Templates Personal Injury Pennsylvania Personal Injury Demand Letter

Pennsylvania Personal Injury Demand Letter

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PERSONAL INJURY DEMAND LETTER — PENNSYLVANIA

FOR SETTLEMENT PURPOSES ONLY — PROTECTED UNDER Pa. R.E. 408


ATTORNEY INFORMATION

Law Firm: [________________________________]

Attorney Name: [________________________________], Esq.

Pennsylvania Bar I.D. No.: [________________________________]

Address: [________________________________]

City, State, ZIP: [________________________________], PA [__________]

Telephone: [________________________________]

Facsimile: [________________________________]

Email: [________________________________]


LETTER DATE AND DELIVERY

Date: [__/__/____]

Via: ☐ Certified Mail, Return Receipt Requested ☐ Email ☐ Facsimile ☐ Hand Delivery


ADDRESSEE — INSURANCE COMPANY / CLAIMS DEPARTMENT

To:

Insurance Company: [________________________________]

Claims Department / Adjuster: [________________________________]

Adjuster Direct Telephone: [________________________________]

Adjuster Email: [________________________________]

Mailing Address: [________________________________]

City, State, ZIP: [________________________________]


CLAIM INFORMATION

Field Information
Claim Number [________________________________]
Policy Number [________________________________]
Date of Loss [__/__/____]
Insured (At-Fault Party) [________________________________]
Claimant [________________________________]
Claimant Date of Birth [__/__/____]
Type of Claim ☐ Bodily Injury Liability ☐ UM/UIM ☐ First-Party Medical Benefits ☐ MedPay

I. INTRODUCTION AND PURPOSE

Dear [________________________________]:

This firm represents [Client Full Name] ("Claimant") in connection with personal injuries sustained on [__/__/____] as a result of the negligence of your insured, [Insured Full Name] ("Tortfeasor"), in [City/Borough/Township], [County] County, Pennsylvania.

This letter constitutes a formal demand for settlement of the above-referenced claim. The Claimant has completed active medical treatment, and we are now in a position to present a comprehensive demand supported by medical documentation, billing records, and applicable Pennsylvania law.

This correspondence is intended for settlement purposes only and is protected under Pennsylvania Rule of Evidence 408. Nothing herein shall be construed as a limitation on the damages recoverable by the Claimant should litigation become necessary.

We have been authorized by our client to resolve this claim and to negotiate a fair and reasonable settlement on [his/her] behalf.


II. FACTUAL BACKGROUND

A. Incident Description

On [__/__/____], at approximately [____] [a.m./p.m.], Claimant was [describe activity — e.g., operating a motor vehicle, walking as a pedestrian, a passenger in a vehicle, riding a bicycle] at or near [________________________________] in [City/Borough/Township], [County] County, Pennsylvania.

At that time, your insured, [Insured Full Name], was operating a [Year, Make, Model, Color] motor vehicle bearing Pennsylvania license plate number [________________________________].

[Describe the specific negligent conduct and how the incident occurred. Include directional details, traffic conditions, and sequence of events.]

[________________________________]
[________________________________]
[________________________________]
[________________________________]
[________________________________]

B. Police Report and Investigation

The incident was investigated by the [________________________________] Police Department / [Municipality] Police / Pennsylvania State Police. The investigating officer was [Officer Name], Badge No. [____]. The Pennsylvania Crash Report (AA-600) was assigned Report No. [________________________________].

Police Report Findings:

  • ☐ Your insured was issued a traffic citation for: [________________________________]
  • ☐ Your insured was found to have violated 75 Pa. C.S. § [________________________________]
  • ☐ Your insured was charged with: [________________________________]
  • ☐ Witnesses were identified and statements taken
  • ☐ Diagram/photographs were included in the report

C. Scene and Conditions

Factor Details
Location [________________________________]
Road Type ☐ Interstate ☐ State Route ☐ County Road ☐ Municipal Street ☐ Intersection ☐ Turnpike
Road Surface ☐ Dry ☐ Wet ☐ Icy ☐ Snow-Covered
Weather ☐ Clear ☐ Rain ☐ Snow ☐ Fog ☐ Sleet ☐ Overcast
Lighting ☐ Daylight ☐ Dusk ☐ Dark — Street Lights ☐ Dark — No Lights
Traffic Controls ☐ Traffic Signal ☐ Stop Sign ☐ Yield Sign ☐ None
Speed Limit [____] MPH
Estimated Speed of Tortfeasor [____] MPH

