< ><<file number>><<Claim Number>>

Insurance / Legal

Delivered by courier

<

<

<<CITY/PROV>>

< >

Dear <

RE:< > < >

DOL:< >

Addendum Due:

Addendum

You previously saw this person for the purpose of an <<Independent Medical Examination>> on <<IME DATE>>. A copy of your report is attached.

Please note there is a tight deadline of << Due Date>> for this Addendum.

The adjuster states that:

INSERT TAST

We enclose some additional medical documentation that has been sent to us. Please see the attached letter from our client, < > of < TEST_AUTO_Insurance_Co_20251031_122831 >, dated DATE with background issues and questions to be addressed in your addendum 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 your addendum, could you please address it to: < > of < TEST_AUTO_Insurance_Co_20251031_122831 >, and please quote our client’s file number.

PLEASE ENSURE THAT YOUR ADDENDUM AND INVOICE ARE SENT 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.