If you have historical loss runs you can attach, then you really do not have to complete any more of this section.
Normally larger accounts with frequent claims will have loss runs available.
LOSS HISTORY
Generally underwriters want 3 to 5 years of loss history. This space only has room for three losses. The ACORD form references two additional forms to use if you need more space. The LOSS SUMMARY and the ADDITIONAL LOSS INFORMATION form. These are not ACORD forms. I suggest you just use a blank piece of paper or the ACORD 101 Additional Remarks form.
NO LOSSES CHECK BOX
Just to the right of the title LOSS HISTORY is a check box you need to check if there are no claims to list.
Immediately under the Tittle LOSS HISTORY is a blank space in the sentence where you should enter the number of years your loss history covers.
At the far right hand side of this section is a box asking you for the TOTAL LOSSES: $. Enter the total dollar amount paid. No need to include amounts reserved for future payments here.
INFORMATION FOR EACH LOSS
DATE OF OCCURRENCE - This is the date of the event, or series of events which caused a claim to be filed.
LINE - The line of business the claim has be filed under. Example: Workers Comp or Auto or General Liability.
TYPE / DESCRIPTION OF OCCURRENCE OR CLAIM
Very brief free form text field.
DATE OF CLAIM - This is the date the initial claim was made. The date of claim may be the same as the date of the occurrence, but for products or completed operations claims that is not likely to be the case. Remember you can have a Claims Made or an Occurrence policy.
AMOUNT PAID - The amount that has actually been paid as of the date you are sending in this application.
AMOUNT RESERVED - This is the amount the carrier may have set aside for future payments.
SUBROGATION Y/N - Subrogation is the assignment of the insured's rights to collect the amount of a loss from the liable party from the Named Insured to the insurance carrier for the coverage type. You should indicate whether this claim paid amount might be able to be recovered using the subrogation clause in the policy.
CLAIM OPEN Y/N - If the claim is closed there should be no amount in reserves.
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