Every personal injury claim is unique. We’ve provided the following demand letter example so you can learn the basic structure and contents of a strong demand for compensation. Use this example as a guide when writing your own settlement demand letter. Be sure to substitute your specific case information where applicable.
The sample demand letter below deals with a slip and fall in a bar. Click on the 
buttons to better understand the language used and for more insight into each section.
Learn more about bar injury claims here.
Slip and Fall Injury Demand Letter Example
October 19, 2014
Doncair Insurance Company
Ms. I. Wonthelp
Claims Adjuster
125 Clay Street, Suite A
Newark, NJ 07110
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FOR SETTLEMENT PURPOSES ONLY
Dear Ms. Wonthelp:
As you are aware, I was seriously injured on September 16, 2014, at approximately 10:00 p.m., when I slipped and fell while on your insured’s premises.
Your insured had a legal duty to protect me from undue harm and injury. That duty included keeping the floor area free from dangerous, slippery liquids. On the evening of September 16, 2014, your insured wholly breached his legal duty. As a direct and proximate result of that breach, I sustained serious injuries to my lower back.
I was initially treated at the Avery Hospital Emergency Room and later at the Freedom Chiropractic Clinic. Both are located in Hope, New Jersey. Through the use of x-rays and an MRI, the doctor determined the fall at your insured’s premises caused me to suffer a severe lower back strain.
At all times related to my injury, I was observant and acted as any other bar patron would have under the same circumstances. While I consumed three beers that evening, I was not intoxicated, and my consumption of alcohol did not contribute to my fall.
I want to make clear from the outset I never asked for any of this to happen. Prior to September 16, 2014, I enjoyed a life free from serious pain and discomfort. On September 16th, however, all that changed.
As a result of your insured’s negligence, I was in severe pain and discomfort for approximately six weeks. Because of my injury, I was unable perform my job duties from September 16, 2014 through October 17, 2014. As a result, I lost substantial income.
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.
FACTUAL SUMMARY
On September 16, 2014, at about 6:30 p.m. my girlfriend, Susan Wunderrfol and I drove to your insured’s premises, the Slippery Gulch Bar. Several minutes after arriving, my girlfriend and I ordered dinner along with a pitcher of beer. Over the next three and a half hours I consumed three (3) twelve-ounce glasses of beer.
As we were leaving the bar at about 10:00 p.m., I suddenly slipped and violently fell to the hard floor. I immediately felt a sharp pain in my lower back. My girlfriend called the manager over. While waiting for the manager, two bar patrons, Joe and Mary Smith, helped me to my feet. I later took their statements, in which they pointed out that there was a large pool of spilled beer and other liquids directly where I fell. You have copies of those statements.
The manager, Joe Humphrey, filled out an incident report and told me he would have the owner’s insurance company contact me. My girlfriend then drove me to Avery Hospital’s Emergency Room. There I was treated by Dr. Robert Noka, who ordered x-rays and an MRI. The MRI indicated strains to the ligaments at the L-5 level.
Before being discharged, Dr. Noka prescribed Vicodin 10mg #12, and Flexeril 15mg #30. He told me to use alternating hot and cold packs on my back and ordered me to seek chiropractic care. He also told me to refrain from lifting any objects heavier than five pounds.
The next morning, September 17, 2014 I was unable to get out of bed. My back had seized and I was in terrible pain. It took several minutes before I was able to stand upright. My girlfriend called the Freedom Chiropractic Clinic and she drove me to the clinic. There I was treated by Dr. Chuck Practor with spinal manipulation and massage.
Dr. Practor explained it would take four to six weeks of therapy before I would be free from the pain and discomfort I was enduring. I followed Dr. Practor’s orders and received therapy twice a week. I was in severe pain and discomfort throughout treatment. I was finally free of pain and discomfort on October 31st, 2014.
From September 16, 2014, to October 17, 2014, I was unable to work at my job as a deliveryman for the UBS Delivery Company. My job duties include lifting boxes weighing up to forty pounds. I had no income for that period.
INJURIES AND TREATMENT
I was initially treated for my injury at Avery Hospital located at 3565 Central Highway, Newark, NJ. Doctor Robert Noka ordered x-rays and an MRI. He also prescribed 10mg #12,and Flexeril 15mg #30.
I was later treated twice weekly by Dr. Chuck Practor at the Freedom Chiropractic Clinic located at 678 Country Road, Newark, NJ. My treatment included spinal manipulation and massage therapy. I followed the orders of Dr. Noka and Dr. Practor and worked diligently during my therapy so I could heal as quickly as possible and return to work.
MEDICAL HISTORY
I am a 34-year-old male with an unremarkable medical history. My prior medical treatment includes hospitalization for a tonsillectomy in 1999, and treatment in 2011 for a broken left tibia suffered in a car accident.
WORK HISTORY
I have been employed since January 16th, 2010 as a deliveryman for the UBS Delivery Company. Over the last four years I have only missed four days of work for illness and six days for jury duty. During my employment with UBS, I have been promoted twice, from customer service representative to my present position as UBS delivery man.
DAMAGES
The following is a list of my medical and chiropractic bills, and other expenses related to my injuries. I have attached copies of representative bills and receipts, along with a signed letter from my employer confirming my lost wages.
In this section you’ll list your medical and chiropractic bills. You will also list your collateral expenses such as the cost of medicines, bandages, hospital parking lot fees, prorated amounts for gasoline used driving to the hospital, etc. Also include your total lost wages.
Do not include pain and suffering in this list. Pain and suffering will be determined as a multiple of your medical costs. As you’ll see below, your total settlement demand, including an amount for pain and suffering, will follow this list.
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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 $27,502.00.
You can determine a total settlement amount by multiplying your medical bills by a factor of 2 to 5 times, then adding your out-of-pocket expenses and lost wages.
In the above example, the victim’s medical and chiropractic bills amount to $6,120.00. By settling for four times medicals ($24,480.00), plus expenses and lost wages ($3,022.00), the victim’s total settlement demand will be $27,502.00. This covers all documented expenses, and includes an amount for pain and suffering.
Keep in mind, the adjuster is not likely to accept your initial settlement demand. If she does, your initial demand was likely too low. Think of your initial demand as a starting point for negotiations. Accordingly, it should be higher than you think is fair.
I look forward to hearing from you.
Sincerely,
________________
Joel Douglas
28 Gott St.
Newark, NJ 07101
555-679-6589
joeld@example.com
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