The Claim Loss History and Coverage Verification (CLH) report provides a list of all of the Coverys policies in effect for the requested time period for an individual healthcare provider, as well as all open and closed professional liability claims and suits related to those policies.
The CLH report will only be released 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. Most requests are processed within 5-7 business days; more complete information will result in more efficient processing.
Once you submit the form, you will receive a confirmation email to let you know that your request is in queue for processing. Please do not submit repeat requests.
To complete a Claim Loss History and Coverage Verification request form, click the red button below.
Submit Request for Report
Please click the button above for 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.
Agents/brokers who represent current insureds are not charged for CLH 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).