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Letter of injury sample
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A demand letter is the first major step in negotiating a personal injury claim, and is the central document in the claim itself. All negotiations of a settlement revolve .

September 27, 2017


H. Smith

Claims Examiner 

Sedgwick CMS

PO Box 14520

Lexington, KY 40512

RE: John and Jane Doe

Your Insured:PL Transportation, Inc. 


Claim #:B66


Dear H. Smith:

As you are aware, our firm represents John and Jane Doe for an accident involving your insured on June 16, 2016. This letter is being sent to you pursuant to O.C.G.A. § 51-12-14 and is in the nature of a demand for purposes of settlement and compromise only. It shall not be admissible for any purpose in the event that we are unable to resolve the case. 


John Doe is a 55 year old Georgia resident who works for Goodwill Industries, and his wife Jane Doe is 49 years old and works for Medicine Wheel Clinic. John suffered a neck injury and an aggravation of low back pain as well as multiple new disc buldges in his lower back. His medical bills exceed $11,000.00. Jane suffered a jaw contusion and her medical bills are in excess of $3,000.00


On June 16, 2016, John and Jane were passengers on a bus on their way to a canoeing trip. They were traveling on GA 8 east of the Madison County Line, attempting to make a left hand turn into a private drive when your insured came up too fast behind them and was unable to stop and veered out of his lane, striking the van as it turned left. Your insured was following too closely and traveling too fast for conditions when the accident occurred. 


Your insured was found to be at-fault for following too closely and negligently caused the collision. He forfeited his bond and paid the citation, meaning he admitted fault and is negligent per se. Liability will not be an issue in this case. The only issue for the jury will be the value of their injuries.


Following the collision, both John and Jane had complaints of injury, but declined medical transport to the hospital. The following morning, they both awoke in pain and sought treatment at Athens Regional Medical Center. They reported being on a bus when the collision occurred, Jane fell to the ground and John fell on top of her.

Jane Doe:

Jane advised the nurses that she had severe jaw pain and believes her husband’s elbow or head must have hit her jaw when they were thrown out of their seats. She also reported tenderness and stiffness in her neck. A CT Scan of her jaw was taken to ensure she had no fractures. She was diagnosed with a jaw contusion and discharged from the hospital. 

John Doe:

John reported he was having neck pain and severe lower back spasms. He advised the triage that he had a history of low back pain but had been pain free for several months after a lumbar facet injection. Following the accident, he began experiencing low back pain again as well as spasms. An x-ray of his lumbar spine was taken, and he was discharged with a neck sprain/strain and lumbar sprain/strain and advised to follow up with his doctor.

After discussing new and aggravated symptoms with his primary care doctor, an MRI of his lumbar spine was ordered and he underwent the MRI at Kaiser Permanente on August 27, 2016. As shown in the MRI report as well as his medical records, the August 27, 2016 was compared to an MRI he had in 2014. The report and records make clear that a new injury producing edema in his L4-L5 facets and pedicles was seen in the August 27, 2016, which the doctors attributed to the accident and stated it was the “likely source of his pain.”

When his back pain did not subside, John sought treatment at Athens Spine Center. He was seen on October 6, 2017. John had previously been a patient at Athens Spine Center earlier in the year when he sought treatment for lower back pain radiating into his left hip which had persisted for several years prior with no precipitating event. He was treated with lumbar facet injections at the in March 2016, which had resolved his pain. He had no treatment or pain following that procedure until this collision occurred. The doctor reviewed his imaging and found no significant changes since his previous MRI in 2012, except an interval development of edema at L4-L5. John reported that he felt like there had been a significant set-back since the motor vehicle collision. On November 3, 2016, John underwent another set of lumbar facet injections. He reported relief lasting five or six days before the pain returned.

On December 8, 2016, John was seen at Polaris Spine for a surgical consult. After review of his MRI and an examination, no surgical intervention was recommended at this time; however, he was recommended medial branch blocks for greater pain relief than facet injections.

On January 30, 2017, John returned to Athens Spine Center. He reported that his back pain was interfering with his daily activities, including work, so his physician recommended a radiofrequency ablation (“RFA”). On March 9, 2017, John underwent an RFA on his lower back.

