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Personal Injury Demand Letter Template (Free, With Full Sample)

Rich MartinBy Rich Martin, Personal Injury Trial AttorneyUpdated September 2026

A demand letter is the single document that sets the value of a personal injury case. Get the structure right and the adjuster reads your number as the logical conclusion of an argument you have already won. Get it wrong and every figure in the letter becomes negotiable.

Below is the structure we use for every third-party bodily injury demand: 14 core sections that appear in every letter, plus two optional sections that depend on the case. You will find a complete sample letter for a rear-end collision that you can read on this page, a Word template you can download, and a guide to the sections that make or break the letter.

Jump to the sample letter

This template is written for attorneys and paralegals at personal injury firms. It is not legal advice, and it does not replace jurisdiction-specific requirements (see the note on state rules below).

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Download the Word template

US Letter, 10 pages. What is inside:

  • All 14 core sections, in the order that keeps an adjuster reading
  • The 2 optional sections (Property Damage, Wage Loss) and the optional pre-existing conditions subsection, each marked with when to include it
  • A complete 16-section sample letter for a rear-end collision, with every table and figure shown
  • Bracketed placeholders [like this] for the letterhead, caption, signature and exhibits
  • Drafting notes for the paralegal doing the work

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Document architecture

The structure: 14 core sections + 2 optional

#SectionCore / OptionalWhat it does
01IntroductionCoreConfirms representation, states the purpose, invokes Rule 408, sets the 30-day window
02Accident InformationCoreDate, time, location, conditions, vehicles, sequence, police report
03LiabilityCoreWhy the insured is at fault, in one tight paragraph: admissions, citations, witnesses
04Property DamageOptionalVehicle damage to both cars, with photos and estimates. Include only when property was damaged
05Causation AnalysisCoreA. Mechanism of injury · B. Temporal causation · C. Pre-existing conditions (optional subsection) · D. Medical causation opinion
06Physical and Emotional Harm: Damages SummaryCoreDOB, specials total, date of first treatment, and every injury by body region in one block
07Summary of InjuriesCoreTable of each diagnosis with ICD-10 code and date first diagnosed
08Summary of TreatmentCoreTable of each provider, visit count, date range, and CPT-level description
09Medical TherapiesCoreThe treatment narrative, provider by provider, ending each with what did not resolve
10RadiologyCoreEvery imaging study with date, facility and verbatim impression
11Positive Orthopedic TestingCoreTable of every objective finding and the dates it was noted
12Duties Under DuressCoreTable of documented functional limitations by provider and date
13Special DamagesCoreItemized bills by provider, totaled
14Wage LossOptionalDocumented disability periods, daily rate, and total. Include only with employer documentation
15Pain and Suffering, Inconvenience and Loss of Enjoyment of LifeCoreThe non-economic argument, anchored to the jury instruction and the record
16Offer to SettleCoreThe demand figure or policy limits, the response window, and the litigation signal

A letter with neither optional section runs 14 sections; with both, 16. The pre-existing conditions subsection (5-C) is added inside Causation Analysis only when the claimant has prior injuries or degenerative findings in the same body region.

Why this order. Liability first, then the mechanism and medical causation, then the injuries and treatment in escalating objective detail, then the money, and only then the number. By the time the adjuster reaches the offer, every figure has already been supported by a table above it. For the reasoning behind the persuasive sequence, see The 14-Section Demand Letter Every PI Paralegal Should Know.

Specimen · synthetic case

Sample personal injury demand letter (rear-end collision, 16 sections)

Sample only. Every name, provider, report number and dollar figure below is fictional. This sample includes both optional sections and omits the pre-existing conditions subsection because the claimant has no relevant prior history.

[YOUR FIRM NAME]
[Street Address] · [City, State ZIP] · [Phone] · [Email]

[Date]

VIA CERTIFIED MAIL AND EMAIL

[Adjuster Name], Claims Adjuster
[Insurance Company]
[Street Address]
[City, State ZIP]

Re: Settlement Demand
Our Client / Claimant: Maria Elena Martinez
Your Insured: Kevin James Thornton
Claim Number: [Claim Number]
Policy Number: [Policy Number]
Date of Loss: September 12, 2025

FOR SETTLEMENT PURPOSES ONLY — PROTECTED BY EVIDENCE RULE 408 AND STATE EQUIVALENTS

Dear [Adjuster Name]:

Introduction

As you know, this firm represents Ms. Maria Elena Martinez regarding injuries and damages she suffered in a rear-end collision on September 12, 2025, at Wilshire Blvd and S. Robertson Blvd, Los Angeles, California, caused by your insured, Kevin James Thornton. The purpose of this letter is to attempt to reach an early settlement of Ms. Martinez's claims prior to litigation. As such, to the fullest extent allowed by law, this letter and all attachments are protected by Evidence Rule 408.

