Along with supporting documents, fax the form to 612-321-3786. A subrogation claim simply includes the amount of money that was paid toward your medical bills.This amount is also called the "subrogation interest." Insurance companies can utilize this letter template to seek reimbursement from the person or entity legally responsible for a loss. National Insurance Co. Ltd. Has paid a claim to an individual for damage to their vehicle. Examples of subrogation clauses include: Example 1. Filing an auto insurance claim against a third party driver; Example 2. Thirtythree years of subrogation litigation experience has distilled ten of the most common mistakes which we see clients continuing to make. An example of this may be a State Trooper who is seriously injured in a motor vehicle accident.