Application format for Reimbursement of Medical Expenses

[Here briefly describe on Medical reimbursement application format. You can also follow these formats as a letter of requesting reimbursement of expenses. You can modify this format as your requirement.]

Date…

The Administration Office,

Medical Institution name…

Institute Address…

Sub: Application for Reimbursement of Medical Expenses

Dear hospital manager,

I am writing to you because I would like to submit an application for reimbursement for my medical expenses. I was recently involved in a road traffic accident. (show your actual problem and situation). The other driver was drunk and driving over the speed limit when he drove around the corner right into my head on. As a result of this, I was badly injured with both my legs broken and my spine chipped with a few broken ribs.

After all the treatment I was given the medical bill and paid. I was later told by my lawyer that I could get the money back because the accident was not my fault and I was not doing anything wrong to contribute to the accident. The cost of my medical bill was two thousand pounds. I took this out of my children’s education savings and took me years to get that for them.

I hope that you will grant me this request and I look forward to hearing back from you.

Yours sincerely,

Name…

Job Designation…

Address and contact no…

Signature…