Insurance Claims Log for NEMT: Track Every Claim Against Your Loss Runs

Your insurer keeps its own record of every claim. It does not keep yours: the day you phoned the agent, the letter that arrived two weeks later, the broker or health plan you also had to tell, or the settled claim that is still open. A claim log holds those facts row by row, so a loss run becomes a check against your own records instead of the first time you learn what an insurer has set aside against your company.

This log is for the money and the status of each claim. The first report of what happened goes on your incident report form, and whether the driver could have prevented it goes on the accident review form.

How to use this template

1. List every policy in Part 1 at each renewal. Include auto, general liability, physical damage, workers’ comp, professional liability, abuse and molestation, and any other. Write the claims phone from the policy and whether it is claims-made. The declarations page or your agent will say.
2. Open a row in Part 2 the day a loss happens, even if no one has made a claim. Illinois and Pennsylvania require a loss run to list occurrences that have not become claims, so they show up on your loss runs too. Tell the insurer or agent first, then fill in the row.
3. Use the trip number, not the rider’s name. The incident report and the insurer’s claim file hold the person’s details. The log needs only enough to find them.
4. Fill in Part 3 as you make each report. Write the date you told the insurer or agent, the date you told your broker or health plan, and the date you sent each demand or legal paper to the insurer.
5. Copy money exactly as the insurer reports it in Part 4. Write the paid amount, the reserve, and the date of the report that gave you both. Never write your own estimate in those columns.
6. Check every loss run in Part 5 the week it arrives. Compare it line by line with Parts 2 to 4, write each difference, and ask the insurer in writing to correct it.
7. Close a row only when the insurer closes the claim. Write the date and who told you.
8. Total the year in Part 6 and keep it with that year’s loss runs.

For the other steps that bring a premium down, see NEMT insurance cost.

The template

Part 1: Policies (update at each renewal)

Policy type	Insurer	Policy no.	Policy period	Agent and phone	Claims phone or email	Occurrence or claims-made (retroactive date)

Part 2: Claims and incidents opened

No.	Date of loss	Policy (type and number)	Van no. and driver	Trip no.	Claim no.	Adjuster (name and phone)
1
2
3
4
5
6
7
8
9
10

Part 3: Who you told and what came back

No.	Told insurer or agent (date, how)	Told broker or health plan (date, person)	Police report no.	Insurer letters received (date, kind)	Demand or legal papers received (date) and sent to insurer (date)
1
2
3
4
5
6
7
8
9
10

Part 4: Money and status

No.	Paid so far	Reserve	Both figures reported on (date)	Recovered from another party	Status	Date closed
1
2
3
4
5
6
7
8
9
10

Status words: incident only (reported, no claim), open, closed with payment, closed without payment, or denied. Use the insurer’s own word when it differs.

Part 5: Loss run check

Insurer and policies covered	Date requested	Date received	Valued as of	Claims on the loss run	Claims in this log	Differences, and what you asked the insurer to fix	Corrected run received (date)

Part 6: The year at a glance

Year: ______________

Policy type	Claims and incidents opened	Still open	Total paid	Total reserved	What changed to prevent the next one
Commercial auto liability
Auto physical damage
General liability
Workers’ comp
Professional liability
Abuse and molestation
Other
Total

Reviewed by the owner (signature and date): ______________________________

What your policy asks you to do after a loss

The standard business auto form, ISO CA 00 01 10 13, lists duties after an accident, claim, suit, or loss, and says the insurer has no duty to provide coverage unless you have met them. You must give prompt notice that says how, when, and where it happened, the insured’s name and address, and, where possible, the names and addresses of injured people and witnesses. You must also assume no obligation, make no payment, and incur no expense without the insurer’s consent, except at your own cost. You must send copies of every request, demand, order, notice, summons, or legal paper right away, cooperate, and authorize the insurer to get medical records. For damage to a van, the form adds notifying the police of a theft, protecting the vehicle from more damage, and keeping a record of your expenses. Your policy may use a different form, so read the conditions section.

California’s insurance department says the same thing in plain words: report every claim to your agent or insurer as soon as you know of it, because handling it yourself violates your duties under the contract. Part 3 is where you prove you did. Write the call, the day, and the name of the person who took it.

Your ride broker or health plan has its own clock. MTM Health’s standard agreement, in the January 1, 2023 version Pennsylvania posts, requires immediate notice of any civil claim against the provider or its drivers arising from the services (section 2.R) and a report of accidents, incidents, and injuries during a member’s transport (section 2.BB). Its Rhode Island handbook, last updated July 1, 2026, wants a written incident and accident report within 24 hours. The incident report form lists more deadlines by broker.

