Letter of Authority

Copy and Paste the below Letter of Authority and install on company letterhead, date and
sign and fax to Questar.

Date

Questar Recovery Group
10592-A Fuqua
Suite 285
Houston, Texas 77089

Subject:        Letter of Authority


To Whom It May Concern,

This letter is to authorize Questar Recovery Group (QRG) to consult with employees and
associates of our worker’s compensation carrier, insurance agent and NCCI for the
purpose of providing information regarding any and all aspects of our worker’s'
compensation policies including but not limited to loss run reports, physical audits and
NCCI modification reports pertaining to our company.

We appreciate your cooperation with QRG in this important matter.

QRG does not sell insurance.

Sincerely,


Your Name
Your Title

Questar Recovery Group   10592-A Fuqua Ste.285 Houston, Texas 77089
Phone: 281-993-5332  Fax: 281-754-4738

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