January 11, 2008

Crime Victims Compensation Bureau
Office of the Attorney General Lisa Madigan
100 West Randolph Street
Chicago, Illinois 60601

Dear Ms. Madigan:

On July 3, 2007, I was the victim of a strong-arm robbery at 1400 South Blue Island, Chicago, Illinois. I am writing this letter to file a claim for resulting costs which are compensable under the Crime Victims Compensation Act, 740 ILCS 45/1 et seq. Enclosed with this letter please find my Crime Victims Compensation Application, along with supporting documents.

My medical insurer, Blue Cross Blue Shield Illinois, has already paid the bulk of my medical expenses. I am seeking compensation for the cost of medical services that I have paid out of pocket, a total amount of $1,176.30.

Aside from medical services, I have incurred the compensable medical expense of prescription medications, a total amount of $53.38.

Finally, I am seeking compensation for transportation expenses to and from medical and treatment facilities incurred on two occasions: (1) a taxicab ride from the emergency room after midnight on the day following the robbery, in the amount of $28.25 and (2) parking at Rush University Medical Center on July 6, 2007, in the amount of $11.25. I traveled by public transportation to receive medical services on all other occasions. I am not seeking compensation for those costs.

In total, my claim is for $1,269.18.

In support of my application, I have attached copies of bills for the amounts I am claiming as medical services expenses which are, in all but one case, accompanied by a copy of the check by which I paid the bill. The one exception was an instance on July 6, 2007 where I paid a $20.00 co-pay by credit card. I am including a copy of the receipt from that payment. Please also note that this $20.00 co-pay is noted on the August 31, 2007 billing statement I received from Midwest Orthopedics at Rush, LLC, which is also enclosed.

To substantiate my claims for compensation for prescription medications and the taxicab transportation, I am including receipts for those costs. Unfortunately, I do not have documentation of my payment of $11.25 for parking on July 6, 2007.

To summarize this cost information, I have prepared a spreadsheet, which I have also enclosed with this letter. Please note that amounts noted in the column “Covered by Insurance” comprises both payments by Blue Cross Blue Shield Illinois and discounts on medical services that I received because of agreements between Blue Cross Blue Shield Illinois and the respective medical services providers. Please refer to the enclosed bills or call me for details.

I have also enclosed a copy of the police report related to the robbery which caused my injury. While officers of the Chicago Police Department contacted me several times during July and August about the crime, as far as I am aware they have made no arrests. In the event that arrests are made, I would be glad to cooperate in appropriate proceedings.

Please note that on September 30, 2007, I moved from xxxxx, Chicago, Illinois to xxxxx, Chicago, Illinois. Most of the enclosed supporting documents show the xxxxx address, as I was living there at the time.

If you have any questions, please do not hesitate to call me at (312) xxx-xxxx. I would be glad to provide you with any additional information or documentation you might need. I look forward to your response.

Yours truly,

weiss

Encls.
posted by weiss @ 10:51 PM