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What Should Be Included in a Demand to an Insurance Company for a Personal Injury Claim

Categories:Auto Accidents

The demand is a letter to an insurance company adjuster, accompanied by all supporting documents, summarizing the basis for a personal injury claim.  After you have determined the insurance coverages available and obtained all medical records and bills, you must set forth the reason why the insurance company should pay a reasonable amount to resolve the claim.  You must establish the elements of negligence: liability, causation, and damages.

Liability is established by showing the insurance company that their insured is solely, or primarily, at fault. You include a copy of the accident report and any witness statements about how the accident happened.  In most circumstances, the fact that a ticket was issued would not be admissible in court, but it can help convince an adjuster of fault.  A factual summary utilizing all of this evidence is helpful.

Next, you need to establish causation which means that this accident caused your injuries.  You need to provide a summary of medical treatment along with copies of all the medical records.  Note portions of the medical records where the doctor says that the accident caused these injuries.  If there have been previous injuries to the same area of the body, you need to note such and offer some proof or explanation that the prior injury had healed or did not interfere with daily life.  In addition to the medical records, you want to include photographs to the damage to each of the vehicle and pictures of your injuries taken right after treatment began.  Almost all cell phones have cameras so everyone should have taken good pictures of the damage to all vehicles involved while still at the scene. Pictures are literally worth a thousand words and go a long way in proving the severity of the impact.

Finally, you need to set forth your damages. This is done by assigning a dollar figure to various types of damage.  Such damages include past medical bills and probable future medical expenses, if any.  You need to include copies of all your medical bills to establish past medical damages.  You may also have the need for future medical care.  If so, you need to include the medical records where each doctor says you will need future care.  Some doctors also note the projected cost of that care in their notes. If not, then you have to provide some information to the adjuster what that future care will cost.  For example, how much does a one level cervical fusion and all follow-up therapy cost? If the future medical care is going to be life long, then you need to consider your age, your life expectancy and the annual cost of that ongoing care. You then determine how much this care will cost you for the rest of your life.

Another type of damage is the effect on your income.  If you missed any work or had to use sick or vacation time, you will need to note such and how much that cost you.  Another type of damage is the loss of future earning capacity.  This is more difficult to establish and may require a vocational expert.  The loss of future earning capacity may be as simple as figuring how much time you will miss from work for any future medical treatment.  It may also involve more significant issues such as job or vocation retraining or a reduced work life expectancy.  This means that although you may be able to work, the injury may prevent you from working all the years you planned to before retirement.

Finally, you come to what is commonly referred to as “pain and suffering”. This is an intangible but important part of your claim.  You need to explain how this injury has disrupted your life.  You can discuss the pain you experience; the little joys of life you no longer can do or have to do differently; and; the effect on your loved ones.  There is no limit to the effects an injury can have on someone. You need to make it personal to you.  The best way is by relaying an anecdote from your daily routine that shows how you deal with the pain.

I’ve always said, “it’s not about the truth, it’s about the proof”.  An insurance adjuster must be able to justify a settlement amount.  The purpose of the demand package is to provide that proof for that justification.  At the end of your letter, you note the dollar amount that you would want to settle the claim, however, ask for more than you would be willing to take to give yourself some room to negotiate.  The summary in the letter along with the medical records, medical bills and photographs offer the proof.  Good luck.

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