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Insurance Demand Letter
This is a template letter to demand settlement from an insurance company. While every situation is unique, you can use this blank form to tailor a letter based on your circumstances requiring an insurance settlement.

Free Sample Template
Format: Word PDF
# of Pages: 2
Printable: Yes

Insurance Demand Letter TemplateForm 3157
Format: Word PDF
Category: Legal, Statement
Type: Letter

Insurance Settlement Demand Letter

[Your Name]

[Address]

[City, State, Zip]

[Date of letter]

[Recipientís Name]

[Title]

[Company Name]

[Address]

[City, State, Zip]

Re: Your Insured, Name: __________________________

Claimant: ______________________________________

Claim Number: __________________________________

Date of Loss: ___/___/_____

Dear [Recipientís name],

I am writing to you today per our phone conversation on ___/___/_____. I was severely injured while riding my bike on the North Mill Bend Road bike path when your insured rode out of his designated bike lane and crashed head on into my bike going at a high rate of speed. There was no time for me to alter my course.

The direct impact threw me flying off my bike and onto the pavement. I was knocked unconscious and scraped up. The Paramedics arrived shortly after the bike accident occurred and rushed me to St. Lukeís Emergency Room. In the ER it was determined that I had a broken arm and a concussion.

My left arm was placed in a cast and I was ordered to remain in bed for five days. Sleeping has been very difficult due to a constant pain in my head. I was also ordered to see my regular physician every other day for the first week to be closely monitored for my injuries from the bike accident.

I missed two weeks of work during this recovery process and when I did return to work my days were not productive at all due to the lingering pain that I am experiencing.

My medical expenses are the following:

Ambulance: $5,000

Emergency Room: $20,000

MRI: $7,000

Cast: $2,500

Medications: $900

Total: $35,400




Please find enclosed a letter from my employer that confirms the days that I missed work and also a letter that documents that I have lost $14,500 in lost wages.

I am demanding compensation for my injuries and general damages in the amount of $75,000. This accident was a complete act of negligence on the part of your insured client and I have gone through a great deal of pain and suffering.

I am looking forward to hearing from you promptly regarding this urgent situation, no more than seven days from the date of this letter.

Best regards,

[Your Signature]