Claim History Request

Our Underwriting department is here to assist you.

For insured or ex-insured clinicians requesting on their own behalf. Fill out the required fields marked by an * to display the button to submit your form.

Requirements for Claims History Requests

Clinician First Name *

Clinician Last Name *

Clinician Title/Degree *

Clinician Title Other *

National Provider Identifier (NPI) *

CRICO-member employer *

Mass General Brigham does not directly employ clinicians. Please be more specific.

Is the clinician still employed by a CRICO-member institution? * Yes No

There is a $25 fee for your request. The link will appear in an email upon submitting this form.

Clinician Email *

Optional: if you need CRICO to fill out a particular form, you can upload that here.

Need CRICO to complete a form?

Confirmation and Follow-Up

I acknowledge this statement to be true. *

By checking the box, you are confirming that you are the current CRICO-insured provider. Further, you acknowledge that you have verified the recipient email address above.

Note to Underwriting

Can’t Reach Us? Assistance for CRICO members with urgent questions or needs may be obtained through the on-call risk manager at your institution.

Claims/Suits: Contact the Claim Manager responsible for your institution or the Senior Vice President of Claims.

Confirmation of Coverage /Facesheets: CRICO-insured physicians needing access to your Confirmation of Coverage (Facesheet), log into your Physician Portal, or email our Underwriting staff or 617.450.8219.

CME Questions: Email Maggie Janes or call 617.4506828.

Media Requests: Email Missy Padoll or call 617.450.6841.

Other Inquiries: To reach someone at CRICO, call 617.450.5500. If you are a physician, identify yourself as such and the organization with which you are affiliated. You will be connected to the CRICO representative responsible for your organization.

Requirements for Claims History Requests

Confirmation and Follow-Up

Case Studies

About CRICO

CME Opportunities

Patient Safety & Claims