Insurance Carrier Loss Runs Key to Underwriting Legal Malpractice Insurance
Loss Run Request Form. Loss runs must be requested by the policyholder or assigned producer and cannot be released to any other party without a broker of record letter. Agent, email address and fax number
Insurance Carrier Loss Runs Key to Underwriting Legal Malpractice Insurance
Request the above mentioned loss runs be released to me. In most instances, the authorization form may be signed by the insured, a group policy authorized representative, or the agent of record for the respective policy/account information. Insured’s name and mailing address (include county & zip+4) telephone number name: One tower square hartford, ct6183 phone: Complete the form below to submit a loss runs request. Create your signature and click ok. Use this form to submit your loss run request. Web this is a confidentiality agreement, authorization, and release form for professional liability insurance customers requesting loss runs. The best approach for this is to email or call them. Agent, email address and fax number
Please allow 2 to 3 business days for us to process your request. Web carrier name and address naic code policy #: _____ our insured’s information at time coverage was provided: A typed, drawn or uploaded signature. Name of the agency , attention to : Web how to request a loss run report loss run reports are created by your insurance carrier. One tower square hartford, ct6183 phone: Use this form to submit your loss run request. Preference on how the report should be sent (email or fax) email fax Create your signature and click ok. Agent, email address and fax number
