Insurance companies can utilize this letter template to seek reimbursement from the person or entity legally responsible for a loss. You have no legal obligations to respond to a subrogation letter.The Plaintiff, above named, complaining of Defendants, above named, alleges and says as follows: 1. View on Westlaw or start a FREE TRIAL today, § 1. Complaint alleging subrogation of automobile collision insurer against party causing damage, Legal Forms. Us, or call Hennepin Health Member Services at. Subrogation Example. This is an example of how subrogation works: EXAMPLE: John has car insurance with State Farm. Along with supporting documents, fax the form to 612-321-3786. No notice of cancellation or reduction in the limits of liability of coverage of an automobile insurance policy under section 65B.