Truck Accident Demand Letter Template
Date: [Date]
Sent Via: ☐ Email ☐ Certified Mail ☐ Online Portal ☐ Other: [Method]
Claim Number: [Claim # (if known)]
Policy Number: [Policy # (if known)]
To (Insurance Company / Claims Adjuster):
[Insurance Company Name]
Attn: [Adjuster Name / Claims Department]
[Address]
[Email/Phone]
From (Claimant): [Your Full Name]
Address: [Your Address]
Phone/Email: [Phone] / [Email]
Re: Demand for Settlement — Truck Accident on [Accident Date] at [Location]
Dear [Adjuster Name or “Claims Department”],
1. Injuries, Treatment, and Functional Impact
1.1 Injuries Reported: [List injuries in plain language].
1.2 Functional Impact: [Pain level pattern] and [sleep] and [driving] and [lifting] and [work limits].
1.3 Treatment Providers: [Provider] — [Dates] and [Provider] — [Dates].
1.4 Current Status: ☐ Fully recovered ☐ Improving ☐ Ongoing symptoms: [__].
1.5 Future Care (if known): [Follow-ups/therapy/imaging/referrals].
2. Accident Summary (Vehicle Movements - Impact Points - Aftermath)
2.1 Date/Time: [Date/Time].
2.2 Location: [Street/City/State].
2.3 Vehicle Movements: [Lane positions and direction and speeds].
2.4 Impact Points: [Primary impact location] and [secondary impacts if any].
2.5 Aftermath: [Vehicle rest positions] and [911] and [tow] and [initial medical evaluation].
2.6 Vehicles: My vehicle: [Year/Make/Model]; Commercial vehicle: [Year/Make/Model] unit/plate: [__].
3. Liability Basis
3.1 Liability Position: [Unsafe lane change/following too closely/failure to yield/speeding/other].
3.2 Evidence Referenced: [Police report ID] and [Photos/Video IDs] and [Witness information] and [Other].
4. Losses and Totals
4.1 Medical Expenses: $[Amount] (to date).
4.2 Wage Loss / Time Off Work: $[Amount] (dates missed: [__]).
4.3 Property Damage: $[Amount] (estimate/invoice reference: [__]).
4.4 Out-of-Pocket Costs: $[Amount] (receipt reference: [__]).
4.5 Total Documented Economic Losses (Estimate): $[Total].
5. Demand and Deadline
5.1 Demand Amount: $[Demand Amount].
5.2 Written Response Deadline: [Deadline Date (allow 10–20 business days)].
6. Payment, Release, and Enclosures
6.1 Payment Instructions: Payable to [Name(s)] and mailed to [Address] or other instructions: [__].
6.2 Release for Review: [Release language requested before payment].
6.3 Attachments: ☐ Police report ☐ Photos/videos ☐ Witness contact list ☐ Medical bills/records summary ☐ Wage verification ☐ Repair estimate/invoice ☐ Receipts ☐ Other: [List].
7. Evidence Checklist (Item - Source - File/ID - Status)
Evidence Item | Source | File/Report ID | Status | Notes |
Police report | [Agency] | [Report #] | [Requested/Received] | [__] |
Photos/video | [Phone/Dashcam/Other] | [File ID] | [Requested/Received] | [__] |
Medical records | [Provider] | [Record ID] | [Requested/Received] | [__] |
Wage verification | [Employer/Client] | [Doc ID] | [Requested/Received] | [__] |
Evidence Item | Source | File/Report ID | Status | Notes |
Police report | [Agency] | [Report #] | [Requested/Received] | [__] |
Photos/video | [Phone/Dashcam/Other] | [File ID] | [Requested/Received] | [__] |
Medical records | [Provider] | [Record ID] | [Requested/Received] | [__] |
Wage verification | [Employer/Client] | [Doc ID] | [Requested/Received] | [__] |
Evidence Item
Source
File/Report ID
Status
Notes
Police report
[Agency]
[Report #]
[Requested/Received]
[__]
Photos/video
[Phone/Dashcam/Other]
[File ID]
Medical records
[Provider]
[Record ID]
Wage verification
[Employer/Client]
[Doc ID]
8. Two-Step Injury Classification (Category - Subtype + Severity Scale)
8.1 Category: [Soft tissue/Neurologic/Orthopedic/Other].
8.2 Subtype: [Neck/Back/Shoulder/Headache/Other].
8.3 Severity Scale: [1–5] with Criteria: [Symptoms] and [treatment intensity] and [functional limits].
9. Treatment Provider Index
9.1 Provider 1: [Name/Facility] — [Address/Phone] — Dates: [__] — Records ID: [__].
9.2 Provider 2: [Name/Facility] — [Address/Phone] — Dates: [__] — Records ID: [__].
9.3 Pharmacy/Imaging (if applicable): [Name] — Dates: [__] — Reference: [__].
Sincerely,
[Your Full Name]
Signature: ___________________________
Printed Name: [Your Full Name]
Enclosures Confirmed By (Optional): ___________________________
Printed Name/Title: [Name/Title]
Evidence Item | Source | File/Report ID | Status | Notes |
Police report | [Agency] | [Report #] | [Requested/Received] | [__] |
Photos/video | [Phone/Dashcam/Other] | [File ID] | [Requested/Received] | [__] |
Medical records | [Provider] | [Record ID] | [Requested/Received] | [__] |
Wage verification | [Employer/Client] | [Doc ID] | [Requested/Received] | [__] |