D. Emergency Response

  • ☐ Claimant was transported by EMS/ambulance to [Hospital Name]
  • ☐ Claimant was airlifted to [Trauma Center Name]
  • ☐ Claimant was transported by private vehicle to [Hospital/Facility]
  • ☐ Claimant was treated and released from the emergency department
  • ☐ Claimant was admitted to the hospital for [____] days

III. LIABILITY ANALYSIS

A. Negligence Under Pennsylvania Law

Under Pennsylvania law, a plaintiff in a negligence action must establish: (1) a duty of care recognized by law was owed by the defendant to the plaintiff; (2) the defendant breached that duty; (3) there was a causal connection between the defendant's breach and the resulting injury; and (4) actual loss or damage resulted to the plaintiff. See Merlini v. Gallitzin Water Authority, 934 A.2d 100 (Pa. 2007).

Your insured owed a duty of care to all persons lawfully on the roadway, including the Claimant. Your insured breached this duty by:

  • ☐ Driving at an unsafe speed — 75 Pa. C.S. § 3361
  • ☐ Following too closely — 75 Pa. C.S. § 3310
  • ☐ Failing to yield the right of way — 75 Pa. C.S. § 3321 et seq.
  • ☐ Disobeying a traffic control device — 75 Pa. C.S. § 3111
  • ☐ Exceeding the speed limit — 75 Pa. C.S. § 3362
  • ☐ Reckless driving — 75 Pa. C.S. § 3736
  • ☐ Careless driving — 75 Pa. C.S. § 3714
  • ☐ Driving under the influence — 75 Pa. C.S. § 3802
  • ☐ Improper lane change — 75 Pa. C.S. § 3309
  • ☐ Failure to signal — 75 Pa. C.S. § 3334
  • ☐ Use of interactive wireless device — 75 Pa. C.S. § 3316
  • ☐ Other: [________________________________]

B. Comparative Fault — 42 Pa. C.S. § 7102

Pennsylvania applies a modified comparative fault standard under 42 Pa. C.S. § 7102(a). A plaintiff's contributory negligence does not bar recovery so long as the plaintiff's negligence is not greater than the causal negligence of the defendant. If the plaintiff is found to be more than 50% at fault, recovery is completely barred.

Where the plaintiff bears some fault (50% or less), damages are diminished by the percentage of causal negligence attributed to the plaintiff.

In this case, the Claimant bears zero (0%) fault for the incident. Your insured is 100% at fault. [If partial fault is acknowledged, address proportionate analysis here.]

C. Tort Option Analysis — 75 Pa. C.S. § 1705

This section applies to motor vehicle accident claims.

Pennsylvania is a choice no-fault state. The Claimant's ability to recover non-economic damages (pain and suffering) depends on the tort option elected on [his/her] auto insurance policy.

Full Tort Election: The Claimant elected the Full Tort option on [his/her] auto insurance policy, Policy No. [________________________________], issued by [Insurance Company]. Under 75 Pa. C.S. § 1705(a), the Claimant has an unrestricted right to recover damages for all injuries, including pain and suffering, without meeting any injury threshold.

Limited Tort Election: The Claimant elected the Limited Tort option. However, the Claimant's injuries satisfy the serious injury threshold under 75 Pa. C.S. § 1705(d), as the Claimant has sustained one or more of the following qualifying injuries:

  • ☐ Death
  • ☐ Serious impairment of body function
  • ☐ Permanent serious disfigurement

Medical Evidence Supporting Serious Injury Exception:
Dr. [________________________________] has provided medical documentation establishing that the Claimant's injuries constitute a [serious impairment of body function / permanent serious disfigurement], specifically: [________________________________]

Exceptions to Limited Tort Restriction (75 Pa. C.S. § 1705(d)(1)-(3)): Even if the Claimant elected limited tort, the restriction does NOT apply because:

