Sample Demand Letter for Settlement in a Supermarket Injury Claim

Injuries are unique to every victim, as are the facts of each injury claim. The sample demand letter below demonstrates how to write a demand for injury compensation. We use the example of a slip and fall injury in a supermarket, but the basic structure of the letter will work for any premises liability claim.

This sample demand letter is meant to serve as a guide to help you construct your own demand letter; simply plug in your own information where applicable.

Click on the buttons to better understand the reasoning behind each section.

Learn more about supermarket accident claims here.

Supermarket Injury Demand Letter Example

February 11, 2014

Doncair Insurance Company
Ms. Wonna Sedle
Claims Adjuster
123 Street – Suite A
Boston, MA 02108


Claim Number:


Your Insured:

Groceries ‘R Us


Karla Myers

Claimant DOB:


Date of Injury:



Because a demand letter is considered part of ongoing settlement negotiations, courts typically disallow the content of demand letters to be brought up at trial. While titling your demand letter with the phrase FOR SETTLEMENT PURPOSES ONLY isn’t a legal requirement, doing so clearly demonstrates your expectation of confidentiality.

Dear Ms. Sedle:

Here you’ll briefly recount the facts leading to your injury and the damages you sustained. Damages can include your medical bills, out-of-pocket expenses, lost wages, and pain and suffering

As you are aware, I was seriously injured on January 10, 2014, at approximately 2:00 p.m., while grocery shopping at your insured’s supermarket located at 875 Middle Road in Mastic, New York. While walking down the produce aisle, I slipped and fell on produce which had apparently fallen from its place on the shelf and onto the floor.

I sustained an injury to my left ankle resulting in medical bills, out-of-pocket expenses, lost wages, and pain and suffering. Your insured’s failure to keep the produce aisle free from hazards constituted negligence. That negligence was the direct and proximate cause of my injury.

It’s important to show the adjuster you understand the legal concept of liability, and are aware of the applicable law. The phrase “direct and proximate cause” establishes a direct connection between the insured’s negligence and your injuries.

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

This language preemptively dispels any allegations you may have acted recklessly or contributed to your own injury.

I want to make one thing clear. I never asked for any of this to happen. Before January 10, I enjoyed shopping at Groceries ‘R Us. On January 10th, however, my life was unalterably changed.

Because of your insured’s negligence, I was in acute pain for two weeks. During that time, I was unable to freely move about without suffering excruciating pain and discomfort to my left ankle. I had to pay for medications, bandages, and other expenses related to my injury. I was unable to work during that time and lost two-weeks’ wages.

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 that you are acting in good faith and prefer to settle your claim, but you won’t hesitate to file your own lawsuit or hire an attorney if necessary.


Here you’ll review the facts of your personal injury claim and set forth the evidence you intend to use in support of your claim. Avoid using the word “accident,” it implies it wasn’t anyone’s fault.

As you are aware, on January 10, 2014, I was shopping at Groceries ‘R Us located at 875 Middle Road in Mastic, New York. At approximately 2:00 p.m., as I was walking down the produce aisle, I suddenly slipped and fell on wet produce that had fallen on the floor. At all times relevant to my fall, I was observant and not distracted.

This language is important as it makes clear you didn’t contribute to your own injury by acting carelessly.

The floor underneath was tiled and extremely hard. When I fell, my left ankle turned unnaturally and I immediately felt a dull pain. I was in shock and laid on the floor for what seemed like an eternity. Fortunately, two other shoppers came to my aid and helped me up. Those shoppers were Anne Cleaves and Sara Bolyn. You possess their witness statements.

Ms. Bolyn went to the front of the store and brought back the manager, Mr. Thomas Cromwell. I immediately pointed to the produce I had fallen on. He apologized and said he would have someone clean up the area right away. The pain in my ankle continued to worsen. I asked Mr. Cromwell to make a store incident report. You previously indicated you have a copy of that report and have reviewed it.

Because I use my right foot to accelerate and brake, I was able to drive home. The next morning I awoke in severe pain. My left ankle was swollen and throbbing, and I could barely walk. I asked my husband, John, to drive me to the Brookhaven Memorial Hospital Emergency Room located at 356 Main Street, Patchogue, NY.

