To whom it may concern,
In addition to this letter and the claim report, I have included some other useful information. The circumstances of my injury are as follows: While in Australia, on the date of July 17, 1996, I fell down a flight of stairs and fractured my wrist. On July 18, I went to the Cairns Base Hospital and had my injury taken care of and returned on July 25 to get a cast. I was not charged by the hospital for any of these services other than the $8.00 to make copies of the x-rays to bring back to my doctor in the U.S. I arrived back in the United States on August 4. On August 19 I went to Dr. Philip A. Stull to get my cast removed and was charged for his services.
Charges incurred during the injury include $8.00 for the x-ray copies (copy of receipt enclosed), $2.95 for a cast cover in order to shower (copy of receipt enclosed), $25.00 for a non-refundable deposit on a scuba diving trip with Reef Encounters that had to be canceled due to the injury (copy of receipt enclosed), and $125.00 for the cast removal and x-rays (copy of receipt enclosed). The photocopies that I included can be explained as follows:
page 1 – passport, drivers license, and ISIC card
page 2 – Australian visa
page 3 – boarding pass for leaving the U.S.
page 4 – boarding pass for arriving back in the U.S., receipt for x-ray copies, and
receipts for the shower bag.
page 5 – receipt for deposit on diving trip
page 6 – receipt for x-rays and cast removal
page 7 – photocopy of x-ray taken at Cairns Base Hospital
If there is any other information that you require in order to process my claim please let me know.