Sample Personal Injury Demand Letter for a Rear-end Collision

Just as injuries are unique to every victim, so are the facts of each injury claim. The sample demand letter below is meant to serve as a general guideline to help you construct your own demand letter. Click on the buttons to better understand the wording and to get insight into settlement negotiations.

Learn more about rear-end accident claims here.

Rear-end Collision Demand Letter Example

August 12, 2014

Lostcause Insurance Company
Mr. Goa Wae
Claims Adjuster
123 Street - Suite A
Houston, TX 52411


Claim Number:
Your Insured:
Claimant DOB:
Date of Loss:

I. Wasatfalt
Nicholas Hoffman


Hint ±
Beginning your demand letter with the phrase "For Settlement Purposes Only" sets an expectation of confidentiality. To facilitate settlements, most judges have a policy protecting the confidentiality of claim negotiations between the insurance company and the victim.

Judges know if information discussed during settlement negotiations could later be used in trial, it would stifle a free and open dialogue. The insurance company or victim might decide not to show their hand during negotiations, for fear of having what they say used against them later if the claim ends up in court.

Dear Mr. Wae:

Hint ±
This is where you'll give a brief description of the events leading to your injury and summarize your claim. You'll have a chance to set out the details in the next section.

As you are aware, I am currently not represented by an attorney. I am writing this letter in good faith, in hope of settling this matter amicably and without the need for litigation.

Hint ±
This sets the stage for the rest of the letter. It lets the adjuster know you are serious about trying to settle your claim, but if you reach an impasse, you won't hesitate to seek legal counsel.

I was seriously injured on July 10, 2014, at approximately 1:00 p.m., when your insured violently collided with the rear of my 2013 Honda accord. The collision occurred at the intersection of Maple Street and Orchard Road in Mineola, NY.

Hint ±
Using words like "violently" and "collided" is a more powerful way to express yourself. Avoid using the word "accident," it implies no one was at fault.

The collision resulted in a serious injury to the upper portion of my left arm. I was initially treated for my injuries at the Winthrop Hospital in Mineola, NY. I was later treated for my injuries at the Optimum Chiropractic Clinic in Garden City, NY.

I am seeking compensation for the damages I sustained in the collision. Those damages include my medical bills, lost wages, out-of-pocket expenses directly related to the injury, and my pain and suffering.

Hint ±
The word "damages" is frequently used in civil cases to describe a victim's losses. Damages can include medical and therapy bills, out-of-pocket expenses such as medications, bandages, crutches, travel costs to treatment, etc., lost wages while recovering, and the victim's pain and suffering.

At all times related to the collision, I was observant and driving in accordance with local motor vehicle laws.

Hint ±
This language highlights the fact there was no comparative negligence.

I want to make clear from the outset that I never asked for any of this to happen. Before July 10, 2014, I enjoyed a life free from physical pain and discomfort. On July 10th, however, all that changed. On that date my life was abruptly altered by your insured's negligence.

As a direct and proximate result of your insured's negligence, I was in serious pain and discomfort for four weeks. Pursuant to doctor's orders, I was unable to work during that time.

Hint ±
"Direct and proximate" is phrasing used to link the collision to the insured's negligence.


Hint ±
The factual summary sets out the details of the collision and the damages you sustained. It's important to give the facts without editorializing or embellishing. Avoid statements such as, "Your insured shouldn't be allowed to drive," or "The police must have been paid off," or similar unprofessional statements.

On July 10, 2014, at approximately 1:00 p.m., I was traveling north on Maple Street, returning to my workplace after having lunch at the Embers Restaurant in Mineola, NY. As I approached the intersection of Maple Street and Orchard Road, I slowed to a stop at a red traffic light. I was then suddenly and violently jolted back into my seat.

Your insured had failed to stop at the light and crashed into the rear of my Honda. As the force of the impact propelled me backward, my left arm was forced upward into the steering wheel. My left arm twisted unnaturally and I felt a sharp pain.

I immediately pulled over to the side of the road and your insured pulled in behind me. He asked if I was all right, and if I needed medical assistance. My adrenaline must still have been flowing, because while I was shaken and my left arm was aching, I didn't believe I needed to go to the hospital.

I called 911 to report the collision. The dispatcher asked if anyone was injured. When I replied "No" the dispatcher informed me the police only respond to collisions involving serious injuries.

