Watson and Lentner Lawyers in Ft. Lauderdale Florida | PIP PPO Reductions
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220 N.E. 51 St. Ft. Lauderdale FL.33334(toll-free)800.566.9358(T) 954.772.6690(F) 954.351.9155		 PIP Law & Forms

DEMAND LETTER
Pursuant to Florida Statute 627.736 (11)

HEALTH CARE PROVIDER:

INSURED:

CLAIMANT:

CLAIM/POLICY NUMBER:

ITEMIZED STATEMENT: see attached HCFA 1500 Forms

REQUEST FOR REIMBURSEMENT: This is a request for reimbursement of the cost of mailing this Demand Letter in the amount of $ .

Click here for demand Letter in document form.

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