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Request for Insurance Statement

Redacted Insurance Company


To Whom It May Concern:


On approximately 10/2/2006, your client was involved in an accident with a vehicle owned by Marion County; my client was passenger in the later vehicle and is named Bridget Early.  This law firm represents the same who was injured in the accident referenced above. Florida Statutes §627.4137 requires you or your insurance agent to disclose the name of each insurance company known to you that may provide you coverage as a result of the accident referenced above, along with the coverage provided.


Pursuant to §627.4137, you are also to forward a copy of this letter to any insurance company that insured or may have insured you or the vehicle in this accident and to any insurance company that may afford you liability coverage for this accident. Each such insurance company shall furnish us, within 30 days, a statement under oath of a corporate officer, claims manager, or claims superintendent, providing the following for each primary, excess, or umbrella policy:


(a)   The name of the insurer;

(b)  The name of each insured;

(c)   A statement of any policy or coverage defense which each insurer reasonable believes is available to such insurer at the time of filing such statement; and

(d)  A copy of the policy.


The information must be amended immediately upon discovery of facts calling for an amendment to the initial response.


Massey & Duffy

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