[Your Name]
[Your Address]
[City, State, ZIP Code]
[Email Address]
[Phone Number]
[Date]
[Recipient’s Name]
[Recipient’s Position]
[Insurance Company’s Name]
[Address]
[City, State, ZIP Code]
Subject: Authorization for Claim Processing
Dear [Recipient’s Name],
I, [Your Name], residing at [Your Address], hereby authorize [Authorized Person’s Name], residing at [Authorized Person’s Address], to act on my behalf in all matters related to the processing of my insurance claim with [Insurance Company’s Name], policy number [Your Policy Number].
This authorization includes the following actions:
- Filing the Claim: Submit all necessary documents and forms to initiate the claim process.
- Correspondence: Communicate with insurance company representatives and respond to any requests for information or documentation.
- Settlement Negotiation: Negotiate the terms and amount of the claim settlement.
- Receiving Payment: Collect any checks or payments issued in settlement of the claim.
Details of my claim are as follows:
- Policyholder Name: [Your Full Name]
- Policy Number: [Your Policy Number]
- Type of Claim: [Type of Claim, e.g., health, auto, home]
- Date of Incident: [Date of Incident]
The purpose of this authorization is to ensure the timely and efficient processing of my claim during my absence due to [reason, e.g., travel, health issues, work commitments]. [Authorized Person’s Name] is fully trustworthy and knowledgeable about the details of my claim.
Attached are copies of my identification, policy document, and [Authorized Person’s Name]’s identification for verification purposes. Should you require any further information or have any questions, please contact me directly at [your phone number] or [your email address].
Thank you for your cooperation.
Sincerely,
[Your Name]
[Signature]
[Notary Public’s Name, Signature, and Seal (if required)]