|
< Date >
< Your Adjudicator's Name
>
< Your Adjudicator's Address >
Dear Mr(s). < Adjudicator's Name >,
| Re: |
Request
for a NEL Assessment
< Your Name > |
| WSIB
Claim No.: |
<
Your Claim Number > |
I am writing to request that my claim be referred
for a NEL assessment without further delay.
Please find enclosed a letter from Dr. Bones
< enter Doctor's Name >, an orthopaedic specialist
< enter Doctor's area of expertise >. As you
can see, (s)he is of the opinion that I have reached maximum medical
recovery, but still have a medical impairment.
It is my understanding that this qualifies
me for a NEL award. Please make the referral as soon as possible.
Thank you for your attention to this matter.
Yours truly,
< Sign Your Name Here >
< Type/Print Your Name >
< 123 Your Street >
< Your City, Ontario >
< X0X 0X0 >
Enclosure
|
