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ZURICH AMERICAN INSURANCE COMPANY PROOF OF CLAIM- ACCIDENT MEDICAL EXPENSE Mail claims to: Zurich American Insurance Company P. O. BOX[removed]
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Document Date: 2012-02-21 10:47:42

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City

WASHINGTON D.C. / WASHINGTON / Schaumburg / NEW YORK / /

Company

Zurich American Insurance Company / No No Address Policy Number / COACH / /

Currency

USD / /

Facility

Facility Name / /

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IndustryTerm

insurance fraud / accident insurance / insurance policy containing / state law / insurance / accident insurance plan / insurance benefits / insurance proceeds / legal services / fraudulent insurance act / /

Organization

Rugby Club / /

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Position

PLAYER Policy / physician / legal representative / any and all such information / /

ProvinceOrState

Texas / Tennessee / Kentucky / New Jersey / West Virginia / New Mexico / Ohio / Minnesota / Virginia / Maine / Pennsylvania / Oklahoma / Illinois / Indiana / Delaware / Oregon / Florida / California / Arizona / Idaho / Colorado / Arkansas / New Hampshire / /

Region

WEST VIRGINIA / /

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