Sample of a Cash Settlement Letter. The information below will help you submit proper notification to DHCS, but you must complete the appropriate form in its entirety and review for accuracy.Use this letter to help you negotiate a full and final settlement offer with a creditor. Read our Mutual Release and Settlement Agreement template to understand our law firm's procedure in most settlements. This page focuses on how to write an effective settlement demand letter to the insurance company in an auto accident case to maximize your settlement amount. The letter should begin with the claimant's full name, address, and contact details. DHCS will order and review the payment records to create a "lien," which is a list of injuryrelated services subject to collection. Sample Confirmation Letter Used In Injury Settlement Negotiations. No one wants to go to court if resolving an issue without litigation is possible. Have not received payment, and have no insurance coverage for these unauthorized charges.