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Free Medical Benefits Request - Reconsider a Denied Claim

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_________________, _________________ _________________

 

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_________________, _________________ _________________

 

Re: Policy _________________

Claim: _________________

 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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