The Demand Letter
Your Demand Letter (DL) is going to be a long letter written in sections and subsections. Think of it as a book report for your claim. The DL is all the data about your claim glued together with words and paragraphs. Behind the lengthy DLr you will attach all your supporting documents. These documents will be indexed by category with a Table of Contents for the adjuster.
You should use, or at least look at, the ClaimClinic Form Demand Letter as you read this module. It is going to walk you through the DL section by section. You will need to replace anything that is highlighted on the form with your own claim’s data.
Make sure you have used our Medical Records Dissection Worksheet to work through the data in your medical records. It is much easier to work with each provider’s records individually and then simply transfer over all the dissected data into the DL.
The Demand Introduction
Before getting into the first section of the DL, let’s go over all the preliminary stuff on the first page, from letterhead to the first paragraph.
Letterhead – you should replace this block with your Name, Address, and phone number. See our Form Letterhead for an example you can copy and paste from.
Certified Mail – you want to send your DL certified mail so you have proof it was delivered. The proper way to cross-reference your letter with the green certified mail receipt slip is to get the slip from the Post Office first before finalizing your DL and putting in an envelope. Take the 20 digit certified mail number from the green slip and plug it in to the xxxx’s behind the Via Certified Mail. This way your letter ties itself to the certified mail slip you used instead of just having a certified mail slip that doesn’t say what was mailed.
Adjuster Contact Information – this is your adjuster’s mailing address. Simple enough.
“RE:” Info Block – RE in a professional letter means Regarding or In Reference To. You need to plug in your date of accident (called Date of Loss by adjusters), your Claim #, and the name of the at-fault driver. This tells the adjuster whose claim this DL is for.
Introductory Paragraph – not much to change here. Just make sure you change the highlighter portion to reflect how you are giving the adjuster your supporting documents. Are you sending them paper or are they on a data CD?
The collision section of your DL should have 2-3 paragraphs.
The first paragraph is a description of the collision. Keep your “story” to just the accident itself, like the police officer did in your police report. Don’t talk about where you were going or coming from. Just state what type of maneuver you were doing just before the collision (driving straight, making a turn, stopped) and what the other driver did. Mention the speed limit as well and how fast the other driver was travelling.
The second paragraph should talk about the data or evidence of the collision. Things to include are:
- Seatbelts worn
- Airbag Deployment
- Loss of Consciousness
- Extent of Property Damage – mild, moderate, or severe. Was your car inoperable? Did pieces fall off from the collision?
- Skid Marks – If the officer didn’t note any skid marks, state lack of skid marks indicates the other driver was driving the speed limit at the time of impact.
- Broken Windows
- Doors/Trunk Jammed Shut from damage
- Broken Interior Parts – Did your seat break, your dash crack, steering wheel bend?
You may need a third paragraph if your accident has aggravating facts, such as DUI or hit-and-run. If so, write a couple of sentences explaining what happened and what happened to the at-fault driver afterwards.
It’s a nice touch to include an embedded satellite image of the scene of the accident in this section of the DL. This gives the adjuster a better feel for the accident then just looking at the police report sketch, which is all they will look at unless you offer them the satellite image.
Your case is most likely an admitted liability case, like the majority of personal injury claims. If this is the case, simply write 1 or 2 sentences explaining that traffic law or statute the other driver broke and that the adjuster has already admitted liability for the claim.
If the adjuster is arguing with you over liability you will need to write a more in depth paragraph laying out all the evidence supporting your position that you are not at fault. You should include information such as:
- Location of damage to the cars
- Summary of what eye witnesses will say
- Statements made by the at-fault driver
- The statutes or rules of the road that the other driver violated
Your Background Info
Supply the adjuster with your date of birth, your age on the date of the accident (called Date of Loss – DOL by adjusters), your height, and weight. Claims software uses the baseline medical information in some of its calculations. This information already exists in your medical records. You are just giving it the adjuster in an easy format.
You also want to provide a brief one paragraph synopsis of who you are. Write a sentence on each of the following at the very least:
- Family – married with kids, etc.
- Career – what you do for a living and your achievements at doing it. This shows the adjuster you are driven and will be liked by a jury. If you are not employed, talk about school, social or charity projects your are involved in, etc.
- Lifestyle – the activities you enjoyed before the accident. Give the adjuster a sense of how active and happy you were prior to the injuries.
If you have had prior injuries that are noted in the records or that would appear in an insurance claim database somewhere (like ISO ClaimSearch) you are sending the adjuster you need to explain what those injuries were and whether you were completely healed at the time of the accident. If prior injuries do not appear in any of these places you do not have to disclose them if you do not want to. Because you are in control of your claim and the information going to the adjuster, you can cherry pick what you disclose. That is the price insurance companies pay for saving money by settling claims without litigation – they don’t have access to all the information that they would get in a lawsuit using the court’s subpoena power.
This small section just contains the total dollar amount for several value drivers that claims software uses. It is placed early on in the DL so that the adjuster can get a quick feel for the severity of the case (higher amounts = more injuries).
Property Damage: Insert the total amount of money it took to repair your car, including supplemental invoices. If your car was totaled or un-repairable, write “totaled” instead of the dollar amount.