  • ☐ The tortfeasor was convicted of or accepted ARD for DUI (75 Pa. C.S. § 3802)
  • ☐ The tortfeasor was operating a vehicle registered in another state
  • ☐ The tortfeasor intentionally caused the injury
  • ☐ The Claimant was a pedestrian, bicyclist, or occupant of a non-motor vehicle
  • ☐ The Claimant was a passenger in a commercial vehicle

D. Joint and Several Liability — Fair Share Act (42 Pa. C.S. § 7102(a.2))

Under the Fair Share Act (42 Pa. C.S. § 7102(a.2)), enacted in 2011:

  • A defendant found to be less than 60% at fault is liable only for that defendant's proportionate share of damages.
  • A defendant found to be 60% or more at fault is jointly and severally liable for all damages.
  • Intentional tortfeasors remain jointly and severally liable regardless of percentage of fault.

[If multiple tortfeasors are involved, address the allocation of fault and the impact of the Fair Share Act here.]


IV. INJURIES AND MEDICAL TREATMENT

A. Nature of Injuries

As a direct and proximate result of the incident, the Claimant sustained the following injuries:

Primary Diagnoses:

  • ☐ Cervical spine injury — [________________________________]
  • ☐ Lumbar spine injury — [________________________________]
  • ☐ Thoracic spine injury — [________________________________]
  • ☐ Traumatic brain injury / Concussion — [________________________________]
  • ☐ Fracture(s) — [________________________________]
  • ☐ Herniated disc(s) — [________________________________]
  • ☐ Disc bulge(s) / Protrusion(s) — [________________________________]
  • ☐ Radiculopathy — [________________________________]
  • ☐ Rotator cuff tear / Shoulder injury — [________________________________]
  • ☐ Knee injury — [________________________________]
  • ☐ Soft tissue injuries — [________________________________]
  • ☐ Lacerations / Contusions / Abrasions — [________________________________]
  • ☐ PTSD / Anxiety / Depression — [________________________________]
  • ☐ Other: [________________________________]

ICD-10 Diagnostic Codes:

Code Description
[________] [________________________________]
[________] [________________________________]
[________] [________________________________]
[________] [________________________________]
[________] [________________________________]

B. Chronological Treatment History

1. Emergency / Acute Care
Date Provider Facility Treatment Cost
[__/__/____] [________________________________] [________________________________] [________________________________] $[________]
[__/__/____] [________________________________] [________________________________] [________________________________] $[________]
2. Diagnostic Imaging
Date Type Facility Findings Cost
[__/__/____] ☐ X-ray ☐ MRI ☐ CT Scan [________________________________] [________________________________] $[________]
[__/__/____] ☐ X-ray ☐ MRI ☐ CT Scan [________________________________] [________________________________] $[________]
[__/__/____] ☐ X-ray ☐ MRI ☐ CT Scan [________________________________] [________________________________] $[________]
3. Specialist Consultations
Date Specialist Specialty Findings/Recommendations Cost
[__/__/____] [________________________________] ☐ Orthopedic ☐ Neurology ☐ Pain Mgmt ☐ Neurosurgery [________________________________] $[________]
[__/__/____] [________________________________] ☐ Orthopedic ☐ Neurology ☐ Pain Mgmt ☐ Neurosurgery [________________________________] $[________]
4. Physical Therapy / Chiropractic / Rehabilitation
Date Range Provider # Sessions Treatment Type Cost
[__/__/____] to [__/__/____] [________________________________] [____] [________________________________] $[________]
[__/__/____] to [__/__/____] [________________________________] [____] [________________________________] $[________]
5. Injections / Procedures
Date Provider Procedure Anatomical Location Cost
[__/__/____] [________________________________] ☐ Epidural ☐ Facet Block ☐ Trigger Point ☐ PRP [________________________________] $[________]
6. Surgical Intervention
Date Surgeon Procedure Facility Cost
[__/__/____] [________________________________] [________________________________] [________________________________] $[________]
7. Mental Health Treatment
Date Range Provider Type # Sessions Cost
[__/__/____] to [__/__/____] [________________________________] ☐ Psychotherapy ☐ Psychiatry ☐ Counseling [____] $[________]
8. Prescription Medications
Medication Prescriber Duration Purpose Cost
[________________________________] [________________________________] [________________________________] [________________________________] $[________]
[________________________________] [________________________________] [________________________________] [________________________________] $[________]

C. Current Medical Status and Prognosis

Dr. [________________________________] has opined, within a reasonable degree of medical certainty, that the Claimant's injuries are [permanent / have reached maximum medical improvement / require ongoing treatment].

