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Letter challenging a ruling on health insurance policy

Marty Murphy
Acme Insurance Company
Hometown OH

Dear Mr. Murphy

As you have informed me earlier during our phone conversation, I am writing to formally document our appeal of the ruling by Big Insurance Company concerning the payment for recuperative care for our son Sam.

Sam Hudson, our son, was involved in an automobile accident on the morning of February 21, 2009. He was admitted to Community Medical Center for injuries to right arm and leg where he was treated and released after a 24 hour stay.

Our family was advised by Doctor Joseph Kutch that Sam would require weekly physical therapy treatment for six weeks after removal of the cast to his arm and leg. At the end of his therapy, the therapist determined that there was need for more work to regain complete use of his arm and hand. This involved three more sessions. Sam has now completed all treatment and has full use of his arm and leg.

Since that time I have received notice from Big Insurance that it will not cover the additional therapy sessions ordered after the initial consultation. The initial therapy sessions were ordered as a result of the injuries being more extensive than previously known.

All of the physical therapy ordered was to repair injuries received from the original incident. According to the policy we purchased, insured members of my family are allowed up to twelve weeks of physical therapy per each covered incident. Because of this I feel that the additional therapy sessions should be covered.

I would like your assistance in obtaining a re-evaluation of this ruling by Big Insurance. We would like for them to pay for all therapy sessions.

Redd Ford