PERS0234
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| Re: | Policy _________________ |
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| | Accident/Treatment Date: _________________ |
Dear _________________:
Our claim for medical services by _________________ for _________________, my _________________, on _________________, was due to an accident. As you will see upon reviewing our policy, we are to be reimbursed 100% for accident-related expenses.
The circumstances of the accident were as follows: _________________.
I would appreciate if you would reconsider this claim in light of this information and recalculate the benefits accordingly.
Sincerely,
_________________
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