We believe we provide you here with all information necessary to properly evaluate this claim. If you believe additional information is needed, please advise me of this immediately to avoid delay. Once you have had an opportunity to review the enclosed materials, please contact me within 30 days of receipt of this offer to discuss settlement.

Accident Information

On September 12, 2025, at approximately 5:42 PM, Ms. Martinez was operating her 2022 Honda Civic westbound on Wilshire Boulevard and was completely stopped at a red signal at the intersection of S. Robertson Boulevard in Los Angeles, California. Conditions were clear, with dry pavement. Kevin James Thornton, traveling westbound on Wilshire Boulevard directly behind Ms. Martinez in a 2023 Ford F-150, failed to stop and struck the rear of her vehicle. No skid marks were observed at the scene. The collision pushed Ms. Martinez's vehicle approximately 12 feet forward into the intersection. Her vehicle sustained significant rear-end damage, including a displaced rear bumper, buckled trunk lid, and deformed rear quarter panels. Ms. Martinez was wearing her seatbelt and was transported from the scene by ambulance to Cedars-Sinai Medical Center. The collision was documented in California Highway Patrol Report No. LA-2025-0912-4478, prepared by Officer Daniel Reeves.

Liability

Kevin James Thornton is clearly at fault for this collision: he rear-ended Ms. Martinez's completely stopped vehicle while admittedly looking at his phone, received citations at the scene, and was determined by the California Highway Patrol to be the primary collision factor — a finding corroborated by two independent witnesses. If you disagree with this assessment, please advise us promptly.

Property DamageOptional section

Ms. Martinez's 2022 Honda Civic EX sustained significant structural rear-end damage as a direct result of the collision: the rear bumper was displaced, the trunk lid buckled, and both rear quarter panels were deformed. The at-fault party's 2023 Ford F-150 XLT also sustained moderate front-end damage to its bumper, hood, and grille, consistent with the force of the impact. Supporting documentation, including post-accident photographs and available damage records, is attached hereto.

Causation Analysis

A. Mechanism of Injury

The September 12, 2025 collision involved a direct rear-end impact to Ms. Martinez's completely stopped vehicle by a 2023 Ford F-150 traveling at an estimated 30–35 mph, with no braking prior to impact. Ms. Martinez reported immediate onset of neck pain, mid-back pain, headache, and bilateral shoulder stiffness upon impact, and was transported from the scene by ambulance.

B. Temporal Causation

Ms. Martinez's cervical and thoracic symptoms were first documented on the date of the collision itself — September 12, 2025 — when she presented to the Cedars-Sinai Medical Center Emergency Department with acute neck pain, mid-back pain, and bilateral shoulder stiffness, with clinical examination confirming significant bilateral paraspinal muscle spasm and markedly restricted cervical range of motion. Physical therapy commenced on September 18, 2025, and an MRI of the cervical spine obtained on October 1, 2025 revealed structural disc injuries at C4-C5 and C5-C6, with signal changes in the paravertebral musculature consistent with edema and strain — objective findings that corroborate the acute traumatic onset documented at the initial emergency visit.

Drafting note — optional subsection C. Pre-existing Conditions. Include only when the claimant has prior injuries, treatment, or degenerative findings in the same body region. State the prior condition plainly, cite the pre-collision records, establish the functional baseline before the date of loss, and argue aggravation. Hiding a prior condition is the fastest way to lose an adjuster's trust; framing it correctly turns it into an aggravation claim. Ms. Martinez has no relevant prior history, so this subsection is omitted. When omitted, relabel D as C.

D. Medical Causation Opinion

Dr. Robert Chen, the treating orthopedic spine specialist at Pacific Spine Institute, reviewed the October 1, 2025 MRI findings and opined that the cervical disc injuries at C4-C5 and C5-C6 are "most likely traumatic in origin" given Ms. Martinez's age and mechanism of injury. Dr. Chen further stated: "It is my medical opinion, within reasonable medical probability, that Ms. Martinez's cervical injuries are directly and causally related to the motor vehicle collision of September 12, 2025." Dr. Chen additionally noted that Ms. Martinez had reached approximately 85% of maximum medical improvement as of October 3, 2025, and that she may experience intermittent cervical pain and stiffness on a permanent basis, with future care potentially including periodic physical therapy, epidural steroid injections, and ergonomic accommodations.

