No fault_letter-J JOHN SEBASTIAN ATTORNEY No fault_letter-J JOHN SEBASTIAN ATTORNEY No fault_letter-J JOHN SEBASTIAN ATTORNEY No fault_letter-J JOHN SEBASTIAN ATTORNEY No fault_letter-J JOHN SEBASTIAN ATTORNEYNo fault_letter-J JOHN SEBASTIAN ATTORNEY

1. [DATE]
VIA CERTIFIED MAIL, RETURN RECEIPT REQUESTED
ATTENTION [NO-FAULT ADUSTER]
[NO-FAULT INSURANCE COMPANY]
[NO-FAULT INSURANCE COMPANY'S ADDRESS]
RE: Claimant: [CLIENT]
Insured: [INSURED]
D/Accident: [DATE OF ACCIDENT]
Claim No.: [NF CLAIM #]
Policy No.: [NF POLICY #]
Our File #: [FILE NUMBER]
Dear [MR./MS.] [NO-FAULT ADJUSTER'S LAST NAME]:
Please be advised that this office represents claimant [CLIENT] for injuries received in a
motor vehicle accident on or about [DATE OF ACCIDENT]. Please forward all forms and
correspondence to the undersigned. Please forward No-Fault application as well as any other
documentation required. A copy of the police report is enclosed for your records..
Until coverage is confirmed on all offending vehicles, all rights are reserved under our
client’s uninsured and/or underinsured and/or SUM motorist coverage.
Please mark your records accordingly. Thank you.
Very truly yours,
[NAME OF ATTORNEY]
Enc. (Police Report)
HIPAA PRIVACY WARNING
You may be contacted by third parties, including the insurer(s) for other vehicles involved in this action.
Under no circumstances are you or anyone from your company authorized to share any of our client’s information of
any nature, including but not limited to medical information, vital statistics (i.e. date of birth, social security number,
etc.), coverage amounts, or any other information collected by your company, without the prior written authorization
of our client.