Letter to Claim from Health Insurance - Template Form

________

________

________

To Whom It May Concern,
________
________

Re.: Letter requesting medical claim under the policy number: ________

I am writing to ________ to formally request reimbursement of medical expenses for Policy Number: ________ with account holders name as: ________. That I have incurred the medical expenses due the following reasons:

________

I was treated at ________ from ________ to ________.

I have enclosed the following supporting documentation:

a. Claim Form.

b. A statement from the hospital.

c. The copies of bills and invoices.

d. Along with the following additional documents:

________

Therefore, I am requesting you to reimburse the claim amount of Rs.________ (________). I am entitled to receive the aforementioned claim amount as per the insurance policy terms. Please do pay the amount in the following manner:

________

Lorem ipsum dolor sit amet consectetur adipiscing elit sed do eiusmod tempor incididunt ut labore et dolore magna aliqua ut enim ad minim veniam quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat duis aute irure dolor in reprehenderit voluptate velit esse cillum dolore eu fugiat nulla pariatur lorem ipsum dolor sit amet consectetur adipiscing elit sed do eiusmod tempor incididunt ut labore et dolore magna aliqua ut.

Looking forward to hearing from you.

Yours faithfully,

________