Physical and Emotional Harm – Damages Summary

DOB: 04/15/1988
Gender: Female
Medical Specials: $16,681.50
Date of First Treatment: 09/12/2025

Injuries: CERVICAL & UPPER EXTREMITIES: Cervical sprain/whiplash with acute paraspinal muscle spasm bilaterally C3-C7 and severely restricted range of motion; post-traumatic cervicalgia; C4-C5 posterior disc protrusion (2.1mm) with annular fissure and mild bilateral foraminal narrowing; C5-C6 broad-based disc bulge (2.8mm) with superimposed left paracentral protrusion, annular tear with high-intensity zone, left foraminal narrowing, and mild cord flattening; C6-C7 minimal disc bulge; bilateral paravertebral muscle edema and strain (longus colli and multifidus); strain of right rotator cuff; bilateral trapezius spasm; permanent intermittent cervical pain and stiffness per treating orthopedic spine specialist | THORACIC & LUMBAR: Thoracic sprain with paraspinal tenderness T2-T6 | HEAD / NEURO: Post-traumatic headache | PSYCHOLOGICAL / EMOTIONAL: Anxiety associated with driving due to restricted cervical rotation | SYSTEMIC / FUNCTIONAL: Disrupted sleep (waking 2–3 times nightly due to neck pain); inability to exercise (previously ran 3x/week); reduced work capacity (limited to 4 hours/day from home); persistent low-grade neck stiffness with prolonged static postures; cervical ROM reduced to approximately 85% of normal at discharge from physical therapy, with incomplete recovery to pre-accident baseline

Summary of Injuries

Description / ICD-10 CodeFirst Diagnosis
Cervical Spine
S13.4XXA – Cervical sprain (whiplash), initial encounter09/12/2025
M54.2 – Cervicalgia09/12/2025
M50.221 – Cervical disc protrusion at C4-C5 (2.1mm posterior, annular fissure, mild bilateral foraminal narrowing, no cord compression)10/03/2025
M50.222 – Cervical disc displacement at C5-C6 (2.8mm broad-based bulge with left paracentral protrusion, left foraminal narrowing, mild cord flattening without signal change, annular tear with high-intensity zone)10/03/2025
M62.838 – Paravertebral muscle edema/strain, bilateral longus colli and multifidus (MRI signal changes)10/03/2025
Thoracic Spine
S23.3XXA – Thoracic sprain, initial encounter09/12/2025
Shoulder
S46.011A – Strain of right rotator cuff, initial encounter09/12/2025
Head / Neurological
R51.9 – Headache, post-traumatic09/12/2025

Summary of Treatment

ProviderNo. of TreatmentsDurationCPT Treatment / Description
Cedars-Sinai Medical Center1 visit09/12/2025Emergency department evaluation — cervical sprain (whiplash), thoracic sprain, cervicalgia, post-traumatic headache, right rotator cuff strain; cervical collar applied; medications prescribed (Naproxen, Cyclobenzaprine, Tramadol)
Pacific Coast Physical Therapy5 visits09/18/2025 – 10/02/2025Physical therapy — initial assessment; cervical mobilization; manual therapy; therapeutic exercise; cervical traction; ultrasound; e-stim; progressive resistance; McKenzie protocol; cervical stabilization exercises; thoracic mobility
Dr. Robert Chen1 visit10/03/2025Orthopedic spine consultation — review of cervical MRI findings (C4-C5, C5-C6 disc injuries); assessment and plan including continued physical therapy, consideration of epidural steroid injections at C5-C6, and surgical consultation criteria

Medical Therapies

On September 12, 2025, Ms. Martinez presented to Cedars-Sinai Medical Center for emergency evaluation following the rear-end collision. Examination revealed significant bilateral paraspinal muscle spasm from C3 through C7, thoracic paraspinal tenderness, and bilateral trapezius spasm, with cervical flexion reduced to 20 degrees and extension to 10 degrees. She was diagnosed with cervical sprain (whiplash), thoracic sprain, cervicalgia, post-traumatic headache, and right rotator cuff strain, and was discharged in a cervical collar with prescriptions for Naproxen, Cyclobenzaprine, and Tramadol. Despite emergency intervention and pharmacological management, Ms. Martinez's cervical pain and restricted range of motion persisted and required immediate referral for ongoing orthopedic care.