Unfortunately, John called his doctor on March 29, 2017 and reported increasing pain since the RFA. His doctor advised that they try an epidural injection and to call and schedule one. However, frustrated that the multiple invasive treatment options had failed thus far, John decided not to move forward with the epidural. Since March 2017, John’s back pain has steadily increased. In fact, he was moved to light duty at his job in the past few weeks.

Although John continues to experience significant pain in his lower back that will undoubtedly require additional treatment going forward, he would like to try to put this claim behind him before litigation if possible. However, should we need to proceed to litigation, John will certainly be at a point physically where additional treatment is needed in the coming months as litigation ensues.


Known Medical Liens:

There are no known medical liens. 

John and Jane’s medical bills were paid by health insurance. Worker’s Compensation, Medicare, and Medicaid are not involved at all.

Our clients have agreed to leave funds in the escrow account sufficient to cover all valid medical liens until such time as those claims can be negotiated and resolved. 


The clients are the injured parties and are over the age of 18 years old. 


Based on the serious nature of the injuries to our clients, our clients hereby demand as follows:

 John demands $25,000.00 in exchange for the execution of a mutually agreeable general release of your insured.

Jane demands $8,000.00 in exchange for the execution of a mutually agreeable general release of your insured.

This demand is made pursuant to O.C.G.A. § 51-12-14. My clients will be entitled to interest on the unliquidated damages if our offer is not accepted within 30 days of receipt of the demand. 

Please send a copy of this demand to your insured.

Enclosed please find medical records and bills in our possession, which evidence our clients’ claims. If you have any questions, please contact me.  


If you're making an injury-related insurance claim, at some point you're probably going You'll also find sample demand letters for different kinds of injury claims.

Personal Injury Demand Letter

letter of injury sample

by FreeAdvice staff

How to Write an Effective Car Insurance Demand Letter

by FreeAdvice staff

As you work with your insurance company after a car accident, it is important that you know how to communicate with a well written demand letter.  An effective insurance demand letter will be able to explain your accident, identify your injuries and treatment, value the cost of your damage and medical expenses, and point to reasons why the insurance company should pay.  When writing a demand letter after a car accident, take the time to research your insurance policy and review the sample letters at the bottom of this page that can be tailored to fit your injury claim.

What to Include in Car Insurance Demand Letter

Before you send your insurance company a written communication, you will need to know what you should include in the letter.  A successful demand letter will contain the following elements:

  • A clear explanation of the physical facts of the accident. Start with the “5 W’s”: Who, What, When, Where and Why; 
  •  A discussion of why the insured is at fault;
  • A detailed description of any injuries, along with proof, such as medical records, photos or correspondence from physicians;
  • Your medical expenses and any property damage or vehicle repair expenses, as documented by medical bills, insurance invoices and repair or replacement documentation. A description of other losses suffered, such as lost income, pain and suffering, missed vacations, trips or events (weddings, graduations, sales meetings, concerts, etc.);
  • A total dollar value for settlement, encompassing your economic (medical bills, property repair, lost wages, etc.) and non-economic (pain and suffering) damages. Make sure your demand is realistic; asking for outlandish amounts gives the impression you are looking for a windfall, not to be made whole. A well-reasoned and well-supported demand will be taken far more seriously than a demand for an excessive amount of money. 

Writing an insurance demand letter does not need to be complicated, but it does need to present your argument clearly.  You do not need to get into details that are not important, simply focus on the facts of the accident, the language of the insurance policy, and the value of your claim. 

NOTE:  It is possible to write and submit a demand letter without the assistance of an attorney.  If you feel like your insurance company has not treated you fairly, you can respond with a well written letter supported by evidence before getting a lawyer involved.

