Sample Settlement Demand Letter for a Restaurant Injury Claim

The facts of every injury claim are different. This demand letter example deals with a restaurant injury caused by employee negligence. It’s meant to serve as a guide to help you construct your own demand letter. Substitute your specific claim information where relevant.

Click on the buttons to better understand the reasoning behind the wording used, and the importance of each section in settlement negotiations.

Learn more about restaurant injury claims here.

Restaurant Injury Demand Letter Example

June 4, 2014

Doncair Insurance Company
Ms. Noa Peigh
Claims Adjuster
125 Charles Street, Suite A
Seattle, WA 98129


Claim Number:


Your Insured:

Danejur Food and Ale


Vicki Timm

Claimant DOB:


Date of Injury:



To facilitate out-of-court settlements, courts have traditionally protected the contents of pre-trial settlement negotiations. This means if your case goes to trial, what you say during negotiations can’t be used against you. Because a demand letter is considered part of pre-trial negotiations, judges typically disallow the content of these letters to be used in court.

While titling your demand letter with the words FOR SETTLEMENT PURPOSES ONLY isn’t a legal requirement, doing so makes clear your expectation of confidentiality.

Dear Ms. Peigh:

Here you will summarize the facts and applicable legal theory supporting your claim for damages.

Please let this letter serve as my formal demand for compensation in the above-referenced claim. As you are aware, I am currently not represented by an attorney. My continuing hope is to avoid litigation by bringing this matter to a prompt and amicable resolution.

This makes clear you have a good faith desire to settle your claim, but if it can’t be settled fairly, you won’t hesitate to consider legal action.

As you know, I was injured on May 28, 2014, when your insured’s employee dropped several plates on our table while attempting to serve us food. When the plates fell onto our table, two of them shattered. Some of the shattered pieces were projected into my face and neck, causing bruising and lacerations.

My husband notified the manager and then drove me to the emergency room for treatment. As a direct and proximate result of the employee’s negligence, I incurred medical bills, out-of-pocket expenses, lost wages, severe discomfort, anxiety, and pain and suffering.

Using the phrase “direct and proximate” shows the adjuster you understand the legal elements of negligence.

I want to make clear from the outset I never asked for any of this to happen. Since the injury I have not been able to eat at restaurants without fear the server will drop the plates and re-injure me.

I am a victim of your insured’s employee’s negligence. Under the legal doctrine of respondeat superior, your insured is liable for the negligent actions of an employee while the employee is acting within the scope of his or her employment. Clearly your insured’s server was acting within the scope of his employment at the time he injured me.

You don’t have to be a legal scholar, but it’s important to let the adjuster know you are aware of the legal doctrine making employers liable for the actions of their employees.


A factual summary is a review of the facts, not the place to discuss the seriousness of your injuries or the pain and discomfort you experienced. Nor is it the place to make statements that might be construed as whiny or immature. Remain professional at all times.

On May 28, 2014, at approximately 7:30 p.m., my husband Alex and I were dining at your insured’s restaurant at 2510 Maple Avenue in Spokane, WA. We both ordered onion soup, fried calamari, and iced tea. Several minutes later, employee John Swift brought our food to the table. As he was lowering our plates to the table, he dropped a bowl of onion soup and a plate of fried calamari on the table.

When the bowl and plate struck the table, they smashed into several pieces and I was struck by flying shards. The shards lacerated and bruised the right side of my neck and my right cheek. I began to bleed from both areas. My husband immediately came to my side of the table and applied several napkins to the injured areas. He also asked our server to have the manager come to our table.

Try to use graphic adjectives and adverbs to describe the events and your injuries. Make the description as real as possible.

Several moments later your insured’s manager, Susan Penn came to our table. She saw the blood underneath the napkins, as well as blood that had dripped onto my blouse. Ms. Penn apologized and asked if we wanted her to call an ambulance. We declined and left the restaurant. My husband immediately drove me to the hospital for treatment.


To properly treat my wounds and to see if the wounds required stitches, my husband Alex drove me to the Holyoke Hospital emergency room. I was still quite upset, anxious, and in great discomfort. After waiting almost an hour, we were able to see the emergency room doctor, Cynthia Rodriguez.

After looking at my wounds, she said I would not require stitches, but would need to keep the wounds clean and freshly bandaged. Doctor Rodriguez prescribed 800mg of Ibuprofen, #15 and 10mg of Xanax, #12.

The doctor told me to take a couple of days off from work to be sure the wounds healed properly, and because she didn’t want me to be driving while taking Xanax.

This language lends credibility to your injuries and the time you took off work. Make sure you follow your doctor’s orders to the letter.

After taking me home, my husband went to CVS pharmacy and had my prescriptions filled. The next morning I called in sick to work. I told my supervisor what had happened and told her the doctor ordered me to take several days off. Following doctor’s orders, I remained home for three days while continuing to take my prescribed medicine.

Unfortunately, I am an hourly employee. When I’m not able to work, I am not paid. My husband and I also paid out-of-pocket for hospital parking and for the medications. Because of your insured’s negligence, I was unable to spend the type and amount of intimacy my husband and I usually share for a week after my injuries.

The loss of intimacy with a spouse caused by the negligence of another is referred to as “loss of consortium,” and can be included as part of your damages.


I am a 34-year-old female with an unremarkable medical history. My prior medical treatment includes a brief hospitalization in 2011 for a serious case of the flu. At the time of the incident made the basis of this claim, I was fully recovered and not suffering from any medical malady.

It’s important to confirm you have no other medical issues that might influence or prolong your recovery, and that you have no prior injury related to your current injury. If you do, the adjuster may claim your current injury is merely an exacerbation of your pre-existing condition.


I have been employed since June 15, 2012, as front lobby hotel clerk at the Hite Regent hotel in Spokane, WA. As a front lobby clerk, my duties include greeting hotel guests and assisting them with their reservations. It is important for all Hite Regent lobby clerks to be dressed in our uniforms and immaculately groomed. Tattoos, apparent scars, and body piercings are forbidden.

Because of the lacerations and bandages to my face, my supervisor temporarily reassigned me to the Hotel’s call center, out of sight of hotel guests. Because my injury did not occur on the job, I wasn’t able to receive workers’ compensation benefits. That meant from May 28, 2014 through May 30, 2014, I received no pay.

It’s important to make clear how the injury has affected not only your wages, but also your employment status.


The following represents my medical bills and other out-of-pocket expenses. I have attached copies of representative bills and receipts, as well as a letter from my employer confirming the amount of my lost wages.

Holyoke Hospital


Medications, bandages


Transportation Costs


Lost Wages


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 $3,027.00.

For soft tissue injuries like abrasions, bruising, and muscle sprains, you can account for pain and suffering by multiplying your total medical costs by 2 to 4 times. Then you add your out-of-pocket expenses and lost wages to come up with a total settlement demand. Keep in mind, your initial demand is a starting point for negotiations, so make it slightly higher than you think is fair.

I look forward to hearing from you.


Vicki Timm
23 Gary Street
Spokane, WA 99207

Only list addresses and phone numbers where you’re comfortable receiving correspondence from the insurance company.

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