To

Cheryl Smith

Claims Manager

Life Safe Insurance Company

San Diego, CA

Date: 13-12-2011

Subject: Letter for health insurance claim

Dear Ms. Smith

Please accept this letter as my, Mr. Sam Beaver’s formal appeal to your company for health insurance claim against my health insurance policy GH87675T.

I have been diagnosed with frozen shoulder and Dr. James G Morgan prescribed a surgery for the shoulder. I have gone through the surgery and total expenditure that I made on surgery, medicines and medical tests is approx $4500. I have also attached hospital bills, claim form, Dr. Morgan’s patient history report for your perusal.

I have checked my health insurance policy and it makes me eligible to claim for this reimbursement. Kindly look into the matter and reimburse my money spent on the treatment. I would appreciate if you can help me with this as soon as possible. You can contact me on 768 654 6578.

Yours’ sincerely

Mr. Sam Beaver