You have no legal obligations to respond to a subrogation letter. Here is a practical example of a subrogation.Insurance companies can utilize this letter template to seek reimbursement from the person or entity legally responsible for a loss. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. It's the process where an insurance company steps into your shoes to recover funds from the party responsible for your injury. Complete this form only if ALL of these statements are true: 1. You are NOT named in the accompanying Summons and Complaint. 2. Please fill out the following form: COPE Form. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. Private insurance companies to fill gaps in Original Medicare.