Lost Wages: Insert the total amount of money you lost at work. Remember you must have documentation supporting this amount.
Medical Expenses: Add up all your medical expenses. Make sure you get everything – ambulance, ER, doctors, radiologists, therapists, chiropractors, medical equipment, prescriptions, etc.
Medical Treatment Overview
Length of Treatment
This section is pretty self explanatory. You are telling the adjuster the total duration of medical treatment in relation to the date of the accident. This is also a high level data point that gives the adjuster an overview of how severe your claim is. Put in the first and last dates of treatment. Then, figure out the number of days between those two dates and how many days transpired from the date of loss to the first and last dates of treatment. You can use a length of days calculator to quickly figure out the durations.
Length of Treatment by Provider
Now we are going to start to drill into the specifics for each person who treated you for your injuries. If you used our Medical Record Dissection Worksheet, you will have already identified the dates, counted the appointments, and figured out the durations.
List each provider in its own row, starting with the first person you treated with. List the provider by a person’s name. This can be an EMT, an ER, or a doctor. Try to list the providers in a rough chronological order based on the first time they treated you. A typical list would like like:
- EMT – head EMT who signed the Trip Report
- ER – the ER doctor listed on the hospital chart
- Primary Care Doctor or Chiropractor – your doctor’s name, not the practice name
- Orthopedic – the doctors name, not the practice name
- Physical Therapist – the PT’s name, not the practice name
Then, identify what type of provider each was. Examples include: ER, chiropractor, physical therapist, orthopedic, physical therapist, etc.
Next, list the first and last days each provider treated you. Then figure out the total number of days between those two dates. Finally, count up the number of visits/appointments you had with each provider.
Treatment Timeline Summary
Below the table laying out the dates and durations of treatment for each provider you will write a paragraph explaining how you moved from one provider to the next. Your paragraph will look something like:
“An ambulance took me to the hospital where I was examined and told to follow up with a doctor. I next went to my primary care doctor who reviewed the hospital’s x-rays and referred me to physical therapy. Once physical therapy did not work, my doctor referred me to an orthopedic doctor who ordered an MRI. The orthopedic doctor performed injections in my lower back, at which point I finished treatment.
You shouldn’t go into great detail about what each doctor did day-by-day. That is all in your medical records and the adjuster will not consider what you say anyway. They will review the medical records for their self. You simply want to give the adjuster a feel for your treatment in a nutshell.
Now that the adjuster has a great overall feel for your case at a high level we are going to drill down into the injuries and treatment. In this section of the DL you will list each and every injury that any doctor identified. You should have already pulled these out of your records using ClaimClinic’s Medical Record Dissection Worksheet. If that is the case, all you need to do is transfer over all your injuries from the Dissection Worksheet to your DL. If you didn’t use the Worksheet, you will need to comb through all the records and pull out each injury, the doctor who noted it, and when it was first noted.
ICD-9 and CPT Codes
Next you need to list out all the ICD-9 and CPT codes that you identified in your medical records. These should already be on your Medical Record Dissection Worksheet from when you analyzed your medical records. List them out in a string in sequential order. You may need to play with the order of the codes as they are listed to get them in sequential order. We use a “|” symbol to separate the codes, but you can use any delimiter you want, such as a coma or a hyphen.
This is tedious work but must be done. Almost all claims software looks for these codes as inputs. It will be time well spent.
Symptoms & Complaints
Next you will set forth all the symptoms and complaints found in your medical records. List the injuries first because that way the adjuster has already been “anchored” by the injuries meaning they have read and accepted the injuries such that they will accept the complaints and symptoms more readily as flowing from the injuries they have already read. If we did it the opposite way, adjusters cynicism may get in the way by their reading a long list of complaints without first knowing the injury diagnosis.
Using your Medical Record Dissection Sheet, write down each symptom or complaint found across all your medical records. A lot of times complaints and symptoms will be the same across different doctors or medical providers. If you have this in your claim, only make one “entry” for the complaint, but then identify the multiple providers who note it along with the dates of service for each. See Row 3 for an example of this.
Once you have all the symptoms and complaints identified along with their first and last dates notices, you need to figure out durations for each. Duration equals time you were in pain and suffering. If for some reason you cannot calculate a duration, write in an N/A instead of a number. This happens sometimes and does should not hurt your claim’s value.
Testing & Diagnostics
Testing and diagnostic imaging, such as x-rays and MRIs, are a great source of objective evidence of injury. Your completed Medical Dissection Worksheets should already have this information identified and you will just need to transfer over the data from your worksheets to the DL data table.
If an MRI or X-ray is positive for injury, write a quick 1-2 word description in the Test Result column and then explain the finding in detail in a paragraph directly beneath the table. Refer to the radiology report and copy the doctor’s diagnosis in a way that makes sense. You shouldn’t have to re-do the radiologist work but rather pull out the nuggets of diagnosis and put them in sentence form.