The same MTM agreement makes the provider pay, resist, or defend claims brought against MTM and its client over the provider’s work (section 10). If a broker passes you a claim that way, log it as a claim that day and send the papers to your insurer before you agree to anything. The auto form says not to assume an obligation without the insurer’s consent unless you bear it yourself.

Claims-made policies and why the dates matter

An occurrence policy covers losses that happen during the policy period, whenever the claim is filed. A claims-made policy covers claims filed during the policy period, however long ago the loss happened, subject to a retroactive date. California’s insurance department defines both in its commercial insurance guide (Form 700, revised June 14, 2024). Part 1 asks which kind each policy is because the dates in this log matter most on a claims-made one. Coverage turns on when the claim is made, and the policy says by when you must report it.

In Pennsylvania, the insurer must give you 60 days after a claims-made policy is canceled or not renewed to buy an extended reporting endorsement, also called tail coverage. If you buy it in that window, it takes effect as of the date the policy ended (Act 86 of 1986, section 5). Note that deadline beside the policy in Part 1 the day a nonrenewal notice arrives. In other states, ask your agent what the policy offers and for how long. Abuse and molestation coverage shows how retroactive dates and tail coverage work when claims arrive years late.

How the log should match a loss run

A loss run lists closed claims with the amount paid, open claims with the reserve, and occurrences you reported that never became claims. Parts 2 to 4 hold the same three kinds of entries, so each run can be checked line by line in Part 5. The loss runs entry shows what each state requires an insurer to include and how fast it must send one.

These are the differences only your own log can catch:

• A date of loss, van, or driver that differs from your Part 2 row.
• A loss you told the insurer about (the date is in Part 3) that does not appear at all.
• A claim you closed in Part 4 that still shows open, or an open claim whose reserve has not moved in months.

Write each difference in Part 5, ask the insurer in writing to correct it, and keep the corrected run with the log.

In workers’ comp, the experience mod counts an open claim at its reserve. California’s insurance department warns that reserves set too high can inflate a mod and raise premiums unfairly. Keep each claim number in Part 2, because the mod worksheet lists every loss over $2,000 by number (NCCI, 2025 edition). In states that use NCCI, insurers do not have to report a policy until 18 months after it starts, so your log is also how you spot a claim that has not reached the mod yet.

Keep rider and employee details out of the log

HIPAA requires a covered entity or business associate to make reasonable efforts to limit protected health information to the minimum necessary for the purpose (45 CFR 164.502(b)). A claim log is for tracking money and dates, so it needs the trip number and the claim number, not the rider’s name, Medicaid ID, or injury. The trip number still points to a rider in your system, so give the log the same limited access as your trip records. The minimum necessary entry shows how that works in a dispatch office.

Employee injuries need the same care. The ADA covers employers with 15 or more employees for 20 or more weeks a year (29 CFR 1630.2(e)). If you are one, EEOC’s guidance says medical information about a work injury or a workers’ comp claim goes on separate forms in a separate medical file, kept confidential (September 3, 1996, question 10). Write only the claim number and the policy in the log.

Worker injuries also go on OSHA forms where they apply

A workers’ comp row does not replace OSHA’s records, and OSHA’s records do not replace the row. If your company had more than 10 employees at any time last year, you keep OSHA injury and illness records (29 CFR 1904.1). Ground passenger transportation and ambulance services are not on OSHA’s list of partially exempt industries (29 CFR 1904.2, Appendix A, as of October 2026).

Every employer, whatever its size, must report a work-related death to OSHA within 8 hours and an in-patient hospitalization, an amputation, or the loss of an eye within 24 hours (29 CFR 1904.39). A crash on a public street or highway outside a construction work zone is the exception, though you still record it if you keep an OSHA log. Report to OSHA by phone, in person, or on its website, because your insurer is not one of the ways. A state that runs its own OSHA plan can set stricter reporting rules, so check yours (29 CFR 1904.37). The employee injury report form shows how to fill in both.

How long to keep the log

Keep each year’s log for at least five years, with the loss runs it was checked against. No rule sets that number. New insurers ask for several years of loss runs, as the loss runs entry explains, and the workers’ comp experience period uses policies that started up to 57 months before the mod’s rating date (NCCI, 2025 edition). By year four, nobody remembers a claim’s dates. The log keeps them.