Sample Personal Injury Demand Letter for a Side-Impact Collision

The facts of every personal injury claim are different. The sample demand letter below is meant to serve as a general guideline to help you construct your own demand letter. You will need to change the specifics to fit your injury case.

Click on the buttons for more insight into how to word your letter and how to think about settlement negotiations.

Learn more about side-impact collision claims here.

Side-impact Collision Demand Letter Example

March 4, 2014

Sinclair Insurance Company
Ms. Willa Jay
Claims Adjuster
123 Street – Suite A
Houston, TX 52411


Claim Number:


Your Insured:

Ira James


Jacob O’Neil

Claimant DOB:


Date of Loss:



If your claim goes to trial, using the phrase “For Settlement Purposes Only” makes it more difficult for the insurance company’s attorney to use what you say here against you. While you aren’t required to bring up issues that may be harmful to your claim, whatever you mention in this demand letter should be entirely truthful. If not, you may lose all credibility with the adjuster.

Dear Ms. Jay:

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.

You don’t want to threaten the adjuster by giving her an ultimatum to settle or you’ll sue. Instead, be positive about settling the claim while subtly letting the adjuster know you haven’t entirely ruled out hiring an attorney if necessary.

As you are aware, I was seriously injured on January 2, 2014 when your insured drove his 2010 Ford Explorer into the side of my 2013 Honda Accord. As a result of the collision, I sustained serious injuries resulting in substantial medical bills, therapy, out-of-pocket expenses, lost wages, severe discomfort, anxiety, and prolonged pain and suffering.

I want to make clear from the outset that I never asked for any of this to happen. Before January 2, 2014, I enjoyed a life free of physical pain and discomfort. On January 2nd, all that changed. My life has been forever altered as a direct and exclusive result of your insured’s negligence.


A factual summary is a review of the facts of the accident. It’s not the place to delve into the specifics of your injuries or the pain and discomfort you experienced. Nor is it the place to editorialize by making statements the adjuster may see as “whining” or “complaining.”

On January 2nd, 2014 at approximately 7:30 a.m., I was traveling northbound on Mott Street in the town of Nottingham, Virginia. Mott Street runs north and south, with three lanes of traffic on each side. At the same time, your insured was also driving northbound on Mott Street in the far left lane.

As I neared the intersection of Mott Street and Anderson Road, suddenly, and without warning, your insured crossed over from the far left lane. He drove across the center and right lanes. I later learned the reason your insured crossed all three lanes was because he had been texting on his cell phone, and when he suddenly realized he was about to drive past his intended exit on Anderson Street, he made the turn without adequately checking for oncoming vehicles.

As your insured crossed in front of me, his Ford Explorer crashed into the front left quarter panel on the driver’s side of my Honda Accord. The force of the collision spun my Honda Accord around in a circle. My head repeatedly and violently smashed into my driver’s side window. The centrifugal force caused my hands and arms to flail about, repeatedly striking the steering wheel.

The force of impact caused my Honda and I to travel over 100 feet northbound on Mott Street. The spinning stopped suddenly when my Honda struck a utility pole.

Your insured then pulled over. Several other drivers also pulled their vehicles over. I was barely conscious when I heard people knocking on my window asking me if I was OK. I was bleeding profusely from my forehead and nose. My left wrist was in severe pain. Someone called 911, and approximately five minutes later the police arrived on the scene. The paramedics arrived minutes later.

Because the force of impact caused the door to wedge shut, it took several minutes for the police to open my car door. When they finally did, they used a knife to cut my seat belt off. I later learned this was normal procedure as the police knew I was seriously injured and didn’t want to risk leaning over me to unfasten the seatbelt. I was transferred by ambulance to St. Mary Catherine’s Hospital in Nottingham, Virginia.


A police report can be crucial to your claim. Because the police are seen as objective, adjusters heavily rely on their report when evaluating injury claims. The police report will contain factual information and opinions of fault.

The Nottingham Police conducted an on-scene investigation. They took witness statements from Mary Carotene of 1561 Maple Ave in Nottingham, VA, and Paul Soruibu of 8256 Baron Drive in nearby Appaloosas, VA. Copies of the witness statements are attached to this demand letter.

Ms. Carotene stated, “I was driving northbound on Mott Street, and I saw the Ford Explorer just cut across in front of me. He didn’t signal, and he almost hit me. I then saw the Explorer crash into the Honda. It was a terrible crash. I called 911 and reported the crash.”

Paul Soruibu states, “I was traveling behind the Honda Accord when suddenly I saw the Ford Explorer come out of nowhere and crash into the car (Honda Accord) in front of me. It was a violent collision. The force of impact caused the Honda to spin around before it hit a utility a pole. I got out of my car, and another witness and I ran up to the Honda. The man was badly injured and bleeding from his head and nose.”

The police also took photographs and used a distance-measuring roller to calculate skid marks, propulsion length, and distribution of wreckage. Your insured was issued several traffic citations including failure to yield, disregarding a traffic signal, and failure to use a turn signal.

As you can see by the diagram on the rear of the police report, driver number two (your insured) cut across three lanes of traffic and collided with the front of driver number one’s (myself) car in the far right lane of traffic. The police also checked the boxes in the report designating my injuries as “serious,” and that I was “transported to hospital.”


I was treated for my injuries at St. Mary Catherine’s Hospital in Nottingham, Virginia. Upon arriving at the emergency room, I was seen by Doctor Amir Nerre. I was bloodied, bruised, and in terrible pain and discomfort. I had lacerations to my forehead and nose, as well as deep bruising to my right arm and wrist.