From September 18, 2025 through October 2, 2025, Ms. Martinez completed 5 visits of physical therapy at Pacific Coast Physical Therapy targeting her post-collision cervical and thoracic symptoms. Treatment progressed from initial assessment with gentle cervical mobilization, ice, and e-stim through manual therapy, cervical traction, therapeutic exercise, ultrasound, progressive resistance, McKenzie protocol, and cervical stabilization with thoracic mobility work. Despite 5 sessions of structured physical therapy, Ms. Martinez's cervical pain continued at 6/10 through her final visit, and her range of motion remained below normal limits, leaving her unable to return to full-time work or resume her prior exercise routine.

On October 3, 2025, Ms. Martinez was evaluated by Dr. Robert Chen, an orthopedic spine specialist, for persistent cervical and thoracic pain following the collision. Dr. Chen reviewed the cervical MRI findings, documenting structural disc injuries at C4-C5 and C5-C6 — including annular fissures and disc protrusions — along with signal changes in the bilateral longus colli and multifidus muscles consistent with edema and strain. He opined, within reasonable medical probability, that Ms. Martinez's cervical injuries are directly and causally related to the September 12, 2025 collision, and assessed her at approximately 85% of maximum medical improvement. Dr. Chen recommended continuation of physical therapy and noted that, if symptoms persist, epidural steroid injections at C5-C6 may be warranted, with surgical consultation reserved for neurological deterioration or failure of conservative measures. Despite the course of conservative treatment completed to that point, Ms. Martinez continued to experience cervical pain and functional limitations — including disrupted sleep and difficulty driving — that persisted and interfered with her ability to work full-time and perform daily activities.

Radiology

X-RAY — CERVICAL SPINE
09/12/2025 — Cedars-Sinai Radiology
Impression:

  1. Loss of normal cervical lordosis consistent with muscle spasm.

CT — HEAD/BRAIN (WITHOUT CONTRAST)
09/12/2025 — Cedars-Sinai Radiology
Impression:

  1. No acute intracranial pathology. No fracture.

MRI — CERVICAL SPINE
10/01/2025 — Beverly Advanced Imaging (ordered by Dr. Robert Chen, MD — Pacific Spine Institute)
Impression:

  1. C4-C5: Small posterior disc protrusion measuring 2.1mm. Mild bilateral foraminal narrowing. Annular fissure noted.
  2. C5-C6: Broad-based disc bulge measuring 2.8mm with superimposed left paracentral protrusion. Left foraminal narrowing. Mild cord flattening without signal change. Annular tear with high-intensity zone.
  3. C6-C7: Minimal disc bulge.
  4. Paravertebral musculature: Signal changes consistent with edema/strain in bilateral longus colli and multifidus muscles.

Positive Orthopedic Testing

Test / Objective FindingDates Noted
Annular Fissure — C4-C5 (MRI)10/01/25
Annular Tear with High-Intensity Zone — C5-C6 (MRI)10/01/25
Bilateral Foraminal Narrowing — C4-C5 (MRI)10/01/25
Bilateral Trapezius Spasm09/12/25
Cervical Paraspinal Muscle Spasm — Bilateral C3-C709/12/25
Decreased Cervical Extension (10 degrees; normal 60)09/12/25, 09/18/25
Decreased Cervical Flexion (20 degrees; normal 50)09/12/25, 09/18/25
Decreased Cervical Rotation — Bilateral (30 degrees)09/18/25
Disc Bulge — C5-C6, Broad-Based, 2.8mm with Left Paracentral Protrusion (MRI)10/01/25
Disc Protrusion — C4-C5, Posterior, 2.1mm (MRI)10/01/25
Left Foraminal Narrowing — C5-C6 (MRI)10/01/25
Loss of Normal Cervical Lordosis (X-Ray)09/12/25
Mild Cord Flattening — C5-C6 (MRI)10/01/25
Paravertebral Muscle Signal Changes — Bilateral Longus Colli and Multifidus (MRI)10/01/25
Tenderness to Palpation — Occipital Region09/12/25
Tenderness to Palpation — Thoracic Paraspinal (T2-T6)09/12/25

Duties Under Duress

Due to her injuries and ongoing pain symptoms, Ms. Martinez was forced to curtail many of her normal activities and experienced significant limitations in her daily living. Her bodily injury claim therefore includes a claim for performing duties under duress, and the following chart reflects those documented limitations.

