Sample Demand Letter for a Slip and Fall Injury in a Bar

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


Claim Number:


Your Insured:

Slippery Gulch Bar


Joel Douglas

Claimant DOB:


Date of Injury:



A demand letter is considered part of pre-trial settlement negotiations, and judges have traditionally disallowed the content of these negotiations to be used in court. While titling your demand letter with the words FOR SETTLEMENT PURPOSES ONLY isn’t a legal requirement, doing so eliminates any question about your intentions.

Dear Ms. Wonthelp:

Here you’ll briefly recount the events leading to your injury, its aftermath, and the damages you sustained. Damages can include your medical and chiropractic bills, out-of-pocket expenses (for items such as medications, bandages, crutches, etc.), lost wages, and your pain and suffering.

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.

It’s important to let the adjuster know you’re aware of the insured’s legal responsibility to protect patrons from harm.

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.

It’s a good idea to address any allegations of comparative negligence. This is a preemptive move, and makes clear your consumption of alcohol had nothing to do with the cause of your injury.

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.

This lets the adjuster know you are sincere in your intention to settle the claim, but if settlement negotiations break down, you will seek legal counsel.


A factual summary is a detailed review of the underlying facts of your personal injury claim. It also sets forth the evidence you intend to use to support your claim.

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.

Do your best to get any witnesses to the incident to give you their contact information and statements. Having an impartial witness to support your version of events will strengthen your claim.

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.


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.

This language confirms you weren’t malingering or trying to prolong your treatment. You followed your doctor’s orders to the letter, so you could heal as quickly as possible and return to work.


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.

This language makes clear to the adjuster you aren’t suffering from a pre-existing injury that might have been exacerbated by your current injury.


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.

Here you’re making clear you have no ulterior motive for making this claim. You are a contributing member of society and it’s rare for you to miss work due to injury or illness. You want to return to work as quickly as possible.


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.

Avery Hospital Emergency Room


Freedom Chiropractic Clinic


Medications, crutches, back brace


Transportation, parking fees


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 $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.


Joel Douglas
28 Gott St.
Newark, NJ 07101

Only list contact information where you’re comfortable receiving correspondence from the insurance company.

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