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Insurance Claim

Jerald Gonzales slipped and fell on a wet floor at Holy Angel University, injuring his right hand. An x-ray revealed a complete fracture of his right hand. His orthopedic surgeon, Dr. Lyndon Bathan, advised that he needed immediate surgery, which cost 56,000 pesos. Gonzales is filing an insurance claim to help cover the costs of the operation since he and his family had to borrow money and are unable to pay the full amount.

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Jan Uriel David
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48 views

Insurance Claim

Jerald Gonzales slipped and fell on a wet floor at Holy Angel University, injuring his right hand. An x-ray revealed a complete fracture of his right hand. His orthopedic surgeon, Dr. Lyndon Bathan, advised that he needed immediate surgery, which cost 56,000 pesos. Gonzales is filing an insurance claim to help cover the costs of the operation since he and his family had to borrow money and are unable to pay the full amount.

Uploaded by

Jan Uriel David
Copyright
© Attribution Non-Commercial (BY-NC)
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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INSURANCE CLAIM AFFIDAVIT OF INCIDENT

I, Jerald Gonzales, of legal age, with postal address of San Vicente Magalang, Pampanga, 4th year CBA student of Holy Angel University. I am executing this Affidavit of Incident for my Insurance Claim. The incident transpired on or about November 19, 2013 that on that day 7pm while Im walking at the hallway of STL Building inside Holy Angel University I accidentally slipped through the wet flooring and I used my left hand to support my head from the impact and with incident I felt that my right hand was bruised and I just went home and applied ice pack but the pain did not subside. 2 days after the incident I decided to undergo X-RAY because my right hand is swelling.

The result of the X-RAY is that I have a complete fracture of my right hand and the roentgenologist advised me to have it looked up by an orthopedian. I then went to an orthopedic surgeon named Dr. Lyndon Bathan and he told me that I should I undergo an operation immediately because the fracture might sustain a bigger problem. I followed my orthopedic surgeons advice and underwent an operation at The Medical City Angeles amounting to P56,000 pesos evidenced by the receipts attached. I am claiming my insurance because we do not have that much money to pay for the amount of my operation. That we only borrowed money to pay it and I am hoping that I can get at least 50% of the amount.

______________ Jerald Gonzales

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