ProviderDate(s)Limitations / Duties Under Duress
Cedars-Sinai Medical Center09/12/2025Limited cervical range of motion (flexion 20 degrees, extension 10 degrees); bilateral shoulder ROM restricted by pain; discharged in cervical collar
Pacific Coast Physical Therapy09/18/2025Severely limited cervical range of motion with flexion 20 degrees, extension 10 degrees, and rotation 30 degrees bilaterally; pain rated 8/10 interfering with functional activity
Dr. Robert Chen10/03/2025Limited ability to work full-time (reduced to 4 hours/day from home); sleep disruption with waking 2–3 times nightly due to neck pain; inability to exercise (previously ran 3 times per week); difficulty driving due to restricted neck rotation

Special Damages

Name of ProviderAmount
AMR Ambulance$1,847.00
Beverly Advanced Imaging$2,850.00
Cedars-Sinai MC — ED$4,107.00
Cedars-Sinai Pharmacy$127.50
Cedars-Sinai Radiology$2,105.00
Pacific Coast PT$4,500.00
Pacific Spine Institute$1,145.00
TOTAL:$16,681.50

Wage LossOptional section

Ms. Martinez sustained a documented, two-phase work disability directly attributable to the collision injuries. From September 12, 2025 through September 26, 2025 — a period of ten full work days — she was completely unable to perform her job duties. Beginning September 29, 2025, she transitioned to a partial-disability status, working only four hours per day through November 7, 2025, a span of thirty work days at fifty percent of her normal capacity. This phased disability is consistent with the orthopedic findings documented at her October 3, 2025 consultation and the functional restrictions noted in her physical therapy discharge summary, which limited her to desk work with mandatory breaks every forty-five minutes.

At a verified daily rate of $375.00, the ten days of full disability account for $3,750.00 in lost wages. The thirty days of partial disability — each representing a fifty-percent reduction in daily earning capacity — account for an additional $5,625.00. Ms. Martinez's total documented wage loss is $9,375.00.

This $9,375.00 figure reflects only the verified period of documented disability through November 7, 2025. As noted in the prognosis, Ms. Martinez had not yet reached maximum medical improvement as of her October 3, 2025 orthopedic evaluation, and her functional capacity remained restricted to half-day work from home. Should her recovery extend the period of partial disability beyond the dates currently documented, the wage loss figure will be supplemented accordingly.

Pain and Suffering, Inconvenience and Loss of Enjoyment of Life

Ms. Martinez is entitled to full and fair compensation for all pain, suffering, and inconvenience caused by the injuries in question. California law recognizes noneconomic damages including physical pain, mental suffering, loss of enjoyment of life, and inconvenience as separate and distinct elements of compensable damages. CACI No. 3905A instructs the jury to award reasonable compensation for physical pain, mental suffering, loss of enjoyment of life, disfigurement, physical impairment, inconvenience, grief, anxiety, humiliation, and emotional distress — both past and with reasonable probability to be experienced in the future. The California Supreme Court has held that there is no fixed standard for evaluating pain and suffering, and the determination rests with the good sense and judgment of the trier of fact. Beagle v. Vasold, 65 Cal.2d 166, 172 (1966).

The structural cervical disc injuries confirmed by MRI — and causally attributed to the collision by Dr. Robert Chen within reasonable medical probability — are not soft-tissue sprains that resolve with rest. They represent documented architectural damage to the cervical spine that has produced chronic pain and ongoing disability in Ms. Martinez's daily function. From the moment of impact, she experienced acute neck pain rated 8/10, with cervical range of motion so severely restricted that even basic head movement was compromised. Weeks of structured physical therapy produced incremental gains, yet pain persisted at 6/10 through her final therapy session and her range of motion remained below normal limits. Dr. Chen documented that Ms. Martinez had reached only approximately 85% of maximum medical improvement at the time of his evaluation — meaning a meaningful deficit in her physical baseline remained unresolved. The pain has disrupted her sleep, waking her two to three times nightly, and has made sustained physical activity impossible for a person who previously ran three times per week.

The emotional toll of these injuries is equally concrete. Ms. Martinez has experienced anxiety directly tied to her physical limitations — specifically, difficulty driving because restricted neck rotation prevents her from checking her mirrors with confidence. For someone whose professional responsibilities require her to function at full capacity, the collision reduced her to working only four hours per day from home. The combination of disrupted sleep, curtailed physical activity, and the daily reminder of physical limitation has imposed a sustained psychological burden that the record documents and that California law recognizes as fully compensable.

