< ><<File No>><<Claim No>>

Insurance/Legal

Delivered by courier

<

< >

<

< > < >

< >

Dear <

RE: < > < >

DOB:< >

DOL:< >

Report Due: <<report due date>>

Document Review

Thank you for agreeing to provide a <<document review>> on this case.

Please note there is a tight deadline of < > for this Document Review.

The adjuster states that:

INSERT TAST

We have enclosed all documentation that has been made available to us. Please see the attached letter from our client, < > of < > dated date with background issues and questions to be addressed in your report. Please respond in a question and answer format.

Please obtain a detailed history, review the documents, and provide your opinion on the following points:

-

-

-

When preparing you report, could you please address it to: < > of < > and please quote the above referenced claim number.

PLEASE ENSURE THAT YOUR INVOICE AND REPORT ARE SENT ONLY TO WESTERN MEDICAL ASSESSMENTS.

Thank you for providing your services in this matter.

Yours sincerely,

Western Medical Assessments Corporation

Roger Hodkinson M.A., M.B. (Cantab), FRCPC

Medical Director

RGH/sz

Encls.