How to Write Your Insurance Demand Letter

The most important thing about writing a good insurance demand letter is keeping it short, sweet, and to the point.  You do not need to go into unnecessary detail, and instead should write clear and focused statements that cover the following elements of your claim:

  • Car accident fault:  Immediately and unequivocally indicate that the adjuster’s insured is at fault for your injuries and damages. Use police reports, accident photos, witness statements, and any other available evidence to hammer your point home. If the driving record of the at-fault driver is bad or shows a pattern of negligence, include it if you can. It could further legitimatize the value of your claim. 
  • Your injury information:  Explain your injuries and your treatment, and then provide documentation of your claims. Include medical records or correspondence from your treating physicians. The medical records should detail any disability-- partial or total—and the duration thereof, and whether the injuries may result in any long-term effects. If you are unable to perform certain functions, such as bathing or dressing, have the doctor include that in his/her report. If your physical problems persist such that your treatment is ongoing, make sure your medical records indicate as much, and offer to supplement your records as you continue to receive treatment. 
  • Your damages:  Attach a complete list of any and all losses and expenses; include any evidence (tangible or descriptive)that supports your claims of pain and suffering. When possible, provide proof of the expenses or losses.
  • Demand the full value:  Finish your letter with the total amount you are demanding the insurance company pay.  You can reference sections of your policy you believe are appropriate, but do not have to.  Keep your demand concise and be sure to include the full value of the claim.

When you have outlined the elements that you are planning on addressing in your insurance demand letter, take a few other style tips into consideration:

  • Use language to your advantage:  While you should not exaggerate your injuries or the accident, using phrases such as “the car slammed into me” rather than “the car hit me” can emphasize the seriousness of your accident. 
  • Give detail about your injuries and treatment:  Going into detail about the medication, diagnosis, and ongoing treatment needs reinforces how serious your injuries are.  Saying “I missed 4 days of work due to severe pain that prevented me from sleeping and performing my duties as a construction worker” is stronger than saying “I could not sleep and missed four days of work.” 
  • Support your demand letter with documentation:  Send copies of all bills, invoices and medical records. Keep the originals.   If your claim is strong, reasonable, and documented, the chances are high you will get the money owed to you.

If you feel like you are unable to write a letter you are confident with, or have a serious injury, you can review your case with an attorney prior to submitting a letter to the insurance company.

Sample Insurance Demand Letters 

Below are two sample demand letters that can be used to initiate the claims process. Revise or rewrite them to fit your situation.

Sample Car Accident Demand Letter for Minor Injuries

January 1, 2015

NoName Insurance Company

Mr. Joe Adjuster

12345 Any Street

Hometown, CA  91111                                                                                                                                                                  

Re: Terri T’Boned

Claim Number: 123-4567

Name of Insured: Mr. Henry HitMyCar

Date of Loss: December 21, 2014

Dear Mr. Adjuster:

On December 21, 2014, I was struck by your insured, Mr. Henry HitMyCar. Mr. HitMyCar negligently struck my 2010 Honda Accord at the corner of Oak Street and 14th Avenue in MyTown, CA, causing injuries to both my person and my car. Mr. HitMyCar, driving a red 2000 Toyota Camry, illegally turned right while at a red light, and crashed into my passenger side door. The enclosed police report confirms Mr. HitMyCar was at fault; he was cited for the accident. Please consider this correspondence a formal demand for settlement of the instant claim.

With regard to the damage to my car, I’ve attached photographs showing the damage. Repairs have totaled $1,500.00. I’ve attached a copy of the repair invoice for your file 

I sought treatment at MyTown Hospital’s emergency room immediately after the crash and was diagnosed with soft tissue damage to my neck and shoulder area. As a result of your insured’s negligence, I experienced severe head and neck pain for several days. Doctors prescribed Vicodin for my pain and ordered me to rest for the next few days.

As a result of my severe pain, I was unable to attend a Rolling Stones concert for which I had purchased tickets. I also canceled my non-refundable Sunday morning tee-time at Nice Resort Golf. 

My monetary losses stemming from your insured’s negligence are as follows: (All documentation attached.)

  • $1,500 in damage to my car
  • $500 for ER visit
  • $100 for prescription Vicodin
  • $250 for my Rolling Stones concert tickets
  • $85 cancellation fee at Nice Resort Golf 

In addition to the losses detailed above, I was in extreme pain for several days, and as such believe that I should be compensated in the amount of $565. Please consider this correspondence a formal demand for compensation in the amount of $3,000 for any and all losses caused by your insured’s negligence. I’d kindly ask that you respond to this demand—in writing—within 15 days. Failure to do so will result in the initiation of formal legal proceedings. Please feel free to contact me with any questions.

