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Claim History Forms
Authorization to Release Confidential Claim Information
This Claims History Report is free for insured physicians of MDAdvantage. Those who are no longer covered can follow the instructions on the form to mail in your payment of $35.00, or you may pay via credit card online here.
Request for Loss Run Report
The Loss Run Report does not provide individual claim histories for each physician associated with the account. It contains the loss experience for the account as of a specified date. There is a $150.00 fee for a Loss Run Report. Please follow the instructions on the form to mail in your payment, or you may pay via credit card online here.
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