Request a Certificate of Insurance (COI) or Loss Run

Please select one or both options:

Please note: You may automatically generate a provider level COI in Policyholder Services. You may also contact your agent to request a COI.

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Please note: Medical Mutual will not send loss runs directly to third parties. Loss runs will be sent to you for forwarding to the appropriate, authorized third party. Please indicate your preferred method for receiving your loss run in the comments section at the bottom of this form.


To request a COI or Loss Run, please provide the information below:

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