Re:Your Claim Number:
Date of Loss:
Dear . :
Please accept this letter, pursuant to C.R.S. 8-41-203(4), as (client), written notice of intent to pursue a claim. (client) *currently* has a claim for workers’ compensation benefits and, at the time of the injury, (client’s) employer was** .
- (client) claim arises from an automobile collision that occurred on (date). (basic accident facts, location).
- The names and addresses of potential negligent persons and/or entities:
- The name and address of attorney representing plaintiff:
D.J. Banovitz, Esq.
Law Office of D.J. Banovitz, L.L.C.
7887 E> Belleview Ave. STE 1100
Englewood, CO 80111
- The name and address of attorney representing alleged negligent parties and/or entities: Unknown at this time.
- The name and address of potential negligent parties and/or entities insurance carrier or third party administrator:
We will keep you apprised of the claim as required. If you have any questions regarding this matter, please feel free to contact me.
Law Office of D.J. Banovitz, L.L.C
cc: Division of Workers’ Compensation
633 17th Street
Denver, CO 80202