Claim Loss History & Coverage Verification

Authorization and Fees

The Claim Loss History & Coverage Verification Report report can be released only when accompanied by an authorization form signed by the healthcare provider. The authorization form must be signed and dated by the healthcare provider within six months of the request. Requestors must enter at least two unique identifiers, such as the last four digits of their Social Security number and date of birth. 

Agents and brokers who represent current insureds are not charged for report requests. However, there is a $30 fee for reports on prior policyholders. We will mail an invoice to the submitter. A signed release may be needed in some instances if the broker was not listed as the agent of record when the policy terminated.  

Current Coverys insureds will not incur a charge when requesting a Claim Loss History report. However, a $30 fee will be charged for each Claim Loss History report requested for previous insureds and for all requests coming from credentialing companies. In addition, a signed release may be needed in some instances if the requesting agent/broker was not listed as the agent of record when the policy terminated. We will mail an invoice to the requestor (please do not send prepayment).
 

Report Timeframe

Most requests are processed within 5-7 business days; more complete information will result in more efficient processing.
 

Use this Request Process for Requests on All Policies

You may use this request process for requests on all policies. This includes ProSelect, ProMutual, Coverys Risk Retention Group, Inc., and Coverys Specialty Insurance policies as well as previous policies from MHA Insurance Company, Preferred Professional Insurance Company (PPIC), and Washington Casualty Company.