[Date] [your claims adjuster]Coast National Insurance Company 8000 S. Chester St., Suite 400A Centennial, CO 80112 RE: Claim # [your name] Dear [claims adjuster], I am the physician who referred [your name] to [name of physical therapy or other doctor office]. [Your name] came to me on [date] suffering from continuing pain due to [your injury] [he/she] sustained in an automobile accident on [date]. I referred [your name] to [Physical Therapy/doctor]. I have a close relationship with the staff there and support their diagnosis and their evaluations. [your name] recently came to me for help interpreting the [date] “[description of what the insurance company is disputing]” initialed by [doctor name] from the [name of Medical Center]. [Doctor name] is unable to give you an explanation of his notes since [he/she] is out of the country. Since [he/she] cannot be reached and I was [your name]'s other treating physician I want to clarify your understanding of [Doctor name]’s’s notes. The statement “disabled x 2 weeks” is a common practice. It is routinely written in the files of patients who have their casts removed. It means the patient is not fit to return to work and should return to a physician in two weeks after having [his/her] cast removed for a re-evaluation of [his/her] injury. In a case like [your name]’s when the injury was a fractured third metacarpal it in no way means [y[your name] would return to 100% of [his/her] pre-accident strengths and abilities two weeks after [his/her] cast was removed. [your name] i is a [your occupation] and [describe how you cannot do your job due to your injury]. It wouldn’t be unreasonable to say that it would take a minimum of four to six weeks of physical therapy to enable [your name] to regain the use and strength in [his/her] [your injured body parts] in order for [him/her] to be able to perform [his/her] duties at work. However, when an insurance company who is responsible for a patient’s medical bills, as you are, doesn’t pay those bills then a patient is unable to receive reasonable medical care. [Describe any hardships you have encountered due to them not paying for your medical bills.] As a doctor who relies on insurance companies to pay for patient care I am appalled at your insensitivity to your obligation to pay for injuries caused by your insured who rear-ended [your name]. I am of the opinion that an insurance company who purposely withholds medical treatment from a patient is responsible for all expenses and loss of wages incurred by that patient for the duration of the period the insurance company withholds treatment. [your name]’s [injured body part] was in pain when [he/she] came to me on [date] . It is my opinion that [he/she] could not have performed [his/her] job as a [your occupation] in the condition [he/she] was in on that day and I firmly believe that [he/she] would absolutely not have been able to return to work two weeks after [his/her] cast was removed. [your name] was released to go back to work on [date] by [Doctor name] at [name of physical therapy or other doctor office] and I will stand behind [his/her] professional evaluation of [your name]’s condition and agree that [your name] was not released to return to work until [date] . Please contact me if you have any questions. Sincerely,
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