After an injury, your demand letter will set the stage for settlement negotiations. After discussing how the accident happened and who may be to blame, you'll need to describe every negative consequence of the accident and how you have been affected -- your injuries, your pain and discomfort, lost income from time missed at work, and so on. Read on to learn more, and make sure to check out the sample demand letters included at the end.
In describing your injuries and treatments, do not be too shy. Emphasize your pain, the length and difficulty of your recovery, the negative effects of your injuries on your daily life, and any long-term or permanent injury -- especially if it is disabling or disfiguring, such as permanent stiffness, soreness, or scarring.
Of course, do not make things up or be overly dramatic. Insurance adjusters are regular people, who are susceptible to the kid-who-cried-wolf phenomenon; they will simply turn a deaf ear to claims they believe are false. To support your claim of injury, pain, and disability, use the words that appear in medical records whenever possible. Choose “official” terms over conversational language; “narrowing of disk spacing” is stronger than “strained back.”
The easiest way to describe your injuries, treatment, recovery, and long-term or permanent effects is to go step-by-step chronologically. Proceed from how the injury occurred, to your pain and what you did about it immediately after the accident, through all the medical examinations, diagnoses, and treatments you received, through all the stages of your pain and disability during recovery. End with any long-term or permanent effects.
Most of what you recover for your injuries is compensation for pain, discomfort, and disruption in your daily life. But sometimes you suffer extra or unusual discomforts, embarrassments, inconveniences, or losses. Review your notes to remind yourself of the kinds of things you went through, or had to miss or give up, because of your injuries. Mention them in your demand letter, and do not be shy about saying how important those things are to you.
Immediately following your description of all your medical treatments, include in the demand letter a list of each medical provider who treated you and the total amount charged by each. If you were treated by an HMO or other prepaid plan, list the charges it provided you with in place of actual bills. List all medical costs, regardless of whether you paid them, your insurance or your employer’s insurance paid them, or they were part of a health plan. Make sure the list matches your medical billing records, copies of which you will be sending to the insurance company along with the demand letter.
If you were in a vehicle accident and your no-fault insurance coverage requires you to meet an expense threshold, include in your demand letter a list of your medical expenses along with copies of the bills. This means you are notifying the insurance company of your right to pursue your claim against its insured.
Make a brief statement of the amount of time you missed from work because of your injuries, and refer to whatever letter you have from your employer verifying your pay and missed time. Then multiply the time missed by your rate of pay to get a total figure for lost income. You do not have to explain why you were unable to work. If the insurance company wishes to challenge your claim that you were unable to work, it will do so during negotiations.
Don’t try to convince the insurer in your demand letter that your injuries made you miss work. Lobbying too strongly may signal that this is a subject for disagreement and negotiation. And you do not have to discuss whether you took sick leave, vacation time, or unpaid time off. The time you missed and the amount you are normally paid are the only things that matter.
If you are irregularly employed or self-employed, explain how you arrived at the total figure for lost income. Your income is impossible to predict exactly, so you do not have to claim that the figure you give is exact. Just explain what basis you used for figuring your rate of income -- a weekly amount based on your previous year’s income as shown on your tax return, for example, or a monthly amount based on the months immediately preceding the accident -- and refer to whatever documents you have to back up that income and your missed work.
If the insurance company wants to dispute your figures or the method you used, let it bring up the matter during negotiations. Don’t worry about convincing the insurer in your demand letter that the method you are using is the best or only method possible.
Along with your demand letter, send the insurance company copies of documents, records, letters, bills, and other proof of things you describe in your letter. Keep the originals for your own files. Although no one’s claim has all of the documents listed below, use the following list to remind yourself of the documents you do have that might support your claim. When you send these documents along with your demand letter, arrange them in the same order in which you refer to them to in the letter.
Supporting documents to enclose with your demand letter might include:
The more documentation you have to support your claim, the better positioned you'll be to negotiate your injury settlement.
See our page of example demand letters to get a sense of what they look like, what to include, and why.
This article is an excerpt from the book, How to Win Your Personal Injury Claim, by Attorney Joseph Matthews (Nolo).