Hillsborough Florida Sample Letter for Irrevocable Assignment and Lien to Medical Provider

• Category: Letters - Legal - Personal Injury
• State: Multi-State
• County: Hillsborough
• 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. Sample Letter for Irrevocable Assignment and Lien to Medical Provider in Hillsborough Florida Dear [Medical Provider's Name], I am writing to formally request an irrevocable assignment and lien arrangement in regard to the medical bills associated with the treatment and care provided to [Patient's Name] at your esteemed medical facility in Hillsborough, Florida. [Patient's Name] was involved in an unfortunate accident on [Date] that resulted in severe injuries requiring immediate medical attention. Your prompt and dedicated medical services played a vital role in their recovery, and we are immensely grateful for the exceptional care provided. In order to ensure that the outstanding medical expenses are promptly cleared, we are hereby assigning to you, as the medical provider, any and all benefits available through any applicable insurance coverage held by [Patient's Name]. Furthermore, we are placing a lien on any settlement, judgment, or recovery that may be obtained in connection with the accident that caused their injuries. This assignment and lien agreement is irrevocable and shall remain in effect until the outstanding balance is fully settled. Its supers.

Sample Letter for Irrevocable Assignment and Lien to Medical Provider in Hillsborough Florida Dear [Medical Provider's Name], I am writing to formally request an irrevocable assignment and lien arrangement in regard to the medical bills associated with the treatment and care provided to [Patient's Name] at your esteemed medical facility in Hillsborough, Florida. [Patient's Name] was involved in an unfortunate accident on [Date] that resulted in severe injuries requiring immediate medical attention. Your prompt and dedicated medical services played a vital role in their recovery, and we are immensely grateful for the exceptional care provided. In order to ensure that the outstanding medical expenses are promptly cleared, we are hereby assigning to you, as the medical provider, any and all benefits available through any applicable insurance coverage held by [Patient's Name]. Furthermore, we are placing a lien on any settlement, judgment, or recovery that may be obtained in connection with the accident that caused their injuries. This assignment and lien agreement is irrevocable and shall remain in effect until the outstanding balance is fully settled. Its supers.