Instructions: The physical examination report, pathology report, or autopsy report submitted is not for the Injured Party of this claim. Please provide a medical report for the Injured Party that documents the diagnosis of the injury alleged on the Claim Form. The report must be dated, signed by a qualified physician, and must include a diagnosis based on a physical examination. A pathology report (if the Injured Party is deceased) or autopsy report is acceptable if it provides the appropriate diagnosis.
Detail Text: The physical examination or pathology report submitted is not for the injured person in this claim. Please provide a medical report for the injured party that documents the diagnosis of the injury alleged on the Claim Form. The report must be dated, signed and must include a diagnosis based on a physical examination by the physician making the diagnosis. A pathology report from a board-certified pathologist (if the claimant is deceased or for Disease Levels V-VIII) is acceptable if it provides the appropriate diagnosis.
