Here is a sample demand letter in a fairly simple claim:

Dear Adjuster,

On October 15, 2005, my 2001 Honda Civic was struck by your insured, Joe Smith’s 2002 Volkswagen Jetta, at the corner of Elm and Main in Silver City when Mr. Smith ran a stop sign. His car’s front end hit my driver’s side door and left fender causing $3,500 in property damage, paid by your company. My seatbelt was on. The police report shows Mr. Smith was at fault. He received a ticket for running the stop sign.

An ambulance took me to Town Hospital’s emergency room where I was x-rayed and examined. My injuries were severe bruises to my upper body, left arm and left hip, and soft tissue damage to my neck and back. I was released from the hospital after several hours and sent home with instructions to stay in bed for a few days, use ice, wear a neck brace, and take Vicodin for pain and Flexiril to relax my muscles.

I stayed home from my job as a teacher for one week. I had follow-up treatment with my family physician, Dr. Harvey Stein, six days later. He told me to continue icing three times a day, and referred me to a physical therapist for my neck and back. I saw Julie Lyons, RPT, for 4 weeks, twice a week, and then for 4 more weeks, once a week. I am still doing the stretching and strengthening exercises at home. I’ve gone back to see Dr. Stein twice and have another appointment with him next week. I still have quite a bit of pain in my neck and back.

My medical bills totaled $3,450 as follows (Copies of bills attached):

Ambulance: $650

Hospital E.R, x-rays, exam, neck brace: $490

Dr. Stein: $225

Julie Lyons, RPT: $1216

Prescriptions: Flexeril, Vicodin: $219

I have lost wages in the amount of $1000. (Documentation attached.)

As a result of the accident, I had to cancel reservations for a conference. The nonrefundable fee was $240. (Receipt attached.)

As a result of being hit by Mr. Smith’s car, I couldn’t take my children to school and back for a week. I hired someone to help with that for $75 (Receipt attached.) I also had to hire a cleaning person to take care of the house and I will continue to need someone as long as I have pain in my neck and back. So far, this has cost me $600. (Cancelled checks attached).

My special damages come to $5,365. My future damages may be another $1,500 for medical bills and house cleaning.

I have had considerable pain and suffering as a result of this accident and continue to suffer from neck and back pain. I demand settlement of my claim in the amount of $25,000. Please respond to this demand with an offer to settle within 15 days.

Thank you.

Sincerely,

For more information about auto insurance claims, check out the following articles:

Evaluating Your Own Car Insurance Claim

The Initial Steps in Settling Your Car Insurance Claim

Negotiating Your Car Insurance Settlement

Making a Demand or Waiting for an Offer

When the Adjuster’s Settlement Offer is Too Low

When Your Car Insurance Claim is Denied

The Medical Authorization Form: What it is and Why You Got One

Check out our Free Advice website if you would like to learn more about auto accidents and the law.