NY PIP-NOFAULT CARRIER2 combo rep ltr and enc PIP-NoFault app

[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 clients 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 WARNINGYou 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 clients 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.