To assist you in completing the sheet, examples of the cases that belong under each case type in item 1 are provided below. Insurance companies can utilize this letter template to seek reimbursement from the person or entity legally responsible for a loss.To submit a claim appeal, complete a. Notice of Provider Dispute form (NOPD), attach any relevant and supporting documentation, and submit it to the. The Plaintiff, above named, complaining of Defendants, above named, alleges and says as follows: 1. Please provide a copy of all attachments supporting your claim. (estimates, bills, receipts, police report, etc.) 1. To ensure compliance with local regulations, please reach out to Alameda Rent Program staff. Plaintiff William Jae Kim (Kim) was severely injured after he lost control of his Toyota Tundra pickup truck and drove off an embankment.