ACORD 611 Loss Run Request | Fillable PDF
ACORD 611 is the Claims History / Loss Run Request form. You fill it in, sign it, and send it to your carrier when you need your claims history, usually because a new carrier or underwriter has asked for it.
When a new carrier wants to quote your commercial insurance, the first thing they ask for is your claims history. That means a loss run, a report from your current or former carrier that shows every claim on a policy and what it cost. The ACORD 611 is the form you send to ask for one.
Think of it like a credit report, but for your insurance. The new carrier looks at it to decide whether to cover you and what to charge. No loss run usually means no quote.
Most businesses never touch this form until a carrier asks for it. By then they’re already short on time.
When you need an ACORD Loss Run Request
Four situations come up most often.
- You’re shopping for a new carrier
- Any new carrier will want three to five years of loss runs before they quote. Get them early, not after the carrier asks.
- Your policy is coming up for renewal
- Carriers sometimes ask for updated loss runs at renewal. Others pull them on their own. Either way, it helps to have them ready.
- An underwriter requests them
- If an underwriter asks for loss runs as part of a quote, this form is the quickest way to get them.
- You want to know what your history looks like
- Most businesses have never seen their own loss runs. You have every right to them, and your current carrier has to send them.
What’s on the ACORD 611 Loss Run Request
One page, seven parts, in the order they appear.
-
1
Agency and contact details
Your agency’s name, address, phone, fax, email, code, and customer ID. This tells the carrier where to send the report.
-
2
Insured’s name and address
The named insured on the policy, with county and ZIP+4. The carrier won’t release records without a match.
-
3
Policy number and carrier
The policy number you want the history for, plus the carrier’s name, address, and NAIC code. If you have policies with more than one carrier, send a separate form for each.
-
4
Number of years
Write how many years of history you want. Three to five years is the standard ask. Workers’ comp claims stay open for years, so underwriters sometimes want seven to ten for those.
-
5
Lines of coverage
Check every line you need: property, liability, auto, workers’ compensation, umbrella or excess, crime, inland marine, or other. Add the policy number next to each one if it’s different from the one at the top.
-
6
Remarks
A large blank box for anything the request needs to explain, like a specific date range or a note about a closed claim.
-
7
Signature
The named insured or applicant signs and dates at the bottom. Without that signature the carrier won’t release anything.
Five things that help the request go smoothly
These come up again and again when a request stalls or a report comes back wrong.
- Send it early
- Most carriers take 5 to 15 business days. Ask 60 to 90 days before renewal, not 30.
- One form per carrier
- If your coverage has been with three carriers over five years, you need three forms. Each carrier only holds its own records.
- Use the full policy number
- A partial number or a wrong number slows everything down. Check the declarations page before you fill in the form.
- Follow up after five business days
- If you haven’t heard back, call the carrier’s claims service center. Don’t wait two weeks.
- Check the report when it arrives
- Look at the dates, the claim amounts, and the status of each claim. Open claims sometimes show larger reserves than they end up costing. If something looks wrong, ask your agent to flag it with the carrier before it goes to an underwriter.
FAQs
Can I request my own loss runs?
Yes. You have every right to your own claims history. Most states require the carrier to send it within 10 business days of a written request. This is the form that makes it official.
Does every carrier accept this form?
Most do. A few carriers and managing general agents prefer their own form or a simple email. If the carrier has a specific process, your agent will know. It works as a backup if they don’t.
How many years should I ask for?
Five years is the standard ask for most lines. Workers’ comp is different because those claims can stay open for years, and underwriters sometimes want seven or ten years for a full picture.
What if I have no claims?
You still need to send the form. The carrier sends back a report that says no losses, and that’s exactly what a new underwriter wants to see.
Is there a fillable ACORD 611 I can type into?
Yes. The ACORD 611 fillable PDF on this page has fields you can type into. Fill it in, save it, print it, and sign it by hand. Then send the signed copy to the carrier.
Daniel Whitfield
Daniel writes plain-language guides to ACORD insurance forms, based directly on what each form actually says.
This site is not affiliated with, endorsed by, or sponsored by ACORD LLC. ACORD® is a registered trademark of ACORD Corporation. This guide is for informational purposes only and is not legal or insurance advice.