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 Name] — Attn: [Adjuster Name / Claims Department]
[Address]
[Email/Phone]
From: [Your Full Name] — [Phone] — [Email]
Address: [Your Address]
Re: Demand for Settlement — Truck Accident on [Accident Date] at [Location]
Dear [Adjuster Name or “Claims Department”],
1. Settlement Demand and Requested Response
1.1 Demand Amount: $[Demand Amount] to settle this claim.
1.2 Response Requested: [Accept/counter/identify missing items] in writing.
1.3 Written Response Deadline: [Deadline Date (allow 10–20 business days)].
2. Liability and Supporting Evidence
2.1 Liability Position: [Unsafe lane change/following too closely/failure to yield/speeding/other].
2.2 Supporting Evidence: [Police report ID] and [Photos/Video IDs] and [Witness information] and [Other].
3. Accident Summary (Roadway Context - Sequence - Dynamics - After)
3.1 Roadway Context: [Lighting/weather/surface/traffic].
3.2 Sequence: [Short event sequence in 1–3 sentences].
3.3 Collision Dynamics: [Point of impact and direction and forces].
3.4 After: [Vehicle positions and emergency response and towing].
3.5 Date/Time and Location: [Accident Date/Time] at [Street/City/State].
3.6 Vehicles: My vehicle: [Year/Make/Model]; Commercial vehicle: [Year/Make/Model] unit/plate: [__].
4. Injuries and Medical Treatment
4.1 Injuries Reported: [List injuries in plain language].
4.2 Treatment Providers: [Provider] — [Dates] and [Provider] — [Dates].
4.3 Current Status: ☐ Fully recovered ☐ Improving ☐ Ongoing symptoms: [__].
4.4 Future Care (if known): [Follow-ups/therapy/imaging/referrals].
5. Damages and Documentation
5.1 Medical Expenses: $[Amount] (to date).
5.2 Wage Loss / Time Off Work: $[Amount] (dates missed: [__]).
5.3 Property Damage: $[Amount] (estimate/invoice reference: [__]).
5.4 Out-of-Pocket Costs: $[Amount] (receipt reference: [__]).
5.5 Total Documented Economic Losses (Estimate): $[Total].
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. Symptom and Functional Limitation Tracker
Date Range | Primary Symptom | Activity Affected | Trigger/Duration | Treatment Step | Notes |
[MM/DD–MM/DD] | [Symptom] | [Driving/Sleep/Work/Other] | [Trigger/Duration] | [PT/Medication/Other] | [__] |
[MM/DD–MM/DD] | [Symptom] | [Driving/Sleep/Work/Other] | [Trigger/Duration] | [PT/Medication/Other] | [__] |
Date Range | Primary Symptom | Activity Affected | Trigger/Duration | Treatment Step | Notes |
[MM/DD–MM/DD] | [Symptom] | [Driving/Sleep/Work/Other] | [Trigger/Duration] | [PT/Medication/Other] | [__] |
[MM/DD–MM/DD] | [Symptom] | [Driving/Sleep/Work/Other] | [Trigger/Duration] | [PT/Medication/Other] | [__] |
Date Range
Primary Symptom
Activity Affected
Trigger/Duration
Treatment Step
Notes
[MM/DD–MM/DD]
[Symptom]
[Driving/Sleep/Work/Other]
[Trigger/Duration]
[PT/Medication/Other]
[__]
8. Response Options and File Confirmation
8.1 If You Dispute Liability: [Identify disputed facts and supporting materials requested].
8.2 If You Dispute Damages: [Identify disputed categories and requested records].
8.3 Confirmation Requested: [Written acknowledgment of receipt and claim number].
9. Evidence Preservation Request
9.1 Preservation Requested For: [Video] and [inspection/maintenance records] and [communications] and [trip-related documents] and [other].
9.2 Collision Identifiers: [Accident Date] and [Location] and [Driver] and [Unit/Plate].
Sincerely,
[Your Full Name]
Signature: ___________________________
Printed Name: [Your Full Name]
Preferred Contact for Settlement Documents: [Name/Email/Phone]
Date Range | Primary Symptom | Activity Affected | Trigger/Duration | Treatment Step | Notes |
[MM/DD–MM/DD] | [Symptom] | [Driving/Sleep/Work/Other] | [Trigger/Duration] | [PT/Medication/Other] | [__] |
[MM/DD–MM/DD] | [Symptom] | [Driving/Sleep/Work/Other] | [Trigger/Duration] | [PT/Medication/Other] | [__] |