Best Regards,

Terri T’Boned

Documentation Attached:

FixMyCar Garage, Car Repair Estimate, December 23, 2014

MyTown Hospital ER, Invoice for Services, December 21, 2014

MyTown Pharmacy, Receipt for Vicodin Prescription, December 21, 2014

TicketMaestro Receipt for Rolling Stones Concert, December 22, 2014

MyCreditCard Statement, Cancellation Fee Charge of $85 from Nice Resort Golf

Sample Car Accident Demand Letter for Serious/Long Term Injuries

January 1, 2015

NoName Insurance Company

Mr. Joe Adjuster

12345 Any Street

Hometown, CA  91111                                                                                                                                                                  

Re: Joe HurtsAlot

Claim Number: 123-4567

Name of Insured: Ms. Jane RanARed

Date of Loss: December 21, 2014

Dear Mr. Adjuster:

On December 21, 2014, your insured, Ms. Jane RanARed, collided with my 2005 Toyota Camry at the corner of First and Main in OurTown, MA. Ms. RanARed, driving a 2001 Honda Civic, negligently ran a red light and crashed into the front, driver side of my car causing $2,000 in damage. The attached police report shows Ms. RanARed was at fault, and she received a ticket for the accident.

Immediately after the accident, I was taken by ambulance to OurTown Hospital’s emergency room where I was x-rayed and examined. My doctor determined that I suffered severe bruising to my upper body, right arm, and hip. I also suffered soft tissue damage to my neck and back. I was treated and released from the hospital, prescribed medication, including Vicodin, for pain, and instructed to stay in bed for a few days to allow my injuries to heal 

Over the course of the next five days, I was in severe pain. The pain was so severe that it not only prevented me from working my job as a grocery store manager, but also left me unable to sleep at night. After five days, I followed up with my physician, Dr. Friendly, who told me to continue icing my injuries and taking my prescription medication. Dr. Friendly prescribed physical therapy to assist my recovery. Thus far, I have worked with Bill BigLifter RPT for three sessions per week for two weeks. I’ve also been doing stretching and strengthening exercises at home.

My medical bills currently total $3,500, and are detailed as follows: (Copies of bills are attached. 

  • Ambulance: $650
  • Hospital E.R., x-rays, neck brace: $500
  • Dr. Friendly visits: $1000
  • Bill BigLifter RPT: $1250
  • Prescription Vicodin: $100

Due to my inability to work, I have lost wages in the amount of $1500. (Documentation is attached).

As a result of the damage to my car caused by your insured’s negligence, I was forced to rent a vehicle for one week at a cost of $500, in order to attend physical therapy. (See documentation attached.)

My total expenses, including property damage, medical bills, lost wages, and additional expenses resulting from your insured’s negligence, now stand at $7,500. I have also been subjected to considerable pain and suffering as a result of my neck and back pain, for which I believe I should be compensated in the amount of $5,500.00. Please let this correspondence serve as a formal demand for settlement of the instant claim in the amount of $13,000, inclusive of all expenditures and compensation for my pain and suffering. I’d kindly ask that you please respond to this demand, in writing, within 15 days. Should you fail to do so, I will be left with no choice but to initiate court proceedings against your insured. Please feel free to contact me with any questions.

Best Regards,

Joe HurtsAlot

Documentation Attached:

Copy of Police Report

Copy of Repair Estimate for Damaged Vehicle

Copy of Receipt for One Week Car Rental

OurTown Ambulance, Copy of Invoice for Services

OurTown Hospital ER, Copy of Invoice for Services

Dr. Friendly, Copy of Invoice for Services & Treatment

MyTown Pharmacy, Copy of Receipt for Vicodin Prescription, December 21, 2014

Bill Biglifter, RPT, Copy of Invoice for Services

Copies of Pay Stubs for Pay Periods Before and After Accident


Free Legal Advice – Get Informed

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Anatomy of a Personal Injury Demand Letter

letter of injury sample

If you are injured or have been caused some sort of harm that has resulted in requiring medical treatment, you may decide that you want to file a claim with an insurance company to pay for your damages. To do so, you need to write and send them a demand letter. This letter will be used as a point of reference during negotiations for liability and compensation. Here are tips to follow when writing a car accident demand letter to learn more about how they are used during the car accident claim negotiation and sample car accident demand letter templates to use.

