Sample Letter To Insurance Company Template (Page 2 of 2) in pdf

Sample Letter To Insurance Company Template Page 2

Date

Name

Title

SENT VIA FAX AND FIRST CLASS MAIL

Insurance Co.

Address

City, State Zip

Your Insured: Name

Policy No.:

Claim No.:

D.O.L.:

Date of Accident or Illness

Dear Mr./Ms.:

This letter references a bill for medical services which we received from (name of

Hospital, or other medical service provider) regarding treatment which I received on the above-

referenced date. We have enclosed a copy of all of the bills related to these charges which we have

received from said hospital. As indicated, since this [accident/illness] is covered by our policy with

your company, we believe that these charges should be paid by your company.

It is important to us that this matter receive your immediate attention and that it not be

reported to any credit agency. Thus, we would appreciate your payment of this claim before the due

date in order to protect our credit standing.

Thank you in advance for your cooperation, and please inform us as soon as possible

of any other claim number and whether you will be accepting responsibility for payment of these

charges. Please contact the undersigned with respect to all aspects of this incident.

Sincerely,

By _______________________

[Your Name]

Enclosures:

[NOTE:

Consider sending a copy to the Hospital for their records]

Sample Letter To Insurance Company Template Page 2