The emergency room physician, Dr. Imar Gonahepue, examined my ankle and ordered x-rays. The x-rays failed to indicate a fracture. Dr. Gonahepue diagnosed my injury as a severe strain to my left ankle. He directed me to wear a splint for two weeks and then undergo physical therapy for another two weeks. Dr. Gonahepue prescribed pain medication and muscle relaxers for the pain and discomfort.

After wearing a splint for two weeks, I received physical therapy at the Blue Point Chiropractic Clinic located at 1667 Main Street in Blue Point, NY. Therapy lasted two weeks. During the four-week period of my treatment and recovery, I suffered great pain and discomfort.

I am employed as a sales clerk at Sweezy’s Department Store in Patchogue, New York. My job duties require me to be on my feet for up to eight hours each day. Because of my injury, however, I was unable to work. Because I am an hourly employee, I was not paid during that time.


I was treated on January 10, 2014 for my injuries at the Brookhaven Memorial Hospital in Patchogue, NY. Dr. Imar Gonahepue was the treating physician. My left ankle was x-rayed, which indicated a severe strain to my posterior talofibular and anterior talofibular ligaments of my left ankle. I was fitted with a splint and crutches.

Dr. Gonahepue prescribed Vicodin 10mg #30, prn for the pain, and Flexeril 10mg #30 for the swelling. Dr. Gonahepue also ordered I stay off my left ankle as much as possible and use crutches during the first two weeks after my discharge.

On January 24, 2014 I returned to Brookhaven Memorial Hospital where Dr. Jane Cleaves removed the splint. I received physical therapy at the Blue Point Chiropractic Clinic from January 25, 2014 through February 7, 2014.


Hopefully you can show that any prior injuries were fully healed at the time of the present injury. If not, the adjuster might contend your new injury isn’t a new injury at all, but rather just an exacerbation of your previous injury.

I am a 33-year-old female with an unremarkable medical history. In June 2010, I sustained a broken right tibia while playing tennis. The injury fully healed. In May of 2012, I was hospitalized for a throat infection. At the time I was injured inside your insured’s grocery store, I was in excellent health.


Show you are a responsible and contributing member of society, and you don’t often take off work for illness or injury. This helps legitimize your claim for lost wages.

I have been employed since February 2011 as a sales clerk at Sweezy’s Department Store in Patchogue, New York. My job duties include constant standing and walking while waiting on customers, stocking shelves, and hanging clothes on racks. Since joining Sweezy’s Clothing Store, I have missed only three days of work due to illness.

Prior to my employment at Sweezy’s, I was employed as a sales clerk at Hathaways Department Store in Long Beach, NY. Prior to my employment at Hathaways, I was a full-time student at Hofstra University in Hempstead, NY.


In this section you’ll list your medical and therapy bills. You will also list your collateral expenses and lost wages. Do not include pain and suffering here.

Below is a list my medical bills, out-of-pocket expenses, and lost wages. I’ve attached copies of receipts and bills documenting these amounts, along with a letter from my employer confirming my lost wages.

Brookhaven Memorial Hospital


Blue Point Chiropractic Clinic


Medications, bandages, crutches


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 $17,471.00.

For soft-tissue injuries like muscle and ligament sprains, you can use a multiple of 2 to 5 times the victim’s medical bills to come up with a settlement amount. The multiple represents the victim’s pain and suffering.

In the above example, the victim’s medical bills amount to $4,700.00. By settling for three times the medical bills plus expenses and lost wages ($14,100.00 + $3,371.00), the victim’s total documented expenses will be fully reimbursed. The remaining amount of $9,400.00 represents the victim’s pain and suffering.

It’s very rare for an insurance adjuster to accept a first demand for settlement. If she does, your demand was likely too low. Your initial demand is more like a starting-off point, and will be followed by a series of negotiations.

I look forward to hearing from you.


Karla Myers
3252 E. Elm St.
Patchogue, NY 32502

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

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