What is a Demand Letter?

A demand letter is the central document in negotiating a car accident settlement. It explains:

  • what happened, including when the accident occurred and where,
  • how and why the other driver was at fault,
  • the injuries you suffered,
  • and what damages or compensation you believe you are due.

That letter, along with all the rest of your supporting documentation, makes your argument and gives you the basis for settlement negotiations. It must therefore be a strong document that contains many details, including:

  • Specific dollar amounts for the medical bills, vehicle repairs, and other expenses you’ve incurred as a result of the accident.
  • Lost wages from missing work and any other financial losses.
  • Other damages, like pain and suffer or ways in which your injuries have affected your personal life.

A demand letter is an important document. A well-crafted letter provides the foundation for negotiating a fair personal injury settlement. It is strongly recommended that you contact an experienced personal injury attorney before writing your auto-accident demand letter. Their legal expertise can give you a significantly higher chance to receive the fairest personal injury settlement.

Need Help? Get a Free Case Evaluation:

Leaving Room for Negotiations

This sample demand letter below details specific expenses. Be sure to attach copies of all bills and other supporting documentation to your own demand letter.

Notice that the total demand for damages is high in the sample below, even considering all of the medical, property damage, and lost wages mentioned. Shooting high with a demand letter is standard. It gives you the ability to negotiate down to an amount that is a fair settlement.

Sample Demand Letter for Car Accident*

The following sample demand letter for a car accident demand letter provides guidance on the level of detail a demand letter must contain. It also indicates the categories of information that should appear in any formal car accident demand letter.


[Your Name]

[Your Address]

[Your City, State, and Zip Code]

[The Date]

[Name of the Claims Adjuster]

[His or Her Job Title]

[Address of the Insurance Company]

[City, State, and Zip Code of the Insurance Company]

Re: Your Insured, [Name of the Defendant]

Claimant: [Your Full Legal Name]

Claim Number: [Assigned by the Insurance Company]

Date of Loss: [Date of the Car Accident]

Dear Mr./Ms. [Name of Claims Adjuster]

As I informed you via phone and letter on May 16, 2014, I was injured in a car accident with your insured, James Smith, on May 5, 2014, in Holtsville, Virginia. I was driving east on 52nd Street and entered the round-about at the intersection of 52nd Street and Meridian Road. I yielded before entering the round-about and allowed a yellow Mustang, driven by Mr. Mike Nikols to proceed before me, per the rules of the road. Your insured, James Smith, entered the round-about behind me, driving in excess of the speed limit, and rear ended my car.

The profound force of the impact causing my head and neck to snap forward and back three times, resulting in whiplash and long-term issues with migraine headaches due to a cracked disc. The impact also caused my seatbelt to lock up, causing two broken ribs on my lower right ribcage and severe bruising on my left shoulder, chest, and stomach.

Mike Nikols, the driver of the yellow Mustang, witnessed the entire incident and can attest to the fact that your insured, James Smith, failed to heed the speed limit and was driving erratically. Mr. Nikols formal statement is enclosed.

I was transported to the emergency room of County Hospital, at 502 North Meridian Street, Holtsville, Virginia, by ambulance immediately after the accident. The treating physician, Dr. Michaelson ordered [insert name of all tests] which showed I had a cracked disc in my neck. I was admitted to the hospital for observation, due to the neck injury and received [insert list of medications]. I was released the next day, May 6, 2014, at 2:00 p.m. Dr. Michaelson prescribed [insert list of medication] for the pain and I had to wear a neck brace and restrict my movements for six weeks while my injuries healed.

At the expiration of the six weeks, I began attending physical therapy at the Pain Management Clinic at 2103 North Meridian Street twice a week, as prescribed by my family practitioner, Dr. David Owens. These physical therapy sessions are ongoing and I am on restricted duty at work until at least October of 2014. Additionally, during the initial six weeks of recovery I was off work and received only a fraction of my standard weekly pay during this period of family medical leave.