Dr. Chen's prognosis establishes that Ms. Martinez's ability to live a normal life has been compromised on an ongoing basis. He opined that she may experience intermittent cervical pain and stiffness on a permanent basis, particularly with prolonged static postures — the very postures demanded by desk work, driving, and the ordinary activities of daily life. Future medical care, including periodic physical therapy and potential epidural steroid injections, is expected to be required. The running she once relied on for physical and mental well-being, the uninterrupted sleep she no longer has, and the freedom to drive without anxiety — these are not abstract losses. They are the documented, day-to-day consequences of structural cervical injuries caused by this collision, and they form the foundation of a substantial noneconomic damages claim.

Offer to Settle

Obviously, we would like to resolve this claim without litigation if that is possible, but please be aware that we are committed to obtaining a just result. Given the seriousness of the crash and considering Ms. Martinez's injuries, she will accept $95,000 or policy limits to resolve her claim. We ask that you respond within the next 30 days.

Please be advised that the offer contained herein is for settlement purposes only and is not to be construed as operative in the event this case proceeds to litigation.

We will negotiate through [date] only, at which time our settlement offer will be revoked, and we will commence litigation without further notice to you.

Sincerely,

[Attorney Name]
[Your Firm Name]
[State Bar No.]

Enclosures:

Exhibit A — California Highway Patrol Report No. LA-2025-0912-4478
Exhibit B — Scene and vehicle photographs; property damage estimate
Exhibit C — Cedars-Sinai Medical Center records, radiology and billing
Exhibit D — Pacific Coast Physical Therapy records and billing
Exhibit E — Beverly Advanced Imaging MRI report and billing
Exhibit F — Pacific Spine Institute (Dr. Robert Chen) consultation and billing
Exhibit G — AMR Ambulance billing
Exhibit H — Employer wage verification

Word template · .docx

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The same 16 sections as the sample above, with bracketed placeholders and drafting notes, as a Word document.

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Drafting guide

How to write each section of a personal injury demand letter

The sample shows what a finished letter looks like. This guide explains what goes into each section, where in the medical records and claim file the content comes from, and the mistake that most often costs money in that section. Four sections carry most of the weight: liability, causation, special damages, and pain and suffering. Get those four right and the adjuster has very little room to discount the number.

1. Introduction

Confirm that the firm represents the claimant, identify the collision by date and location, name the insured, and state that the purpose of the letter is to settle the bodily injury claim before litigation. Invoke Evidence Rule 408 and the state equivalent so the letter cannot be used against the client later. Close with the response window, usually 30 days from receipt. Keep it to two short paragraphs. The introduction is not the place to argue; it is the place to tell the insurance adjuster what the document is and when they need to answer.

Source: retainer agreement, claim acknowledgment letter, police report for the date and location.
Common mistake: burying the deadline, or omitting the Rule 408 language.

2. Accident information

Tell the story of the crash in one paragraph, in chronological order, with specifics: time of day, direction of travel, road and weather conditions, both vehicles, the point of impact, how far the client's vehicle was pushed, whether the client was belted, and how the client left the scene. Cite the police report number and the reporting officer by name. The goal is a picture so concrete that the adjuster can see the collision before reading a word about fault.

Source: police or highway patrol report, client intake, scene photographs, witness statements.
Common mistake: vague language ("a serious collision occurred") where the police report gives exact facts.

3. Liability

State fault in one tight paragraph and stack the evidence: the insured's admission, the citation issued at the scene, the officer's primary collision factor finding, and independent witnesses. Where the facts support it, name the duty breached under the applicable vehicle code. End by inviting the adjuster to dispute liability promptly, which puts them on record if they later try to raise comparative fault.

Source: police report narrative and citation, recorded statements, witness contact sheet.
Common mistake: describing the accident again instead of arguing fault. Section 2 tells what happened; Section 3 says why the insured is responsible.

4. Property damage (optional)

Describe the damage to the client's vehicle and to the insured's vehicle, because damage to the striking vehicle corroborates the force of impact. Reference photographs, the repair estimate or total-loss valuation, and any airbag deployment. Include this section when there is property damage to document; omit it when the property claim was resolved separately and adds nothing to the injury argument.

Source: repair estimates, body shop photographs, property damage adjuster's valuation.
Common mistake: leaving out the insured's vehicle damage, which is often the best evidence against a "low-impact" defense.

5. Causation analysis

This section connects the collision to the diagnoses, and it is where insurance company software and adjusters look hardest for a reason to discount. Build it in three or four parts. Mechanism of injury explains how the physics of the impact produced the injuries claimed. Temporal causation shows that symptoms were documented on the date of loss and that treatment followed without gaps. Pre-existing conditions, when the client has prior injuries or degenerative findings in the same body region, states the baseline honestly and argues aggravation. Medical causation opinion quotes the treating physician's opinion that the injuries are related to the collision "within reasonable medical probability," along with the MMI status and prognosis.

