This form is a sample letter in Word format covering the subject matter of the title of the form.
[Your Name] [Your Address] [City, State, ZIP] [Email Address] [Phone Number] [Date] [Insurance Company Name] [Address] [City, State, ZIP] Re: Automobile Accident Demand for Damages to Party Opposite Claim Number: [Claim Number] Insured: [Insured's Name] Policy Number: [Policy Number] Dear Claims Adjuster, I am writing to formally demand compensation for the damages I suffered as a result of an automobile accident involving your insured, [Insured's Name]. The accident occurred on [Date] at the intersection of [Intersection Name], [City], [County], West Virginia. I was driving my [Your Vehicle Make, Model, Year] lawfully when your insured negligently collided with me. The collision was entirely your insured's fault and resulted in significant damages, injuries, and financial losses to me. Below, I provide a detailed description of the accident and the resulting damages. Accident Details: — Date: [Date— - Time: [Time] - Location: Intersection of [Intersection Name] — Weather Conditions: [Weather Conditions] — Road Conditions: [Road Conditions— - Traffic Conditions: [Traffic Conditions] Description of the Accident: [Provide a detailed account of how the accident occurred, including the actions of each party involved and any supporting evidence such as witness statements, police reports, or photographs.] Injuries and Damages: As a direct result of the accident caused by your insured's negligence, I suffered the following injuries and damages: 1. Personal Injuries: [Provide a comprehensive list of all injuries sustained, including but not limited to fractures, sprains, disc herniation, head injuries, soft tissue damage, emotional distress, and any other relevant injuries. If medical treatment was required, list the medical providers and the treatments received.] 2. Property Damages: [Describe the damages to your vehicle and any other personal property, including estimated repair costs or the fair market value if the vehicle was deemed a total loss.] 3. Lost Wages and Income: [Provide a detailed breakdown of the time you were unable to work due to the accident, including missed days, reduced work hours, and any accompanying documentation such as pay stubs or employment verification.] 4. Pain and Suffering: [Explain the physical and emotional pain you have experienced as a result of the accident, detailing any ongoing or chronic pain, mental anguish, inconvenience, and overall decrease in the quality of life.] 5. Other Miscellaneous Expenses: [Include any other relevant expenses related to the accident, such as transportation costs, rental vehicle expenses, or home modifications necessary for your recovery.] Demand for Damages: Based on the facts outlined above and in consideration of the damages and losses I have incurred, I hereby demand the following compensation: 1. Personal Injury Damages: $[Enter specific amount]. 2. Property Damage: $[Enter specific amount]. 3. Lost Wages: $[Enter specific amount]. 4. Pain and Suffering: $[Enter specific amount]. 5. Other Miscellaneous Expenses: $[Enter specific amount]. Total Amount of Demand: $[Enter total amount]. Please note that the above amounts are not exhaustive and are subject to further revision as additional damages and expenses may arise in the future. I request you to conduct a thorough investigation of this claim and respond within [reasonable time frame, often 30 days] with a fair and reasonable settlement offer. In the event that we are unable to reach a satisfactory settlement, I am prepared to pursue legal action to protect my rights and seek full compensation for the damages caused by your insured's negligence. Please consider this letter as a final opportunity to resolve this matter amicably. I kindly request that you forward this letter to the appropriate decision-maker within your company. I have attached copies of the following supporting documents for your reference: — Photographic evidence of the accident scene and vehicle damages — Police reportavailablebl— - Medical records, including all doctor's reports, bills, and treatment plans — Proof of lost wages anincomeom— - Any other relevant documents or evidence supporting my claim. Should you require any further documentation or information, please contact me directly at [Your Phone Number] or [Your Email Address]. I expect your prompt attention to this matter and appreciate your cooperation in resolving this claim swiftly. Thank you for your immediate attention to this matter. Sincerely, [Your Name]
[Your Name] [Your Address] [City, State, ZIP] [Email Address] [Phone Number] [Date] [Insurance Company Name] [Address] [City, State, ZIP] Re: Automobile Accident Demand for Damages to Party Opposite Claim Number: [Claim Number] Insured: [Insured's Name] Policy Number: [Policy Number] Dear Claims Adjuster, I am writing to formally demand compensation for the damages I suffered as a result of an automobile accident involving your insured, [Insured's Name]. The accident occurred on [Date] at the intersection of [Intersection Name], [City], [County], West Virginia. I was driving my [Your Vehicle Make, Model, Year] lawfully when your insured negligently collided with me. The collision was entirely your insured's fault and resulted in significant damages, injuries, and financial losses to me. Below, I provide a detailed description of the accident and the resulting damages. Accident Details: — Date: [Date— - Time: [Time] - Location: Intersection of [Intersection Name] — Weather Conditions: [Weather Conditions] — Road Conditions: [Road Conditions— - Traffic Conditions: [Traffic Conditions] Description of the Accident: [Provide a detailed account of how the accident occurred, including the actions of each party involved and any supporting evidence such as witness statements, police reports, or photographs.] Injuries and Damages: As a direct result of the accident caused by your insured's negligence, I suffered the following injuries and damages: 1. Personal Injuries: [Provide a comprehensive list of all injuries sustained, including but not limited to fractures, sprains, disc herniation, head injuries, soft tissue damage, emotional distress, and any other relevant injuries. If medical treatment was required, list the medical providers and the treatments received.] 2. Property Damages: [Describe the damages to your vehicle and any other personal property, including estimated repair costs or the fair market value if the vehicle was deemed a total loss.] 3. Lost Wages and Income: [Provide a detailed breakdown of the time you were unable to work due to the accident, including missed days, reduced work hours, and any accompanying documentation such as pay stubs or employment verification.] 4. Pain and Suffering: [Explain the physical and emotional pain you have experienced as a result of the accident, detailing any ongoing or chronic pain, mental anguish, inconvenience, and overall decrease in the quality of life.] 5. Other Miscellaneous Expenses: [Include any other relevant expenses related to the accident, such as transportation costs, rental vehicle expenses, or home modifications necessary for your recovery.] Demand for Damages: Based on the facts outlined above and in consideration of the damages and losses I have incurred, I hereby demand the following compensation: 1. Personal Injury Damages: $[Enter specific amount]. 2. Property Damage: $[Enter specific amount]. 3. Lost Wages: $[Enter specific amount]. 4. Pain and Suffering: $[Enter specific amount]. 5. Other Miscellaneous Expenses: $[Enter specific amount]. Total Amount of Demand: $[Enter total amount]. Please note that the above amounts are not exhaustive and are subject to further revision as additional damages and expenses may arise in the future. I request you to conduct a thorough investigation of this claim and respond within [reasonable time frame, often 30 days] with a fair and reasonable settlement offer. In the event that we are unable to reach a satisfactory settlement, I am prepared to pursue legal action to protect my rights and seek full compensation for the damages caused by your insured's negligence. Please consider this letter as a final opportunity to resolve this matter amicably. I kindly request that you forward this letter to the appropriate decision-maker within your company. I have attached copies of the following supporting documents for your reference: — Photographic evidence of the accident scene and vehicle damages — Police reportavailablebl— - Medical records, including all doctor's reports, bills, and treatment plans — Proof of lost wages anincomeom— - Any other relevant documents or evidence supporting my claim. Should you require any further documentation or information, please contact me directly at [Your Phone Number] or [Your Email Address]. I expect your prompt attention to this matter and appreciate your cooperation in resolving this claim swiftly. Thank you for your immediate attention to this matter. Sincerely, [Your Name]