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Personal Injury Demand Letter Template
Clearly present your personal injury claim and settlement demand in a structured letter to the insurer or responsible party.
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Personal Injury Demand Letter Template
[Your Full Name]
[Street Address]
[City, State/Province, ZIP/Postal Code]
[Phone Number]
[Email Address]
[Date]
[Claims Adjuster Full Name]
[Insurance Company Name]
[Claims Department / Address Line 1]
[City, State/Province, ZIP/Postal Code]
Re: Personal Injury Claim – [Your Name]
Claim Number: [Claim Number]
Date of Loss: [MM/DD/YYYY]
Insured: [Name of Insured / At-Fault Party]
1. Introduction and Purpose of This Letter
Dear [Mr./Ms./Mx.] [Adjuster Last Name]:
This letter is my formal settlement demand arising from the personal injuries and damages I sustained in the incident that occurred on [Date of Incident] in [City, State/Province]. Based on the facts of the accident, my medical treatment, documented expenses, loss of income, and ongoing pain and suffering, I respectfully submit this demand for full and fair compensation.
2. Liability and Description of the Incident
On [Date of Incident] at approximately [Time] in [Location – street/intersection/business premises], I was [briefly describe what you were doing – e.g., “lawfully driving northbound on [Street],” “walking through the store aisle,” “working at my job site,” etc.].
The incident occurred as follows:
[Describe the actions of the at-fault party. For example: “Your insured failed to yield the right of way and struck my vehicle in the intersection,” or “The store failed to clean or warn about liquid on the floor.”]
[Explain how the impact or fall happened and how your body was affected.]
[Describe any immediate symptoms you felt at the scene.]
As a result of these actions and conditions, your insured/your insured’s premises caused the incident and my resulting injuries. To my knowledge, I did not engage in any negligent conduct that contributed to this event.
3. Injuries Sustained
Immediately after the incident, I experienced [briefly list initial symptoms – e.g., neck pain, back pain, headache, shoulder pain, knee pain, etc.].
The primary injuries diagnosed include:
[Injury 1 – e.g., “Cervical strain/whiplash”]
[Injury 2 – e.g., “Lumbar strain”]
[Injury 3 – e.g., “Right knee contusion and sprain”]
[Any fractures, tears, concussions, or other significant conditions]
These injuries have caused ongoing pain, limited movement, and disruption of my normal work, household activities, and daily life, as described below.
4. Medical Treatment Summary
Following the incident, I obtained medical care as summarized below:
[Date] – [Emergency Room / Urgent Care / Initial Clinic] at [Facility Name]. Evaluated for [symptoms]. [X-rays/CT/MRI/other tests] performed. Diagnosed with [diagnoses]. Prescribed [medications] and initial restrictions.
[Date range] – Follow-up visits with [Primary Care Provider / Specialist Name] for continuing symptoms in [body parts]. Recommended [rest, medications, physical therapy, referrals, etc.].
[Date range] – Physical therapy at [Clinic Name]. [Number] sessions focusing on [body parts, range-of-motion work, strengthening, manual therapy, etc.].
[Any injections, procedures, surgery, chiropractic care, counseling, or additional treatment.]
As of the date of this letter, my treatment status is: [e.g., “ongoing,” “released from active treatment but with residual symptoms,” “awaiting further evaluation,” etc.]. Copies of my medical records and bills are enclosed or will be provided upon request.
5. Medical Expenses (Special Damages – Medical)
To date, my known medical expenses related to this incident are as follows (billed amounts before any insurance adjustments):
[Provider / Facility Name] – $[Amount]
[Provider / Facility Name] – $[Amount]
[Physical Therapy / Rehabilitation] – $[Amount]
[Imaging / Diagnostic Tests] – $[Amount]
[Pharmacy / Medications] – $[Amount]
[Other Medical Expenses] – $[Amount]
Total Medical Expenses to Date: $[Total Medical Bills]
All available medical bills and statements supporting these amounts are enclosed or can be provided upon request.
6. Lost Income and Loss of Earning Capacity
Due to my injuries and related limitations, I have suffered a loss of income. In particular:
I was unable to work from [Start Date of Absence] to [End Date or “Ongoing”].
During this period, I missed approximately [Number] full workdays and [Number] partial workdays.
Before the incident, my average earnings were approximately $[Amount] per [hour/week/month].
Based on this information, my current documented loss of income is:
Total Lost Income to Date: $[Total Lost Wages]
[Optional paragraph:] My symptoms and restrictions may also affect my future earning capacity. I reserve the right to supplement this portion of my claim if additional information or documentation becomes available. Employer letters, pay stubs, and/or tax records supporting my wage loss are enclosed or available upon request.
