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Sample Letter of Representation Insurance Company– Underinsured Carrier

Sample-Letter-of-Representation-Insurance-Company– Underinsured-Carrier


{Today’s Date}

Sent via facsimile: {(xxx) xxx-xxxx}

{Adjuster’s Name and Title}
{Insurance Company Name}
{Address – Line 1}
{Address – Line 2}
{City, State, Zip}

Re:      Our Client/Your Insured:        {Client/Insured’s Name}
           Claim No:                              {}
           Policy No.:                              {}
Date of Loss:                          {}

Dear {Adjuster’s Name}:

This firm has been retained to represent the interests of {our client/insured’s name} for injuries {he/she} sustained in connection with a motor vehicle accident that occurred in {insert city and state} on the above-referenced date. Please direct all correspondence and communications to this office.

This letter is to put your company on notice that this claim may result in an uninsured or underinsured motorist claim to be made on behalf of our clients. Therefore, please forward a copy of the declaration page, which outlines all available coverages including uninsured, underinsured as well as medical payment benefits, which was in effect on the date of loss.

If there are medical payment benefits available for our client, please forward the necessary Application for Benefits. Also, in the event you elect to inspect the subject vehicle, we would appreciate being provided with all property damage estimates and color photographs depicting damage to the vehicle.

As a result of this accident, {client/insured’s name} is currently receiving accident related medical treatment. As such, we will provide you with periodic updates on {his/her} medical status so that you may set your reserves.




{attorney’s name}

Arizona Personal Injury Complaints

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Disclaimer: The information and forms on this site are for illustrative purposes only. The information is not intended to be used by anyone other than a licensed Arizona attorney familiar with Arizona personal injury law. The forms and the information contained in them may not be up-to-date and must be independently reviewed, cite checked, rule checked, and otherwise verified by a licensed Arizona attorney. The information contained in the forms on this website cannot and must be relied on for the purposes of filing legal documents or otherwise pursuing a claim. If you have any questions about this, please contract and attorney at or by calling 602-833-1274.