurer sends the loss runs via secure portal or PDF.

Configuring an online loss runs request workflow

Set up an electronic request template to standardize submissions and reduce processing time across carriers.

Template name Loss runs request template with standard fields
Recipient field Insurer or agent contact email entered here
Authentication Email verification or SMS code for signer
Attachments Attach signed authorization or POA if required
Retention policy Store responses for the required retention period

Digital delivery and platform requirements

Use an eSignature or document-delivery platform that supports secure file upload, detailed audit trails, and role-based access control for sensitive insurance data.

  • File formats: PDF and DOCX supported
  • Integrations: Salesforce, NetSuite, Google Workspace
  • Authentication: Email, SMS code, or SSO

Timing expectations and response windows

Insurers and agents commonly follow informal timelines for loss runs; understanding typical windows helps plan renewals and audits.

Request submission timing:

Submit at least 30–60 days before renewal for best results

Insurer response target:

10–30 business days is a common insurer turnaround window

Agent follow-up cadence:

Follow up after 7–14 days if no acknowledgment received

Retention recommendation:

Keep copies three to seven years depending on record type

Renewal planning window:

Start assembling documents 60–90 days before renewal

Key milestones from request to delivery

Track these sequential milestones to monitor progress and escalate when timelines slip.

01

Request Submitted

Originator files the loss runs request with insurer or broker.

02

Authorization Verified

Insurer confirms authority or requests signed release if needed.

03

Records Retrieved

Claims system compiles matching claims and export fields.

04

Report Delivered

Carrier delivers loss runs via portal or secure email.

How loss runs compare to related insurance documents

Compare the Insurance Loss Runs Form with other records to understand scope, typical use, and when each is preferred.

Document Type Use Case Primary Audience
Insurance Loss Runs underwriting detail carriers, brokers
Policy Declarations coverage summary policyholders
CLUE report consumer claims history insurers, consumers
Claims Narrative incident detail adjusters, legal teams

Essential components to include in a professional loss runs report

A complete Insurance Loss Runs Form contains specific fields that underwriters expect; include these items to avoid follow-up and ensure usability.

Date of Loss

Exact loss date entry for each claim, recorded as MM/DD/YYYY, so underwriters can analyze frequency over discrete policy periods and correlate events to exposures.

Claim Number

Carrier-assigned claim identifier used to reconcile reserves, payments, and correspondence histories across claims-management systems and adjuster files for audit purposes.

Reserve Amount

Current case reserves and any payments to date, showing insurer exposure and reserve development trends that influence pricing and retention decisions.

Payment History

Detail of indemnity and expense payments by date and amount to assess loss severity, subrogation activity, and total incurred costs for each claim.

Cause of Loss

Structured cause codes or brief descriptions for each claim to enable loss-cause trending and identification of systemic risks requiring underwriting attention.

Claim Status

Clear status labels (open, closed, pending) with last activity date to inform whether claims remain active and could impact renewal exposure or terms.

Related deliverables and export options to request

Ask insurers for formats and supporting documents that make loss runs actionable for underwriting and audit reviewers.

Native CSV Export

Request a CSV or spreadsheet export to allow sorting, filtering, and importing into underwriting models or broker analysis tools for faster review.

Paged PDF Report

A paged PDF preserves insurer formatting and human-readable notes while providing a reliable archival copy suitable for audit records and regulatory review.

Claims Narratives

When available, include brief adjuster narratives for significant claims to provide context beyond numeric fields and support loss control discussions.

Data Dictionary

Ask for a legend or data dictionary explaining codes, status values, and column definitions to avoid misinterpretation during analysis.

Practical tips for accurate, efficient loss run handling

Adopt standardized templates and electronic workflows to reduce errors, speed delivery, and maintain audit-ready records across carriers and brokers.

Standardize request templates
Use a consistent template with full legal name, exact policy numbers, MM/DD/YYYY date ranges, and a clear list of required columns to prevent insurer confusion and minimize follow-up.
Request electronically
Submit requests via insurer portals or secure eSignature platforms to ensure delivery tracking, receipt acknowledgment, and a tamper-evident audit trail for compliance.
Include authorization
Attach a signed authorization or broker appointment when requesting records on behalf of an insured to avoid denials or redactions that delay underwriting.
Verify immediately
On receipt, check that loss runs include claim numbers, reserves, payments, cause of loss, and status; flag omissions within 48 hours to allow timely corrections.

Illustrative scenarios showing how loss runs are used

These two anonymized examples show common business reasons to request Insurance Loss Runs Form and the outcomes they support.

Commercial Auto Account

A mid-size fleet operator requested three years of loss runs to support a renewal

  • The broker highlighted frequency of small claims
  • The carrier adjusted limits and offered a loss control plan, reducing expected premium volatility and improving terms at renewal.

Manufacturing Risk

A manufacturer seeking acquisition financing compiled loss runs for all sites over five years

  • The lender evaluated severity and reserve adequacy
  • Detailed loss runs enabled underwriting to quantify contingent liabilities and complete due diligence on schedule.

eSignature vendor comparison for signing and delivering loss runs

Compare core pricing and feature availability for common eSignature vendors; signNow appears first by design. Verify specific plan details with each vendor.

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 Yes Yes Yes Varies
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

FAQs and troubleshooting for Insurance Loss Runs Form requests

Answers to common questions about requesting, validating, and using Insurance Loss Runs Form to reduce delays and improve accuracy.


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