7. Pain, Suffering, and Impact on Daily Life
Beyond medical bills and lost wages, this incident has significantly affected my quality of life. Since the date of the incident:
I experience ongoing pain in [body parts], often described as [sharp/aching/throbbing/burning]. On a 0–10 scale, my average daily pain is about [X], and at its worst can reach [Y].
Routine activities such as [sleeping, sitting, standing, walking, driving, housework, caring for family, etc.] are now difficult and often painful.
I have had to reduce or stop activities I previously enjoyed, including [sports, exercise, hobbies, social events, travel, etc.].
The injuries and limitations have caused emotional distress, including [anxiety, frustration, sadness, worry about my future health and finances, etc.].
These physical and emotional consequences are directly related to the incident and are supported by my treatment records and personal statements.
8. Other Out-of-Pocket Expenses
In addition to medical bills and lost income, I have incurred other reasonable and necessary expenses, including:
Transportation to and from medical appointments (mileage, rideshare, parking): $[Amount]
Medical devices or equipment (braces, splints, supports, etc.): $[Amount]
Over-the-counter medications and supplies: $[Amount]
Other documented costs (childcare, home help, etc.): $[Amount]
Total Other Injury-Related Expenses: $[Total Other Expenses]
9. Settlement Demand
Considering the clear liability of your insured, the nature and extent of my injuries, my medical treatment and expenses, my lost income, my pain and suffering, and other documented losses, I hereby demand the following amount in full and final settlement of my personal injury claim:
Total Settlement Demand: $[Demand Amount]
This demand is based on:
Medical expenses: $[Total Medical Bills]
Lost income: $[Total Lost Wages]
Other out-of-pocket expenses: $[Total Other Expenses]
Pain, suffering, and loss of enjoyment of life: $[Non-Economic Damages Component]
10. Response Deadline
Please provide a written response to this settlement demand within [30] days of the date of this letter. You may send your response to me at the address and email listed above, or to my legal representative, if any, at:
[Attorney Name / Law Firm]
[Street Address]
[City, State/Province, ZIP/Postal Code]
[Phone Number]
[Email Address]
11. Reservation of Rights
Nothing in this letter should be interpreted as a waiver of any rights or remedies I may have under applicable law. I reserve the right to supplement, amend, or revise this demand as additional information, medical records, or losses become known.
Sincerely,
[Your Signature]
[Your Printed Name]
12. Enclosures
Enclosures (check or list as applicable):
Medical records
Medical bills and statements
Proof of lost income (pay stubs, employer letter, tax records)
Receipts for out-of-pocket expenses
Photographs of injuries or property damage
Police or incident reports
Other supporting documents: [Describe]
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Personal Injury Demand Letter Template
PERSONAL INJURY DEMAND LETTER TEMPLATE FAQ
What is a personal injury demand letter?
A personal injury demand letter is a formal written letter sent to an insurance company or at-fault party that explains how an accident occurred, what injuries you suffered, what treatment you received, what your financial losses are, and how much money you are demanding to settle your claim. It is usually the starting point for settlement negotiations.
When should I send a personal injury demand letter?
Most people send a personal injury demand letter after they have completed most of their medical treatment or their doctor has explained their long-term condition. That way, you can include your known medical bills, lost income, and a clear description of your pain, suffering, and future limitations. You still need to be aware of any legal deadlines (statutes of limitation) that may apply in your jurisdiction.
What should I include in a personal injury settlement demand letter?
A strong personal injury demand letter typically includes: a brief description of the accident and why the other party is responsible (liability), a summary of your injuries and treatment, a breakdown of your medical bills and other expenses, an explanation of your lost income, a description of your pain, suffering, and life impact, a total settlement amount, and a deadline for response.
How detailed should a personal injury demand letter be?
It should be detailed enough to show that your claim is serious and well-documented, but still clear and organized. Use dates, names of providers, diagnosis terms from your records, and specific dollar amounts. Attach supporting documents such as medical records, bills, photos, and employer letters rather than trying to put every detail inside the body of the letter.
Does sending a personal injury demand letter guarantee payment?
No. A demand letter does not guarantee that the insurer or at-fault party will pay the full amount you request. The insurance company may accept your demand, deny the claim, or make a counter-offer. The letter is a negotiation tool and a record of your position, not a court judgment or binding agreement.
Can AI Lawyer help me prepare a personal injury demand letter?
Yes. AI Lawyer can help you organize your facts, medical history, and expense information into clear, structured language using this template. You must still provide accurate details and review the letter carefully before sending it. This template and any AI-generated content are for document organization only and are not legal advice — always consult a licensed attorney for guidance on your specific case.
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