Bronx New York Sample Letter for Irrevocable Assignment and Lien to Medical Provider

• Category: Letters - Legal - Personal Injury
• State: Multi-State
• County: Bronx
• Control #: US-0531LTR
• Format: Word; Rich Text

Description

This form is a sample letter in Word format covering the subject matter of the title of the form. Dear Medical Provider, I am writing to formally notify you of an irrevocable assignment and lien on behalf of [Patient's Name]. This letter serves as an official document that authorizes you to direct any and all insurance claims, medical reimbursements, settlements, judgments, or any other form of compensation related to the medical services provided to the aforementioned individual directly to the holder of this lien. [Patient's Name] has agreed to assign, transfer, and convey all rights, title, and interest in any and all insurance or third-party claims, benefits, or payments, including but not limited to, personal injury protection (PIP), medical payments, bodily injury, uninsured/under insured motorists, and any other applicable coverage, to the lien holder herein. This assignment is irrevocable, meaning that it cannot be revoked or altered without the lien holder's express written consent. The lien holder, [Loan Company or Medical Funding Company Name], has agreed to provide financial assistance to [Patient's Name] for their medical expenses. In return, [Patient's Name], fully understands and acknowledges that any reimbursements received by the medical provider will be used to satisfy the accrued medical debts owed to the lien holder. By accepting this assignment and lien, you agree to safeguard the rights of all parties involved, diligently collecting and remitting any and all reimbursements directly to the lien holder. The medical provider agrees not to release any insurance or third-party settlements, claims, or payments directly to the patient or any other party without the prior written consent of the lien holder. In case of any potential claims, settlements, or judgments, the lien holder should be promptly notified, and the appropriate documentation should be provided to them. It is also important to note that the lien holder reserves the right to negotiate or settle any claims on behalf of the patient, with the understanding that any agreement reached will be binding on all parties involved. Please find enclosed a copy of the assignment and lien for your records. If you have any questions or require further clarification regarding this irrevocable assignment and lien, please do not hesitate to contact the lien holder directly. Thank you for your attention to this matter, and we appreciate your cooperation in ensuring the smooth processing of all insurance claims and reimbursements. Sincerely, [Your Name] [Your Title/Position] [Your Contact Information] Keywords: Bronx New York, sample letter, irrevocable assignment, lien, medical provider, insurance claims, medical reimbursements, settlements, judgments, compensation, personal injury protection, medical payments, bodily injury, uninsured motorists, under insured motorists, Loan Company, Medical Funding Company, financial assistance, medical expenses, accrued medical debts, reimbursement, documentation, negotiation, settlement.

Dear Medical Provider, I am writing to formally notify you of an irrevocable assignment and lien on behalf of [Patient's Name]. This letter serves as an official document that authorizes you to direct any and all insurance claims, medical reimbursements, settlements, judgments, or any other form of compensation related to the medical services provided to the aforementioned individual directly to the holder of this lien. [Patient's Name] has agreed to assign, transfer, and convey all rights, title, and interest in any and all insurance or third-party claims, benefits, or payments, including but not limited to, personal injury protection (PIP), medical payments, bodily injury, uninsured/under insured motorists, and any other applicable coverage, to the lien holder herein. This assignment is irrevocable, meaning that it cannot be revoked or altered without the lien holder's express written consent. The lien holder, [Loan Company or Medical Funding Company Name], has agreed to provide financial assistance to [Patient's Name] for their medical expenses. In return, [Patient's Name], fully understands and acknowledges that any reimbursements received by the medical provider will be used to satisfy the accrued medical debts owed to the lien holder. By accepting this assignment and lien, you agree to safeguard the rights of all parties involved, diligently collecting and remitting any and all reimbursements directly to the lien holder. The medical provider agrees not to release any insurance or third-party settlements, claims, or payments directly to the patient or any other party without the prior written consent of the lien holder. In case of any potential claims, settlements, or judgments, the lien holder should be promptly notified, and the appropriate documentation should be provided to them. It is also important to note that the lien holder reserves the right to negotiate or settle any claims on behalf of the patient, with the understanding that any agreement reached will be binding on all parties involved. Please find enclosed a copy of the assignment and lien for your records. If you have any questions or require further clarification regarding this irrevocable assignment and lien, please do not hesitate to contact the lien holder directly. Thank you for your attention to this matter, and we appreciate your cooperation in ensuring the smooth processing of all insurance claims and reimbursements. Sincerely, [Your Name] [Your Title/Position] [Your Contact Information] Keywords: Bronx New York, sample letter, irrevocable assignment, lien, medical provider, insurance claims, medical reimbursements, settlements, judgments, compensation, personal injury protection, medical payments, bodily injury, uninsured motorists, under insured motorists, Loan Company, Medical Funding Company, financial assistance, medical expenses, accrued medical debts, reimbursement, documentation, negotiation, settlement.