Next, you are going to identify all the treatments you endured as part of your recover. Again, these treatments should already have been identified in your Medical Record Dissection Worksheet for each provider. If you did not do the Worksheet, refer back to Analyzing Medical Records – Treatments for a list of treatments. This will help you get in the right frame of mind for scanning your medical records for treatments. For each treatment you need to give the adjuster the first and last date that treatment is noted in your records along with the number of days between those two dates. Again, duration of treatments is “data” of how long you were injured and in pain.
A lot of times multiple medical providers will perform the same treatments on you. If you have this in your claim, only list the treatment once but list out all the providers and last dates of service for each.
Below the data table you can write a paragraph or two laying out your treatments in a narrative fashion. You can talk about why you were moved from one treatment to another for example. This is not necessary but could provide the adjuster with a better understanding of why the treatments ran the course they did.
Medications & Devices
Like treatment, injuries, and symptoms, transfer over the data from your Medical Record Dissection Worksheets regarding prescriptions. When you list each prescription, make sure you include the dosage amount behind its name. Like everything else, you also need to give the adjuster the first and last time the medicine appears in your record so the adjuster and claims software can see the duration of time you were taking the medications.
Duties Under Duress
It is widely believed that Duties Under Duress is a very big value driver for your claim’s value. So, it is worth the time and effort to really make sure you get this section right. Start by writing out the Duties Under Duress that you endured regardless of whether they appear in your medical records or not. Then you will provide the adjuster with where some of these Duties Under Duress that also appear in your medical records.
Use the Duties Under Duress Worksheet to identify all the Duties Under Duress you endured regardless of whether they appear in your medical records or not. These are one of the hardest things to get in your records. Some doctors are better at it then others.
Your Medical Dissection Worksheets will have already identified all the places in your records where doctors are noting you were performing duties under duress. You need to list out each type of duress and the doctors who noted it and the first date it was noted. Duties under Duress often won’t be in the records more than once so you won’t have a begin and end date like a lot of your claim’s other data.
Loss of Enjoyment
Loss of enjoyment refers to how injuries and your pain affect your lifestyle or your inability to participate in activities and pleasures you normally enjoyed. This part of the DL is up to you to draft using the information you identified in your Loss of Enjoyment Worksheet.
We have provided an introductory paragraph to help you get this section started. You need to change the first sentence to reflect whether your loss of enjoyment of life was temporary or ongoing.
The second paragraph is unfortunately all up to you. Take all the items you identified in the Loss of Enjoyment Worksheet and use them to create a concise paragraph or two telling your story of how your life was effected. Where possible, mention where in your medical records any support for your claims can be found. You do this by giving the adjuster the doctor and date of service where the item can be found.
If your doctor has assigned you a permanent impairment rating, you will need to include this section. If you don’t have an impairment, you should delete this section from your DL.
Asserting your permanent impairment rating in your DL is relatively straight forward. You simply need to state:
- the doctor who assigned the rating
- the date of service on which the rating was given
- the impairment rating for the body part
- the whole body impairment rating that correlates with the body part rating
- the AMA chart page number and edition that the doctor used to determine the ratings – your doctor should tell you this or have it in his/her notes already.
“Dr. Smith on December 12, 2011 opined that I continue to suffer from a 25% lower extremity impairment arising out of my right ankle injury and that this correlates with a 10% whole body impairment under the AMA 5th Edition Guidelines under table 17-33 on page 547.
Medical expenses consist of all your medical bills, your prescriptions, and medical equipment you had to purchase, and mileage to/from your doctors.
Start by identifying each doctor or medical facility and the total of all their bills for treatment. Then add prescriptions and medical equipment expenses to that list.
Next write a paragraph documenting mileage reimbursement. The sample DL already has the paragraph written and you need only plug in the round trip mileage for each doctor or facility you saw. Take the total number of trips to each doctor and multiply it by the round trip mileage. This will give you the total mileage for that doctor/facility. Do that for each doctor/facility. Then add up all the total mileages and multiply it by the IRS mileage rate for medical treatment, which is currently $.165/mile. Your calculations will look something like:
- Doctor A round trip is 21 miles. I went to that doctor 3 times. 3×21 is 63, so I drove a total of 63 miles for that specific doctor.
- Physical therapy round trip is 28 miles. I went to physical therapy a total of 18 times. 18×28 is a total of 504 miles driven for physical therapy treatments.
- That gives me a total miles driven of 567. Multiply 567 by 16.5 cents/mile and you are due a total of $93.55 in mileage expenses.
If you missed work because of your injuries or treatment, you are entitled to lost wages as part of your personal injury claim. As discussed in documenting lost wages, you will most likely need documentation from your employer to support a claim for lost wages. The wage verification should set out the calculations for your lost income. If it does not, you will need to walk the adjuster through the numbers.
If you get paid by the hour, simply multiply the hours you missed times your hourly wage to get the total amount of lost income.
If you get paid a salary, you will need to figure out your either your average hourly wage or daily wage and then use that number to multiple the number of missed days.
You have shown the adjuster all the data and evidence about your claim and are now in a position to make a demand for a specific dollar amount. Read all about personal injury demand amounts and then fill in the Demand paragraph with the dollar amount you want to use as your high amount to begin negotiations.