Sample "BuyBack" Letter for Refunding Lost Time

I've just received a form from an insurance company asking for information about an employee's lost wages due to absence for an auto accident.

They ask if our office participates in a "BuyBack Plan" and ask for a letter so stating. I assume they are just asking if we will reinstate sick or personal time to an employee if we receive evidence that the employee was paid for the time .. or something like that.

Does anyone have a sample letter they can share?

Thanks.

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