Health Insurance Claim Application Letter – Sample Application Letter for Medical Claim

The ______________ (Concerned Authority),
________________ (Insurance Company Name),
________________ (Address)

Date: __/__/____ (Date)

Subject: Application for claim approval of policy no. __________ (policy number)

Respected Sir/Madam,

I am _______________ (Name) a policy holder in your company bearing policy number _______________ (Policy Number). Policy name is ________________ (Policy Name – If applicable) and my permanent residential address is ______________ (Address).

I am writing this letter to request you regarding approval of the claim for a total amount of Rs. __________ (Amount). The patient is hospitalized in ____________ (hospital Name), in ___________ (Room type) due to the reason (Reason Of Hospitalization).

The following are the details of the patient:

Name: _______________
Gender: _______________
Address: _______________

I am hereby attaching ____________ (a copy of bill/ ID Proof/ Address Proof/ Application Form/ Form duely filled attested by hospital/ Any other document Required).

I shall be highly obliged if you take this as genuine and pass the claim as early as possible.

Thanking you,
______________ (Signature)
______________ (Name),
______________ (Contact Number)

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