While I was recovering from my injuries, I lost out on an incredible opportunity to couch my son’s little league team. The opportunity for this bonding experience will never present itself in the same way again, even if I am able to coach at some time in the future. This was his first season in little league and the invitation for me to coach was an incredible honor.

The expenses for my medical care, documented by the enclosed bills, are:

County Hospital’s Emergency Room: $924.00

Dr. Tina Reid, ER Doctor: $523.00

CAT Scan, X-Rays, Labwork: $2,322.00

County Hospital, Outpatient Stay: $7,610.42

Prescription Medications: $435.00

Dr. David Owens: $325.00

Physical Therapy to date: $3,000.00

TOTAL $15,139.42

During my six weeks of and short-term disability and family medical leave from work, I lost [insert dollar figure] in wages, as documented in the letter enclosed from the Personnel Department of my employer Backen, Statem, and Tomas.

Physical therapy is still required and moving forward I will be attending sessions at the Pain Management Clinic once a week. Each appointment costs $125.00, for a total projected cost of $1,250.00 for another 10 weeks of therapy.

Damage done to my vehicle in the accident on May 5, 2014 resulted in repair expenses in excess of $4,000.00. Invoices for repair work are attached here.

The negligence of your insured, James Smith, caused me severe pain and discomfort and limited mobility that has lasted more than three months and will continue to plague me for the foreseeable future. Ongoing struggles with depression and loss of sleep due to my injuries have stolen invaluable time from my personal life, my family, and my hobbies as well. The loss of the opportunity to couch my son’s first season of little league is a chance I will never get back.

As a result of the cumulative financial and personal losses your insured caused with his illegal and irresponsible actions, I demand compensation for my injuries, lost wages, and general damages in the amount of $52,000.00

I anticipate receiving your reply no longer than 30 days from the date of this letter.


[Your Signature]

[Your Name – printed]


*Getting Help with a Personal Injury Claim

The car accident demand letter is a very important document and must be well constructed in order for settlement negotiations to be favorable. The sample demand letter for a car accident provided here is only to illustrate methods and general structure. To compose a letter of your own, you may need assistance from an attorney. He or she can ensure your letter presents a strong argument and gives you the basis for successfully negotiation a fair settlement for your injuries.

A demand letter (often called a "settlement letter") is your best chance to Here's what a demand letter might look like in a sidewalk slip-and-fall injury claim.

Let Our Award Winning Attorneys Fight for You

letter of injury sample

Attorney Shefman on her Iron 883 Motorcycle

This is meant to be a tool for those folks who choose to represent themselves following a minor crash where they are seeking personal injury or bodily injury losses in the Texas Justice of the Peace Courts in an amount under $10,000. As Austin personal injury attorneys, we’ve noticed that often folks will choose not to hire an attorney, perhaps liability is clear they just need some help writing a letter to the insurance company. If you are not sure what to include, this sample letter will provide an idea of how to structure your letter and what to include. There are many ways to do this, this is a simple outline that we hope is useful and easy to follow. If for any reason you do need a motorcycle accident attorney or car accident injury attorney, make sure to contact Shefman Law. We fight, and we win.



Sample Demand Letter for Pro Per (Self Representation) where you are seeking $10,000 and under (Justice of the Peace Cases):


This is where you provide a short statement of who you are, your age, your occupation, (a snapshot of who you are in your own words).
Include a picture of yourself. Mention that this is an offer for early resolution of your claim.

Facts Establishing Liability

Write about the crash. Where you were coming from. What the other driver did just before the crash. What you did. How the crash occurred. Be careful not to get too specific about time and distances if you are uncertain and can’t be exact. Discuss the choices the other driver made when they hit you that make the incident the other party’s fault. Liability has either been established –If it has not been established by a police report or admission of party that hit you, then state why they are at fault, for example did they violate your right-of-way? Did they run a red light? Were they talking on the phone?

How do you know they are at fault? List your observations, the other driver, witness or passenger statements. Put all of that information in this section to establish your arguments why the other person is at fault. Whatever evidence you have to support your argument, include it as an attachment and reference it in this section. Any good car accident injury attorney will want this information as well in case you do end up seeking legal assistance.

