Sample Claim File Request (Page 3 of 3) in pdf

Sample Claim File Request Page 3

regarding this claim all “electronically stored information (ESI)” regarding this claim, my CLIENT, or the issues

involved in his claim. This would include, but certainly not be limited to, information sent to others,

information received from others, all internal emails or other electronic communications, and all emails or

other electronic communications sent to or received from external sources. This request applies to all ESI

whether in your regular system, or in any backup system whether maintained by you or maintained by others.

Please be advised that this letter serves as your notice that any prior releases signed by my CLIENT to obtain

medical records, medical information, personal information, or other information of any kind are hereby

revoked to the extent that such authorizations allow you to contact any sources of information in a manner

other than in writing. You may continue to use the previously signed releases or authorizations to obtain

records and reports in writing, but any direct communication outside of a writing will be considered an invasion

of my CLIENT’s privacy.

Please address all additional correspondence and inquiries to the undersigned.

Sincerely yours,

This form originally appeared in An Attorney’s Guide to ERISA Disability Claims.

Sample Claim File Request Page 3