Insurance companies can utilize this letter template to seek reimbursement from the person or entity legally responsible for a loss. The Plaintiff, above named, complaining of Defendants, above named, alleges and says as follows: 1.In car accident injury claims, subrogation may be used to recover money from a third party. Learn how an insurer's right of subrogation affects your claim. Here is a practical example of a subrogation. As a specific example, an insurance company that did not actually pay out a claim to the policyholder has no grounds for a subrogation claim. The Risk Management Division manages programs in the areas of employee safety, loss prevention, property, casualty, and employee benefits and wellness. Please fill out the below form or contact us at 1-866-796-0530. Commission award complete with proposal form. In the form of an insurance certificate and endorsement.