If it is a violation of a right-of-way, or a failure to stop at a red light, speeding, inattention of the other driver (driving while distracted), not keeping a safe distance provide the code section for that law and copy that law into your paragraph. For instance, most of these code sections can be found through google, but you can also look directly at this site: http://www.statutes.legis.state.tx.us/Docs/TN/htm/TN.545.htm. Then state, the law “Sec. 545.152. VEHICLE TURNING LEFT. To turn left at an intersection or into an alley or private road or driveway, an operator shall yield the right-of-way to a vehicle that is approaching from the opposite direction and that is in the intersection or in such proximity to the intersection as to be an immediate hazard.” When Mr. Defendant Driver made the left hand turn directly into my lane of oncoming traffic, there was no time, reflexive or deliberate to avoid a collision. Therefore, Mr. Defendant Driver is liable for the resulting injuries.

(Include photos of crash or car)

Injuries Related to the Crash

What happened to you, immediate harms, treatment you received, physical losses, emotional losses (harms and losses) things you were unable to do. What were your pain scales 1-10 and list out in table format.

Provide a pain scale of 1-10 for the parts of your body injured immediately following the crash, three days after crash, one week, two weeks, three weeks, one month, etc.
1st Day 3d Day 1 Week 2 Weeks 3 Weeks 1 Month
Head: 3 5 4
Low Back:
Right Ankle:

For each treatment provider, list the date of treatment, the physician or therapist, then list what the record states in summary. Do this for each treatment date, and for each treatment provider.

Describe how these injuries affected your life and what setbacks, if any, the injuries caused you. List in as much detail with as many descriptor words as you can, what these injuries prevented you from doing and why. For instance, if you hurt your neck and were diagnosed with whiplash perhaps you could not drive for a period of several days. Maybe you are a new dad or mom and you could not lift your child? Describe what you were unable to do as a result of your pain.


These are the financial losses you have as a result of the crash. List every economic loss you have, this will include wages lost, medical costs, co-pays, ambulance bills, repair and replace costs of clothing you may have been wearing that was soiled or property damage. If you broke a watch for instance, provide the receipt and a photo. If you have no receipt or photo look it up on amazon and get the cost to repair and/or replace the watch. For your motorcycle, bike, or other vehicle, send the estimate to repair or replace with photos of the damage. Again, you’ll want to detail this information even if you wind up seeking the assistance of a motorcycle accident attorney or personal injury lawyer here in Austin.

For medical treatment, provide records for every item listed. Reference the record and bill and attach it to the letter in order it is mentioned in the letter or embed it into the demand with a readable snapsnot.

Treatment provider Cost of treatment
1. seton Hospital $1,100.00
2. CVS Pharmacy $17.00
3. Primary M.D. $135.00
Total: $1252.00


This section is a short recap of what happened, why liability is clear, why you are entitled to payment for reimbursement and also all of the harms and losses you suffered including lost wages, and emotional and physical pain both past and future. List your demand. Some people list demand amounts to include pain and suffering and emotional distress as a multiplier of the amount of bills they have. $1500 X2 or X3. This is a subjective number and only you know the value of your loss. If there is no egregious behavior involved and it is simple crash from simple negligence x 2 or x 3 is maybe a fair number. Remember you want to be reasonable so you can resolve the claim with the insurance company.

If writing the demand is unsuccessful you will have to pursue your claim in small claims or justice of the peace court.

Include as attachments or embedded in your document to be sent to the insurance adjuster for the defendant (not your insurance company) all documentary evidence, photos of your damaged property, your injuries, reports, bills, wage loss letter from your employer or a paycheck stub (insurance company will probably ask for a letter) etc.

Remember, you may want to give yourself time after you feel healed to make sure nothing else comes up as a result of the crash. Once you resolve the claim with the insurance company, you cannot reopen your case and ask for anything else. Your case will be resolved for all times. As Austin car accident injury lawyers, we recommend this to most clients.


WATCH THE VIDEO ON THEME: What To Include With Your Auto Injury Demand Letter

If you've been hit in a rear-end accident, use this sample correspondence as a guide in crafting your own demand letter to the insurance adjuster for the at-fault .

letter of injury sample
Written by JoJolar
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