|
< Date >
< Your Adjudicator's Name
>
< Your Adjudicator's Address >
Dear Mr(s). < Adjudicator's Name >,
| Re: |
Request for a NEL Re-assessment
< Your Name > |
| WSIB Claim No.: |
<
Your Claim Number > |
I am writing to request a re-assessment of
my NEL award based on a deterioration in my condition.
Please find enclosed a letter from Dr. Bones
< enter Doctor's Name >, my orthopaedic specialist
< enter Doctor's area of expertise >. She has
reviewed the NEL medical assessment from two years ago and says
that my condition is now considerably worse. Some of the figures
given for the range of motion in my back and knee are only half
as bad as they are now.
Please take this report into account and refer
my file for a NEL re-assessment.
Thank you for your attention to this matter.
I look forward to your reply.
Yours truly,
< Sign Your Name Here >
< Type/Print Your Name >
< 123 Your Street >
< Your City, Ontario >
< X0X 0X0 >
Enclosure
|
