Representation Letter to Insurance Company

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This Representation Letter to Insurance Company is from an attorney to client's auto insurance company informing them of representation. It also requests information regarding the limits under the client's insurance policy.

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This Representation Letter to Insurance Company is formal notice from an attorney to an insurance company regarding representation of a client who was involved in an auto accident. This letter requests confirmation that the client has medical payment benefits as well as uninsured/underinsured motorist coverage. A HIPPA Authorization signed by the client will also be included with this representation letter.

This Representation Letter to Insurance Company includes:
  • Parties: Sets forth the name of the client, date of loss and claim number (if applicable);
  • Confirmation: Sets forth a request for confirmation of policy limits for both insured and uninsured motorist coverage under the client's policy;
  • Authorization: Encloses an authorization signed by the client which allows the insurance company to provide the necessary information.

Protect yourself and your rights by using our attorney-prepared orms.

This attorney-prepared packet contains:
  1. General Information
  2. Representation Letter to Insurance Company
State Law Compliance: This form complies with the laws of all states
Number of Pages2
DimensionsDesigned for Letter Size (8.5" x 11")
EditableYes (.doc, .wpd and .rtf)
UsageUnlimited number of prints
Product number#28072
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