Source: emergency department record for onset, first physical therapy evaluation, imaging reports, the treating specialist's consultation note.
Common mistake: hiding a prior condition. Adjusters have the claims history. A disclosed and well-argued aggravation claim survives; a concealed one collapses the whole letter.

6. Physical and emotional harm: damages summary

A one-block snapshot for the adjuster who skims: date of birth, gender, total medical specials, date of first treatment, and every injury grouped by body region, including functional and psychological effects. This block is what gets entered into claim evaluation software, so use precise diagnostic language and include measurements (disc protrusion size, range-of-motion deficits, pain scores).

Source: the diagnosis list from every provider, the specials total from Section 13.
Common mistake: listing only the headline injury and leaving out headaches, sleep disruption, driving anxiety, and reduced work capacity, each of which carries value.

7. Summary of injuries

A table of every diagnosis with its ICD-10 code and the date it was first documented, grouped by body region. Codes matter because they are what the adjuster's software reads. Include imaging-confirmed findings as separate rows with the measurement in the description.

Source: diagnosis codes on each provider's billing and clinical notes, radiology impressions.
Common mistake: copying codes from a superbill without checking them against the clinical note, which produces codes for conditions the physician never diagnosed.

8. Summary of treatment

A table of every provider with the number of visits, the date range, and a CPT-level description of what was done. This table proves the course of care was reasonable and continuous, and it lets the adjuster verify the specials against the treatment.

Source: billing ledgers and CPT codes from each provider, therapy attendance logs.
Common mistake: visit counts that do not match the bills. Reconcile the two before the letter goes out.

9. Medical therapies

The treatment narrative, provider by provider in chronological order. Each paragraph should state what was found, what was done, and what did not resolve, because the persistence of symptoms after each stage of care is what justifies the next stage and the non-economic damages. Quote objective measurements: degrees of flexion and extension, pain scores, prescriptions.

Source: clinical notes, discharge summaries, medication lists.
Common mistake: summarizing treatment as "the client attended physical therapy" without the findings that show why it was needed and what remained afterward.

10. Radiology

Reproduce the impression section of every imaging study verbatim, with the date, the facility, and the ordering physician. Include negative studies too: a normal head CT after a collision shows the emergency department took the mechanism seriously.

Source: radiology reports, not the referring physician's paraphrase.
Common mistake: paraphrasing the impression. The exact wording ("annular tear with high-intensity zone") is the evidence.

11. Positive orthopedic testing

A table of every objective finding, physical or imaging, with the dates it was noted, sorted so the adjuster can see the same finding recorded across multiple visits. Objective findings are what separate a documented injury from a soft-tissue complaint, and repeated findings across providers are the strongest form.

Source: physical examination sections of every clinical note, imaging impressions.
Common mistake: listing symptoms (pain, stiffness) as findings. Spasm on palpation, measured range-of-motion loss, and MRI findings are objective; the client's report of pain is not.

12. Duties under duress

A table showing, by provider and date, the activities the client had to perform despite documented limitations: working with restrictions, driving with reduced neck rotation, caring for children while in a cervical collar. This section converts the clinical record into daily-life impact and supports the inconvenience component of non-economic damages.

Source: work restrictions in clinical notes, therapy functional assessments, client's pain journal.
Common mistake: omitting the section for a client who kept working. Working through the injury is the duress; it is not evidence that the injury was minor.

13. Special damages

An itemized table of every medical bill by provider at the billed amount, totaled. Include ambulance, pharmacy, imaging and any out-of-pocket items. Whether to present billed or paid amounts depends on your state's collateral source rule; know the rule before choosing.

Source: itemized bills and ledgers from every provider, pharmacy printouts, client receipts.
Common mistake: a total that does not add up, or a provider listed in the treatment summary that is missing from the specials. Reconcile all three tables (7, 8 and 13) against each other.

14. Wage loss (optional)

Document each period of disability with dates, the client's verified daily or hourly rate, and the arithmetic. Distinguish full disability from partial (reduced hours or duties), and tie each period to a physician's restriction. Where the client has not reached MMI, say so and reserve the right to supplement. Omit the section when there is no employer documentation; an undocumented wage claim weakens the documented ones.

Source: employer wage verification, pay stubs, physician work restriction notes.
Common mistake: claiming lost wages for days the medical records do not support.

