Personal Injury Demand Letter Template

You can open the Personal Injury Demand Letter Template in multiple formats, including PDF, Word, and Google Docs.

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Sample

Personal Injury Demand Letter

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Examples

Personal Injury Demand Letter Template (1)
From:
[Your Name]
[Your Address]
[Your Phone Number]
[Your Email]
To:
[Insurance Company Name]
[Insurance Adjuster’s Name]
[Insurance Company Address]
Date:
[Date]
Claim Number:
[Your Claim Number]
Subject:
Demand for Compensation for Personal Injury
Introduction:
This letter serves as a formal demand for compensation due to injuries sustained on [Date of Incident] as a result of [Description of Incident].
Details of the Incident:
On [date], I was [describe how the accident happened, location, conditions, etc.]. As a result, I sustained the following injuries: [List injuries with details].
Medical Treatment:
Since the incident, I have received the following medical treatments: [List of treatments, healthcare providers, dates, and costs].
Impact on Life:
This incident has had significant adverse effects on my life including [describe limitations, pain, suffering, days missed from work, etc.].
Demand for Compensation:
Based on the documentation and medical evidence, I am formally requesting compensation in the amount of [Specify amount based on damages, medical expenses, lost wages, and pain and suffering].
Supporting Documentation:
Attached to this letter are copies of [list documents such as medical records, bills, photographs of injuries, and any relevant evidence].
Response Request:
I kindly request a response to this demand by [Specify a date, typically 30 days from the date of the letter]. Failure to respond within this time frame may compel me to consider further action.
Sincerely,
[Your Signature]
[Your Printed Name]
Personal Injury Demand Letter Template (2)
From:
[Your Name]
[Your Address]
[Your Phone Number]
[Your Email]
To:
[Insurance Company Name]
[Insurance Adjuster’s Name]
[Insurance Company Address]
Date:
[Date]
Claim Number:
[Your Claim Number]
Subject:
Demand for Compensation for Personal Injury
Overview of the Incident:
On [date], I was involved in [provide detailed account of the incident, including location and circumstances]. This resulted in personal injuries that have caused me [specify injuries].
Medical Evidence:
Following the incident, I consulted with healthcare professionals and underwent treatments including [list treatments and their costs].
Personal Impact:
Due to the injuries sustained, I have experienced [discuss lifestyle changes, emotional distress, and financial impacts].
Compensation Request:
Considering the impact of this incident on my life, I am formally requesting a total compensation of [Specify amount], which encompasses [breakdown of damages].
Attached Documentation:
Enclosed are the following documents for your review: [list attached documents].
Required Response:
Please provide your response to this demand by [Specify a date]. I look forward to resolving this matter amicably.
Sincerely,
[Your Signature]
[Your Printed Name]

Template Online

Format

Please complete the form below to create the Personal Injury Demand Letter Template. All fields must be filled out to ensure a clear and complete demand. We provide examples to guide you through each step.

Personal Injury Demand Letter Template

1. Claimant Information


2. Insurance Information



3. Accident Details

4. Description of Injuries

5. Medical Treatment

6. Lost Wages and Impact

7. Pain and Suffering

8. Total Demand Amount

9. Declaration and Signature


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WORD

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Printable

Personal Injury Demand Letter

Printable | Editable Form

PDF 1 PDF 2

Personal Injury Demand Letter Template