Sample Demand Letter for a Clothing Store Injury Claim

This demand letter example is meant to serve as a guide to help you construct your own letter. Just as injuries are unique to every victim, so are the facts of each injury claim. Using this letter as a guide, substitute your information where applicable.

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Learn more about retail store injury claims here.

Retail Store Injury Demand Letter Example

August 3, 2014

ABC Insurance Company
Ms. Anna Smith
Claims Adjuster
123 Street – Suite A
Boston, MA 02108


Claim Number:


Your Insured:

Sweeny’s Clothing Store


Leanne Sweeney

Claimant DOB:


Date of Injury:



The phrase “For Settlement Purposes Only” conveys your expectation of confidentiality. A demand letter is considered part of ongoing settlement negotiations, which the courts have traditionally protected as confidential. Being able to freely discuss matters related to your claim without fear of that information being used against you later in trial is critical.

Dear Ms. Smith:

Begin by setting out a brief, general description of the events leading to your injury, the aftermath, and your treatment.

As you are aware, I was seriously injured on July 15, 2014, at approximately 9:30 a.m., while trying on a pair of jeans in your insured’s dressing room. While in the dressing room, I stepped on a clothing pin, which punctured my right foot causing it to bleed profusely. The injury caused me great pain and discomfort.

I was treated for my injury at the Hillcrest Hospital Emergency Room. My treatment included cleansing my wound and three stitches.

Your insured was clearly negligent by failing to keep the floor in the dressing room free from inherently dangerous clothing pins. Your insured had a legal duty to protect me from undue harm and injury, but wholly failed to do so. Your insured’s negligence was the direct and proximate cause of my injury and resulting damages.

It’s important to let the adjuster know you’re aware of the applicable law and you understand the concepts of negligence and liability. The phrase “direct and proximate cause” directly connects the insured’s negligence to your injury.

At all times related to my injury I was observant and acted as any other customer would have under the same circumstances.

This preemptively addresses any allegations of contributory negligence. It makes clear you had nothing to do with your own injury.

I want to make clear from the outset that I never asked for any of this to happen. Before July 15, 2014, I enjoyed shopping at your insured’s store and other retail clothing stores. On July 15th, however, all that changed. As a result of your insured’s negligence, I was in pain for several weeks.

The doctor ordered me not to put pressure on my right foot for two weeks until the stitches dissolved and the puncture wound was sufficiently healed. This meant I was unable perform my job duties for two weeks, causing me to lose 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 makes clear you’re acting in good faith and prefer to settle your claim, but you won’t hesitate to file a lawsuit or retain an attorney if necessary.


A factual summary is a concise review of the events leading to your injury and the subsequent damages you sustained. Refrain from using the word “accident.” It implies it really wasn’t the insured’s fault.

On July 15, 2014, I drove to Sweeny’s Clothing Store located at 367 Bayview Avenue, Patchogue, NY 11712. I arrived at approximately 9:00 a.m. After perusing the racks of jeans, I found two pairs to try on. I walked to the nearest dressing room; once in the private booth, I removed my pants and shoes.

After pulling on the first pair of jeans I stood up. As I did, I felt a very sharp pain in my right foot. I immediately sat down and looked underneath my foot and saw my sock filling with blood. I saw an approximately two-inch clothing pin sticking out of the sock. As I pulled off the sock, the clothing pin came with it, causing searing pain.

I took off the bloody sock and hobbled out to the nearest sales clerk. I asked her to call the manager. I later learned the sales clerk’s name was Mary Witnus. Ms. Witnus pulled over a chair and asked me to sit while she called the manager over. Several minutes later, with my foot still bleeding, the manager came over. I later learned his name was Zer Gosemyraze.

Mr. Gosemyraze acted indifferently and merely offered to get a band-aid from the back office. I was quite upset. I showed him my bloody sock and I demanded he make a written report of the incident. He appeared to ignore me. I later learned from you that he did complete an incident report.

Because I couldn’t walk without pain, I called my sister. She arrived several minutes later and immediately drove me to Hillcrest Hospital’s Emergency Room. After waiting over an hour, I was seen by Dr. Emma Pathy. She examined my wound and told me it needed three stitches. A nurse cleaned my wound and the doctor completed suturing me. I was in prolonged and acute pain the entire time.

Doctor Pathy ordered me to stay off my right foot for two weeks to give my wound sufficient time to heal and for the stitches to dissolve. Doctor Pathy prescribed Erythromycin to fight infection and Lortab for the pain.

I am employed as an apartment leasing manager. My job duties include showing prospective tenants available apartments, which requires extensive walking. Because I was unable to walk, I was forced to take two weeks off from work.


I was treated for my injury at Hillcrest Hospital located at 36889 Nichols Road, Smithtown, New York. My wound was cleansed with an antibiotic cleanser. Doctor Emma Pathy sewed three stitches into the bottom of my right foot. I was prescribed Erythromycin to combat infection, and Lortab 15 mg #30 PRN to treat the pain. I was also prescribed Zelon antibiotic cream and the hospital gave me a set of crutches.

I followed Doctor Pathy’s orders and remained off my right foot for two weeks. I applied Zelon cream according to instructions and took the antibiotic Erythromycin through its entire course. I also took the Lortab PRN. I was healed sufficiently to return to work on August 2, 2014.

Adding this language confirms you aren’t a malingerer. You followed the Doctor’s orders precisely and did everything you could to heal quickly.


I am a 28-year-old female with an unremarkable medical history. In 2011, I had a Cesarean Section birth of my child. While playing soccer in 2009, I sustained a broken left clavicle. At the time I was injured on your insured’s premises, I was in excellent health.

This makes clear that you didn’t have a pre-existing injury that might have contributed to or exacerbated your current injury.


I have been employed since May 2012 as a leasing agent by Armitage Residential Properties, Inc. My job duties include showing available rental properties to prospective tenants. In the past 3 years, I have missed only three days of work due to illness. Prior to working at Armitage, I worked for two years as a waitress at the Embers Restaurant in Mineola, NY. Before that I was a student at Hofstra University in Hempstead, NY.

Here you are telling the adjuster you are a responsible person who is a contributing member of society. It’s unusual for you to miss work due to illness or injury.


The following is a list of my medical bills and other financial losses. I have attached copies of representative bills and invoices, and a letter from my employer confirming my lost earnings.

Include all your medical, chiropractic and therapy bills. Also include out-of-pocket expenses such as the cost of medicines, bandages, crutches, hospital parking lot fees, prorated amounts of gasoline driving to and from the hospital, etc. You’ll need a letter from your employer confirming your lost earnings. Do not include pain and suffering in this list. As you’ll see below, you will add an amount for pain and suffering to the total of your financial losses.

Hillcrest Hospital Emergency Room


Lost Wages


Medications, bandages, crutches


Transportation Costs


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 $5,194.00.

For soft-tissue injuries like small puncture wounds, you can use a multiple of 2 to 5 times medical bills to come up with a total settlement demand. That amount covers all medical costs and other financial losses. The multiple represents your pain and suffering compensation.

I look forward to hearing from you.


Leanne Sweeney
325 E 34rd Rd.
Smithtown, NY 11502

Be sure to list only those addresses and phone numbers where you’re comfortable receiving correspondence from the insurance company.

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