Current Symptoms:

  • ☐ Chronic pain in [________________________________]
  • ☐ Restricted range of motion in [________________________________]
  • ☐ Numbness/tingling in [________________________________]
  • ☐ Headaches — frequency: [________________________________]
  • ☐ Sleep disturbance
  • ☐ Cognitive difficulties
  • ☐ Emotional distress / Anxiety / Depression
  • ☐ Other: [________________________________]

Future Medical Needs:

  • ☐ Ongoing physical therapy — estimated cost: $[________] per year
  • ☐ Future surgical intervention — estimated cost: $[________]
  • ☐ Pain management — estimated cost: $[________] per year
  • ☐ Future diagnostic imaging — estimated cost: $[________]
  • ☐ Prescription medications — estimated cost: $[________] per year
  • ☐ Durable medical equipment — estimated cost: $[________]
  • ☐ Home health care — estimated cost: $[________]
  • ☐ Life care plan has been prepared by: [________________________________]

V. DAMAGES CALCULATION

A. Economic Damages

1. Past Medical Expenses
Provider Service Dates Description Amount Billed
[________________________________] [__/__/____] to [__/__/____] [________________________________] $[________]
[________________________________] [__/__/____] to [__/__/____] [________________________________] $[________]
[________________________________] [__/__/____] to [__/__/____] [________________________________] $[________]
[________________________________] [__/__/____] to [__/__/____] [________________________________] $[________]
[________________________________] [__/__/____] to [__/__/____] [________________________________] $[________]
[________________________________] [__/__/____] to [__/__/____] [________________________________] $[________]
[________________________________] [__/__/____] to [__/__/____] [________________________________] $[________]
[________________________________] [__/__/____] to [__/__/____] [________________________________] $[________]
TOTAL PAST MEDICAL EXPENSES $[________]

Note: Under 75 Pa. C.S. § 1722, in motor vehicle cases, first-party medical benefits ($5,000 minimum coverage) paid by the Claimant's own auto insurer are deducted from the third-party claim and are NOT recoverable from the tortfeasor. The amounts listed above represent expenses in excess of first-party benefits or expenses not covered by first-party benefits.

2. Future Medical Expenses
Category Estimated Annual Cost Duration Total Estimated Cost
[________________________________] $[________] [____] years $[________]
[________________________________] $[________] [____] years $[________]
[________________________________] $[________] [____] years $[________]
TOTAL FUTURE MEDICAL EXPENSES $[________]
3. Lost Wages — Past
Employer Position Period of Absence Rate of Pay Total Lost
[________________________________] [________________________________] [__/__/____] to [__/__/____] $[________]/[hr/wk/mo] $[________]

Note: Under 75 Pa. C.S. § 1722, first-party work loss benefits are deducted from the third-party claim. Lost wages above represent the amount in excess of first-party work loss benefits.

Supporting Documentation: ☐ Employer verification letter ☐ Tax returns ☐ Pay stubs ☐ W-2 forms

4. Lost Earning Capacity — Future
Basis Reduction Amount Duration Present Value
[________________________________] $[________]/year [____] years $[________]

Vocational Expert: [________________________________]

5. Other Economic Damages
Category Amount
Out-of-pocket medical expenses $[________]
Travel to/from medical appointments $[________]
Household services $[________]
Property damage (vehicle) $[________]
Rental vehicle $[________]
Other: [________________________________] $[________]
TOTAL OTHER ECONOMIC DAMAGES $[________]

B. Non-Economic Damages

Note: Pennsylvania does NOT impose any statutory cap on non-economic damages in personal injury cases.

Tort Election Consideration: Non-economic damages are recoverable without restriction if the Claimant elected Full Tort. If the Claimant elected Limited Tort, non-economic damages are recoverable only upon demonstrating a serious injury under 75 Pa. C.S. § 1705(d) or the applicability of an exception thereto.