The rear bumper of my Honda was dented. You insured's car appeared to have sustained little, if any damages. After the collision, I filed an accident report with the Nassau County Police Department. A copy is attached.

Hint ±
A police report showing the other driver was at fault can be the deciding factor in a personal injury claim. If the police weren't dispatched to the scene of your collision, you can file a report yourself with the local police department.

I awoke the next morning in substantially more pain and discomfort. My body was stiff and it ached. Moreover, my left arm was in acute pain. I took the day off from work so I could seek treatment from my physician, Dr. Fealbeter. After a thorough examination, Dr. Fealbeter sent me to Winthrop Hospital in Mineola, NY. He ordered X-Rays and an MRI examination.

The next day, July 12, 2014, I returned to Dr. Fealbeter's office. He informed me the MRI indicated a serious strain to the ligaments in my left arm. Dr. Fealbeter ordered physical therapy, stating it would expedite my recovery. Between treatment sessions, I was ordered to keep my left arm immobilized in a sling.

On July 13, 2014 my wife Amy drove me to the Optimum Chiropractic Clinic in Garden City, where I was examined and treated by Dr. Charles Procter. Following his direction, I received therapeutic care including electrical stimulation, massage, and stretching exercises. I saw Dr. Procter three times a week for four weeks. During that time, I continued to endure substantial pain and discomfort.

At the time of the collision, I was employed by the Nassau County Humane Shelter bathing and grooming dogs. My injury made it impossible for me to work during my treatment. Because my injury was not work-related, I could not receive workers' compensation benefits. I had no income during the time I was unable to work. I had to borrow money from friends and family to merely survive.


I was initially treated for my injuries at the office of Dr. John Fealbeter. He was concerned about the possibility of a hairline fracture in my left arm, so he sent me to Winthrop Hospital where my arm was X-rayed and an MRI was conducted. While the diagnostics failed to indicate any fracture, the MRI did indicate a severe strain to the extensor flexor ligaments in the upper region of my left arm.

I subsequently received chiropractic therapy for my left arm at the office of Dr. Charles Procter at the Optimum Chiropractic Clinic in Garden City, NY. My four-week treatment included electrical stimulation, massage, and stretching exercises. Between sessions I was required to immobilize my left arm in a sling.

At all times during my medical and therapeutic treatment, I worked diligently to recover as quickly as possible and return to work. Following my doctor's orders, I returned to work on August 8, 2014.

Hint ±
This language makes it clear to the claims adjuster you were following the treatment program as ordered by your doctor. You weren't malingering or trying to unnecessarily prolong your treatment.


I am a twenty-four-year-old male. My past medical history is unremarkable. In 2011, I was treated for an inguinal hernia. In 1998, I was treated for a fractured left clavicle. I presently take Detrol LA 4 mg to treat a bladder malady.

Hint ±
It's important to let the adjuster know that at the time of the collision you weren't suffering from a pre-existing injury. If the adjuster can blur the line between a pre-existing injury and your current injury, your settlement offer will be substantially lowered.


At the time of the collision, I was employed by the Nassau County Humane Association. My job duties included dog grooming, dog bathing, cleaning dog cages, and general maintenance of the dog areas. Immediately prior to my employment with the Nassau County Humane Association, I was employed as a clerk with Petco in Wantaugh, NY. Prior to that, I was a student.


The following is a list of my medical bills and other financial losses related to the collision. I have attached copies of representative bills and invoices, and a letter from my employer detailing my lost wages.

Dr. John Fealbeter
Winthrop Hospital X-Rays and MRI
Optimum Chiropractic Clinic
Lost Wages
Out-of-Pocket Expenses


After careful consideration of liability and damages, and an in-depth review of standard settlements for injury cases with similar fact patterns, I am convinced a fair and reasonable settlement, inclusive of my pain and suffering, is $23,410.00.

Hint ±
For soft-tissue injuries like muscle and ligament strains and sprains, whiplash, minor burns, small puncture wounds, and other similar injuries, you can use a multiple of 2 to 5 times medical bills, plus expenses and lost wages, to come up with a total settlement demand. That settlement amount will include reimbursement for all your medical bills and other costs, plus an amount for your pain and suffering.

It's rare for an adjuster to agree to a first demand (if she does, your demand was probably too low). The initial demand is more of a starting point for further negotiations.

I look forward to hearing from you. Please contact me if you have any questions.


Nicholas Hoffman
3240 West Elm Rd.
Mineola, NY 12405

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