August 11, 2017


“Adjuster Name”

123 lala Avenue

Los Angeles, CA 90010

  1. (XXX) XXX. XXXX

HINT: Having all of the insurance companies info; i.e. address, adjuster name, etc lets them know that you are organized and on top of things! Also, it lets them know that you know where to serve a lawsuit if need be. 

SENT VIA FACSIMILE TO (xxx) xxx-xxxx

RE:                  Your Insured:                                   David Doe                             

           Claimant:                               Johnny Appleseed

           Claim Number:                     XXX-XXXXXX

           Date of loss:                           September 1, 2016

           Settlement Demand:             $25,000.00

           Expiration of Demand:        September 11, 2017 by 5:00 PM

SUBJECT:      Settlement Offer: All Rights Reserved Pursuant to Evidence Code Sections 1152 and 1154

Dear (“adjuster name”) and “XYZ Insurance Company”,

This letter shall serve as a representation of damages I sustained after your insured crashed into me at a high rate of speed on September 1, 2016. (insert date of accident here).


HINT: Writing a small paragraph regarding liability will help the insurance company remember that the accident is 100% their insured’s fault and that they are liable for your injuries and damages and you must be compensated for your loss.

No issue of liability surfaces in this matter: On, (insert date of accident) your insured ran a red light and T-boned me as I was lawfully traveling through the intersection at Apple and Cherry Avenue in Los Angeles California . The impact caused thousands of dollars in property damage and injuries to my person and psyche.

HINT: Always put the accident location so the insurance company and adjuster know you’re familiar with the area and so they can locate it on a map it will almost always help your position with respect to liability.


HINT: A section including the injuries you sustained in the accident and a brief description of the doctors or hospitals you visited throughout treatment lets the insurance company and adjuster know that you were injured and required medical treatment. You will attach your medical bills/reports to the demand so you can prove your damages which the insurance company is required to pay by law.

Immediately after the accident I attempted to relieve my ailments via the use of home remedies such as Advil and Tylenol. Unfortunately these methods failed to substantially resolve my back, neck, and shoulder pain, and at this time, I decided to seek professional medical attention for my injuries.

HINT: This helps the insurance company see that you were actually injured. Additionally, if you didn’t feel any pain right after the crash (which is normal due to shock,) this helps the insurance company understand that you began feeling your injuries a week or 2 after the accident (extremely common in auto accidents).


On (insert date you first saw medical provider/doctor) I saw Dr. XYZ due my persistent complaints of pain throughout my body. Dr. XYZ examined me and told me that I sustained injuries to my neck, back, and shoulder in the crash. Dr. XYZ told me to return to his office 2-3 times per week until my pain is resolved.

HINT: Putting the doctors recommendation in your demand lets the insurance company or adjuster know that the doctor prescribed you a course of treatment and that you’re not going to the doctor for no reason or to attempt to build up your claim.

On (insert date you returned to Dr.) I returned to Dr. XYZ for treatment of my injuries and ongoing pain in my back, neck, and shoulders. At this time he examined me and found that I need an MRI to better evaluate the internal damage done to my spine in the crash.

HINT: If the doctor prescribes an MRI, make sure you get it. If you don’t the insurance adjuster may think you were uninjured because you didn’t follow the doctors recommendations.

California Imaging

On (date) I went to California Imaging to get an MRI of my cervical spine per Dr. XYZ’s orders. The MRI results are as follows:


  1. Example: Neck injury
  2. Example: Back injury
  3. Example: Shoulder injury

HINT: Listing your MRI results shows the adjuster that you were actually injured in this crash and that you’re not making anything up. If you have positive MRI findings, there is no better evidence to prove your injuries. If you have a large number of medical providers, make sure you list each and every one, and the length of time you treated with that Dr. or facility before moving on to the next section of your demand.  Your medical treatment is the most important part of your claim. Medical treatment is so important because it shows the insurance company that you were injured, and suffered real damages as a result. Your medical bills and records are the most important part of your claim, so make sure you don’t leave any bills/records out of your demand.


HINT: If you lost wages due to missing work for doctors appointments, make sure you document the hours missed along with proof of your income like a pay-stub or paycheck so you can list them at the end of your demand and prove your loss so you can eventually be compensated for it. All of the time you missed from work can be recovered in your settlement.

Make sure to write a little about your work history, length of employment, etc so that you can help the adjuster understand how frustrating, difficult, and inconvenient missing time from work has been.


HINT: This is arguably the most important section of your demand because it lists the amount of your medical bills, lost wages, etc. These items are commonly referred to as, “damages.”

Please see below for a list of damages I sustained as a direct and proximate result of the negligence of your insured.

HINT: Proximate is a word meaning “legal” and helps the adjuster understand they are required by law to pay for your damages

Dr. XYZ………………..……$5,000.00

California MRI………………$2,000.00

Physical Therapy…………….$5,000.00


Lost Wages………………….$1,000.00


TOTAL:                                 $15,500.00

HINT: Putting the total amount of damages helps the adjuster clearly see the costs you have incurred, and the value of your potential claim.


I suffered immensely as a result of the negligence of your insured. After consideration of my injuries and the medical treatment I have been through I believe $30,000.00 is a fair and reasonable sum to compensate me for my loss. Had your insured been paying attention and not ran the red light, I never would have been injured. With this in mind, please get back to me no later than September 11, 2017 by 5:00 PM to discuss.

Very truly yours,


Phone: (xxx) xxx-xxxx

HINT: You must make sure to give the adjuster a time-frame in which to respond to your demand or they will delay evaluating your claim. Always make sure to provide a deadline and a number that you are looking to settle your case for. Make sure not to ask for too much, but make sure you ask for more than you want to settle the claim for so there is room to negotiate.