Loss run request template
Ask for an insured's loss history and track it to delivery.
For agencies and brokers chasing loss runs across carriers: one record per carrier request, the insured's signed authorization attached up front, and a workflow that shows which requests are still sitting with a carrier.
Free on every plan. Opens in the builder as an editable draft — nothing is published until you say so.
Used for insurance claims intake — Claims from policyholders and brokers, with calculated estimates, approvals and a trail that survives a dispute.
What’s in the form
9 fields — every one editable once the template is yours.
- Agency or brokerage *
- Email *
- Insured *
- Carrier *
- Policy number *
- Years of history *
- Needed by
- Signed authorization from the insured
- Anything else the carrier needs
Included workflow
What happens after someone submits
A submission lands in the first state and moves through the rest — each move is a named, permissioned act, and every one of these states and moves is editable.
- Sent to carrier — Requested → With the carrier
- Loss runs received — With the carrier → Received
- Delivered to requester — Received → Delivered
Questions
The loss run request template, answered
What picking this template does and does not commit you to.
Is the loss run request template free?
Yes — free on every plan. It opens in the builder as an editable draft in your own account, and nothing is published until you choose to publish it.
Can I change the fields in the loss run request template?
All of them. The template is an ordinary draft form: add, remove or reword any of its 9 fields, then publish when it reads right.
What does the included workflow do?
A submission lands in “Requested” and moves through the included states — Requested, With the carrier, Received, Delivered. Every state and move is editable before you publish.
How do people fill it in?
Publish the form and share its public link — submitters need no account and are never a paid seat. Rotate the link at any time to revoke it.
More templates
Each one opens the same way: an editable draft in your own account, free on any plan.
Make the loss run request form yours
One click loads it into the builder as a draft in your own account — edit anything, then publish a public link when it reads right.
No card required.