Letter Generator

Which law firm?

What staff is formatting/co-drafting?

Taren Marsaw

Alex Castillo

Tracey Dieson

Which letter(s) are you generating for Marsaw Legal?(Required)

Which letter(s) are you generating for THLF?(Required)

General Letter

PIP Demand

35% Contingency Engagement Letter

1st Party LOR to Send to Our Client’s Insurance

1st Party LOP (Sent to Treatment Providers)

3rd Party LOR to Send to At-Fault Driver’s Insurance

Case Rejection

Spoliation

Medical and Billing Records + Affidavit

Client's Full Name(Required)

Client's Date of Birth(Required)

Date of Accident(Required)

Spoliation Letter

What is the core matter?

Motor Vehicle Accident

Trucking / Commercial Vehicle

Slip and Fall

Premises Liability

Negligent Security

Workplace / Employment

General Civil Litigation

Wrongful Death / Survival

Other

Time of Incident(Required)

Date of Spoliation incident(Required)

Video time window requested

Custom time window of incident(Required)

Location of Incident(Required)

Short Description of What Happened(Required)

Describe what happened, who was involved, and why you believe evidence may exist.

Who should receive the spoliation letter?(Required)

Individual

Business

Insurance Carrier

Employer

Property Owner / Manager

Government Entity

Other

Recipient Name / Company(Required)

Recipient Contact Person

Recipient Email

Recipient Address(Required)

Street Address Address Line 2 City State ZIP Code

Medical Bills

Medical Bills or Receipts

Drop files here or

Max. file size: 32 MB.

Address for Recipient Medical Provider's Billing Department(Required)

Name of Medical Provider Street Address and Suite Number City State ZIP Code

Address for Recipient Medical Provider's Medical Record Department(Required)

Name of Medical Provider Street Address and Suite Number City State ZIP Code

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Today's Date

Letter Generator

Who is receiving the letter?(Required)

Recipient's Email(Required)

Title of Letter(Required)

RE: Line(Required)

Intro(Required)

First ¶ Heading(Required)

First ¶(Required)

Second ¶ Heading(Required)

Second ¶(Required)

Third ¶ Heading(Required)

Third ¶(Required)

Fourth ¶ Heading

Fourth ¶

Fifth ¶ Heading

Fifth ¶

Sixth ¶ Heading

Sixth ¶

Seventh ¶ Heading

Seventh ¶

Eighth ¶ Heading

Eighth ¶

Ninth ¶ Heading

Ninth ¶

Contingency Agreement

Client's Email(Required)

Matter Description(Required)

1st Party LOR Information

GEICO P.O. Box 9506 Fredericksburg, VA 22403 geicoclaims@geico.com

AAA PO Box 8082, Royal Oak, MI 48068

Name of Client's Insurance Provider(Required)

Client's Insurance Company's Fax Number

Client's Insurance Company's Email(Required)

Address of Client's Insurance Provider(Required)

Street Address Address Line 2 City State ZIP Code

Client's Insurance Company's Assigned Claim No.(Required)

3rd Party LOR Information

Name of 3rd Party(Required)

Name of 3rd Party's Insurance Provider(Required)

3rd Party's Insurance Company's Fax Number

3rd Party's Insurance Company's Email(Required)

Address of 3rd Party's Insurance Provider(Required)

Street Address Address Line 2 City State ZIP Code

3rd Party Insurance Company's Assigned Claim No.(Required)

3rd Party Insured's Name(Required)

LOP Information

Treatment Provider's Fax Number

Treatment Provider's Company Name(Required)

Treatment Provider's Address(Required)

Street Address Address Line 2 City State ZIP Code

Treatment Provider's Phone(Required)

Treatment Provider's Email(Required)

Settlement Demand(s) – Stowers and True Value

Cause No.(Required)

Court Type(Required)

County(Required)

Plaintiff(Required)

Defendant(Required)

Defendant's pronoun(Required)

she

they

Defendant's possessive(Required)

her

his

their

its

Insurance Block(Required)

Defense Counsel Block(Required)

True Value(Required)

Property Damage(Required)

Medical Bills to Date(Required)

Anticipated future medical costs(Required)

Anticipated future medical treatments(Required)

Permanent or long-term impairments(Required)

Impacted Activities and Daily Life(Required)

Spousal/Consortium Claims(Required)

Bad Facts(Required)

Notice Facts(Required)

PIP Demand

Insurance Company Email(Required)

Recipient Adjuster's Name(Required)

RE: Claim Number(Required)

Location of the accident(Required)

Medical Billing Summary(Required)

CPT Code

Date of Service

Provider

Charge Amount

Paid/Applied

Balance

Total Charge Amount

Total Outstanding Amount

Amount of PIP the client carries(Required)

MedPay Demand

Insurance Company's Email(Required)

Recipient Adjuster Name(Required)

RE: Claim No.(Required)

Accident Location(Required)

Summary of Medical Billing(Required)

CPT Code

Date of Service

Provider

Charge Amount

Paid/Applied

Balance

Total of Charge Amount

Total of Outstanding Amount

Amount of MedPay the client carries(Required)

Georgia Leave of Absence

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Today's Date

Medical appointment
Personal illness
Family medical matter
Caring for child
Caring for parent
Caring for spouse/partner
Bereavement / funeral
Mental health day
Rest and recovery
Religious observance
Jury duty
Court appearance
Out-of-State Trial

Military obligation
School event for child
Childcare issue
Transportation issue
Home emergency
Utility outage / home repair
Moving / relocation
Travel already scheduled
Wedding / family event
Personal business matter
Financial / banking appointment
Immigration / government appointment
Bereavement/funeral

Continuing education / training
Professional licensing matter
Volunteer / community service
Weather-related issue
Need personal time
Vacation / planned time off
Stress management
Burnout prevention
Pregnancy-related appointment
Maternity / paternity bonding
Recovery from procedure
Follow-up treatment
Religious Observance
Other (please specify)

List of Dates to Request Off

Date Range

Reason for Leave of Absence