Sample Application format for Reimbursement of Medical Bill

[Below briefly describe on Sample Application format for Reimbursement of Medical Bill. You can follow this sample medical reimbursement application letter or requesting letter for reimbursement of expenses. You can also follow these sample as Covering letter for medical claim requesting reimbursement of medical expenses.]

Date…

Hospital Manager,

Hospital Name…

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. (Explain the actual cause and situation). The other driver was drunk and driving over the speed limit when he drove around the corner right into my head on. (Describe in your own words). As a result of this, I was badly injured with both my hands broken and my spine chipped with a few broken ribs. (Describe actual physical situation).

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. (Explain on requirements). The cost of my medical bill was (Money amount). 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,

Your name…

Address…

Contact no. and Signature…

Dear Sir,

I was suffering from (disease name) from last few months. I have operated from (Bank branch name). (Describe in your own words). Total expense (Money amount) are incurred. (Explain on requirements). Please reimburse this amount; I have attached all the necessary documents and Invoices. (Explain the actual cause and situation)

I shall be highly grateful to you.

Your name…

Address…

Contact no. and Signature…