My wounds were disinfected and bandaged. Dr. Nerre ordered X-rays, an MRI exam, and a CT scan. The CT scan indicated a soft tissue hematoma and ligament rupture to my neck and shoulders. The CT scan also showed a soft tissue hematoma to the subcutaneous area in my right wrist surrounding the median nerve, along with ligament and tendon strain.

The MRI indicated compressed nerves in my neck and shoulders. Dr. Nerre diagnosed my injuries as severe whiplash resulting from hyperextension and hyperflexion, and deep bruising to my right wrist caused by repeated trauma.

While you don’t have to be an expert in the mechanisms of X-rays, MRIs and CT scans, it’s important to understand what these tests are, and how they were used to diagnose your injuries. This also lets the adjuster know you’re well-informed, and that you know your injuries are real and supported by medical evidence.

I was discharged several hours later wearing a cervical collar. Dr. Nerre also prescribed pain medication and muscle relaxants. He told me to follow up with my own doctor. I went to bed that night with a pounding headache. While the pain medication seemed to help somewhat, it made me nauseous.

The next morning I awoke in agonizing pain. I could barely get out of bed. My right arm was swollen and bruised. My nose and forehead ached, and I could barely turn my head and neck. I was truly in agony.

Make sure the adjuster knows how much pain you were in. Using descriptive language helps convey the amount of suffering you endured.

After calling in sick to work, my wife called Dr. Susan Smythe and made an appointment for me. The doctor couldn’t see me until the next day. I was relegated to bed. I continued to take my pain medication and muscle relaxants.

The next day my wife helped me out of bed. She had to help me dress and help me into the car. I continued to experience symptoms such as wrist pain, neck pain and stiffness, headaches, pain running down into my shoulder blades, and fatigue from not being able to sleep.

Dr. Smythe confirmed the diagnosis of whiplash and trauma to my right wrist. She told me to continue to wear the cervical collar for the next four weeks. Dr. Smythe also prescribed a splint for my right wrist along with the wrist brace. She prescribed Vicodin for the pain and Flexeril for my sprained muscles.

While Dr. Smythe indicated the best treatment for my injuries was therapy and chiropractic treatment, she also advised me not to return to my former job duties for at least six weeks, as doing so would likely aggravate my injuries and prolong my treatment.

Adding this language makes clear to the adjuster you weren’t malingering or trying to prolong your treatment unnecessarily. You were following your doctor’s orders to the letter.

I then made an appointment with Dr. Alan Eamy, a local chiropractor. Dr. Eamy once again confirmed the diagnosis of whiplash and trauma to my right wrist. I began treatment with Dr. Eamy, and for the next eight weeks my treatments included flexion-distraction, spinal manipulation, interferential electrical stimulation, and massage.

My recovery was long, difficult, and painful. While I have reached a point where continued treatment won’t be of any further benefit, I am left with lingering discomfort, soreness, and difficulty sleeping. I have only recently been able to get back in a car and drive. As a result of the accident I continue to suffer great anxiety while driving.


I am a healthy 31-year-old male with an unremarkable medical history. My prior medical treatment includes treatment for a broken left clavicle in 1998. I fully recovered and since that time have not had a recurrence of pain or discomfort. In 2005, I was hospitalized overnight for a case of food poisoning. I have had no other injuries requiring medical treatment.

While you don’t have to talk about your medical history in depth, it’s a good way to anticipate and squash any claims by the adjuster that your current injury was merely an exacerbation of a pre-existing injury.


I’ve been employed for the past four years as a delivery driver for United Delivery Service (UDS). My job duties require me to lift boxes weighing up to forty pounds and place them into my delivery truck, and carry those boxes off the truck as I deliver them to the customers on my assigned route.

My job also requires me to drive safely, which means frequently turning my head, neck and shoulders to check traffic. I also have to firmly hold the steering wheel. I have an impecable driving record for my entire four years of employment.

I was only able to resume my former job duties on February 20, 2014. Because my injury did not occur on the job, I wasn’t able to receive workers’ compensation benefits. That meant from January 2, 2014 until my first pay period on February 28, 2014, I had no income.

During this time I had to pay my own medical and therapy bills and other out-of-pocket expenses related to my injuries and treatment. In addition, I still had to pay my regular living expenses including rent, utilities, food, insurance, and more. My wife and I had to borrow money from friends and family just to survive.


The following is a list of my medical bills, out-of-pocket expenses related to my injuries and treatment, and the wages I lost while recovering. I have attached copies of representative bills and invoices, and a letter from my employer detailing my lost wages.

St. Mary Catherine’s Hospital


Dr. Susan Smythe


Dr. Alan Eamy


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 for my claim is $38,890.00.

In soft-tissue injury claims like whiplash, a simple way to calculate a settlement demand is to multiply the total medical bills by a factor between 2 and 5x (depending on the severity of the injuries and duration of treatment). This multiple method takes into account compensation for your pain and suffering. Then you’d add your lost wages and out-of-pocket expenses to come up with a total demand.

I look forward to hearing from you.


Jacob O’Neil
Phone: 555-234-5678

Be sure to only list contact details where you’re comfortable receiving correspondence from the insurance company.

How Much is Your Injury Claim Worth?

Find out now with a FREE case review from an attorney…

  • Your Accident
  • Your Claim
  • Contact Info
  • Your Evaluation