15. Pain and suffering, inconvenience and loss of enjoyment of life

Open with the legal standard: the pattern jury instruction for your state and the leading case on non-economic damages. Then argue from the record, not from adjectives. Use the numbers already established above (pain scores, range-of-motion deficits, MMI percentage), the specific activities the client lost, the emotional effects documented by providers, and the physician's prognosis for permanence and future care. Every sentence in this section should be traceable to something the adjuster has already read in Sections 6 through 12.

Source: everything above, plus the client's own account of daily life before and after.
Common mistake: generic language ("severe pain and suffering") that could describe any case. Specificity is what the adjuster cannot dismiss.

16. Offer to settle

State the demand in one sentence: a specific figure, or the policy limits when documented damages approach or exceed them. Restate the response window, say that the offer is for settlement purposes only, and set the date on which the offer is withdrawn and suit will be filed without further notice. The tone is firm and brief; the argument was made in the sections above.

Source: the damages summary, the insured's confirmed policy limits.
Common mistake: leaving the deadline open-ended, which removes the pressure the whole letter was built to create.

When to send it

Send once the client has reached maximum medical improvement or has a clear prognosis. The completeness of the medical picture, not the calendar, should drive timing, because every gap in documentation is a dollar the adjuster gets to keep. Where MMI has not been reached, say so and reserve the right to supplement, as the sample does in the wage loss section. Built by hand from a full medical file, the drafting itself is a 15-to-20-hour job; see How Long Does It Actually Take to Write a Demand Letter? for where those hours go.

A note on state-specific requirements

The sample above is written for California and cites CACI No. 3905A and Beagle v. Vasold. Replace those references with your state's pattern jury instruction and controlling authority on noneconomic damages. Several states also regulate time-limited or pre-suit demands in motor vehicle cases, and a demand that misses a statutory element may lose the bad-faith leverage it was meant to create. Georgia's O.C.G.A. § 9-11-67.1 is the best-known example. Before sending, confirm your jurisdiction's rules on required contents, response periods, and policy-limits demands.

Frequently asked questions

Follow the structure above: establish liability and causation first, document the injuries and treatment with objective findings, itemize every economic damage with the source bill, argue non-economic damages from the record, then state a single demand figure and a response deadline. Attach every record you rely on as an exhibit.

Fourteen core sections in every letter, plus two optional sections (property damage and wage loss) that depend on the case, for a total of 14 to 16. A claimant with prior injuries in the same body region also needs a pre-existing conditions subsection in the causation analysis.

The demand should be the conclusion of the damages sections, not a round number chosen first. Anchor high enough to leave negotiating room but close enough to a supportable valuation that the adjuster takes it seriously. When documented damages approach or exceed the insured's limits, demand policy limits, as the sample does.

As long as the case requires. The sample above runs about nine pages plus exhibits for a moderate cervical disc injury with three providers. Completeness of each section matters more than page count.

The insurance adjuster reviews the letter and exhibits, enters the injuries and specials into the carrier's evaluation software, and responds in one of three ways: an acceptance, a counteroffer, or a request for additional documentation. Negotiation follows, often through several rounds. If the insurer does not respond reasonably by the deadline, the demand is withdrawn and the next step is filing a lawsuit.

It varies by carrier and jurisdiction. A straightforward claim with clear liability and complete records tends to move within the response window the letter sets; claims with disputed liability, policy-limits issues, or incomplete medical documentation take longer, and some do not settle until after suit is filed. The single biggest factor a firm controls is sending a complete letter the first time, so the adjuster has nothing to request.

When documented damages approach or exceed the insured's bodily injury limits, yes. A policy-limits demand with a clear deadline and complete supporting records puts the carrier at risk of a bad-faith claim if it fails to tender, which is the strongest leverage a claimant has. Confirm the limits in writing first, and check whether your state imposes statutory requirements on time-limited demands before sending one.

Built by hand from a full medical file, 15 to 20 hours is typical: reading the records, ordering the chronology, coding the diagnoses, itemizing the specials, and drafting the narrative. Our article on how long a demand letter takes breaks the hours down by task.

No. It is a drafting resource for attorneys and their staff. Adapt it to your jurisdiction and your case, and have every letter reviewed by counsel before it is sent.

Keep going

The template gives you the structure. Your records give you the content.

Building 14 to 16 sections by hand from 300 pages of medical records is a 15-to-20-hour job. Lexyno reads the records, builds the injury, treatment and specials tables, and drafts the sections the case supports, with every fact linked back to its source page. You review, edit and send.

Lexyno is a Settlement Intelligence platform for personal injury law firms. It supports attorney review and decision-making but does not provide legal advice.

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