Get Uninsured Expense Reimbursement Form - Stephens Margolin

The Uninsured Expense Reimbursement Form - Stephens Margolin is designed to facilitate the reimbursement of uninsured expenses between parties. This guide provides detailed instructions for users to complete the form accurately and efficiently.

Follow the steps to fill out the form correctly.

1. Press the ‘Get Form’ button to access the form and open it in the editing interface.
2. Begin filling in the blank fields. Enter the name of the person who owes reimbursement in the designated spot. Ensure accuracy in spelling and format.
3. Next, provide the mailing address of the person who owes reimbursement. This should accurately reflect their current postal address.
4. In the section labeled 'From,' input the name of the person making the claim. This should be the individual or entity requesting reimbursement.
5. Complete the mailing address for the claimant in the corresponding field, ensuring it is correct for communication purposes.
6. Input the date on which the form is being mailed. This must be formatted correctly to avoid confusion.
7. Record the date that payment is due from the other party in the specific field provided.
8. Calculate and enter the total amount due from the other party based on the percentage reimbursement obligation, ensuring all calculations are accurate.
9. For each expense incurred, fill out the respective fields for date of service, provider/purpose, and amount paid out of pocket, making sure to specify if the expenses were not reimbursed by any employer or insurance.
10. If possible, submit the completed form to the other party on a monthly basis, including copies of related billings.
11. Retain a copy of all completed documents and note the date the form was mailed for your records.
12. Keep copies of any checks or credit card statements as proof of payment made.
13. Ensure reimbursement is made to the other party as per any existing court order or judgment regarding payments.
14. Utilize additional pages for any extra information if necessary, as this form is designed to streamline communication of uninsured reimbursement claims.
15. Once all fields are filled, save your changes to the document, and consider downloading or printing the form for your records and to share as required.

Complete your Uninsured Expense Reimbursement Form online today for a smooth reimbursement process.