Category Amount Claimed
Physical pain and suffering (past) $[________]
Physical pain and suffering (future) $[________]
Mental anguish and emotional distress $[________]
Loss of enjoyment of life $[________]
Disfigurement / Scarring $[________]
Disability / Physical impairment $[________]
Loss of consortium (spouse claim) $[________]
TOTAL NON-ECONOMIC DAMAGES $[________]

C. Total Damages Summary

Category Amount
Past Medical Expenses (above first-party benefits) $[________]
Future Medical Expenses $[________]
Past Lost Wages (above first-party benefits) $[________]
Future Lost Earning Capacity $[________]
Other Economic Damages $[________]
Total Economic Damages $[________]
Total Non-Economic Damages $[________]
TOTAL DAMAGES $[________]

VI. INSURANCE COVERAGE ANALYSIS

A. Tortfeasor's Liability Coverage

Coverage Limits
Bodily Injury — Per Person $[________]
Bodily Injury — Per Accident $[________]
Property Damage $[________]
Policy Number [________________________________]
Insurer [________________________________]

B. Claimant's Own Coverage (First-Party)

First-Party Medical Benefits — 75 Pa. C.S. § 1711
Coverage Details
Medical Benefits Limit $[________] (PA minimum: $5,000)
Medical Benefits Paid $[________]
Medical Benefits Remaining $[________]
Insurer [________________________________]
Policy Number [________________________________]

☐ Claimant has exhausted first-party medical benefits.
☐ First-party benefits are currently being paid.

Income Loss Benefits — 75 Pa. C.S. § 1712
Coverage Details
Work Loss Limit $[________]
Work Loss Benefits Paid $[________]
Tort Election Status
Coverage Details
Tort Election ☐ Full Tort ☐ Limited Tort
Policy Number [________________________________]
Insurer [________________________________]
UM/UIM — Uninsured/Underinsured Motorist Coverage
Coverage Limits
UM Bodily Injury — Per Person $[________]
UM Bodily Injury — Per Accident $[________]
UIM Bodily Injury — Per Person $[________]
UIM Bodily Injury — Per Accident $[________]
Stacking ☐ Yes (75 Pa. C.S. § 1738) ☐ No (Waived)
Number of Vehicles on Policy [____]

Note: Under 75 Pa. C.S. § 1731, UM/UIM coverage is optional in Pennsylvania and may be waived in writing. Stacking of UM/UIM benefits is available unless specifically waived under 75 Pa. C.S. § 1738.

☐ UIM claim is being asserted. Tortfeasor's limits of $[________] are insufficient.
☐ UM claim is being asserted. Tortfeasor was uninsured.
☐ UM/UIM coverage was waived.

C. Additional Coverage Sources

  • ☐ Umbrella / Excess Policy: $[________]
  • ☐ Health insurance subrogation lien: $[________] — Carrier: [________________________________]
  • ☐ Workers' compensation lien: $[________]
  • ☐ Medicare/Medicaid conditional payments: $[________]
  • ☐ ERISA lien: $[________]

D. Pennsylvania Minimum Insurance Requirements

Pennsylvania requires the following minimum automobile insurance (75 Pa. C.S. § 1786):

Coverage Minimum
Bodily Injury — Per Person $15,000
Bodily Injury — Per Accident $30,000
Property Damage $5,000
First-Party Medical Benefits $5,000
Income Loss (Work Loss) Included in first-party benefits
UM/UIM Optional (waivable)

Pennsylvania is a choice no-fault state — policyholders select Full Tort or Limited Tort. First-party benefits are available regardless of fault. The tort option determines the right to recover non-economic damages from the tortfeasor.


VII. DELAY DAMAGES — Pa. R.C.P. 238

Pennsylvania does not use the traditional "prejudgment interest" framework. Instead, Pennsylvania awards delay damages under Pa. R.C.P. 238.

Key Provisions:

  • At the plaintiff's request, damages for delay are added to the compensatory damages award.
  • Delay damages accrue from one year after the date original process was first served until the date of the award, verdict, or decision.
  • Rate: The prime rate as listed in the first edition of the Wall Street Journal published for each calendar year for which damages are awarded, plus one percent (1%), NOT compounded.
  • The plaintiff must request delay damages within ten (10) days of the verdict or decision.

Defendant's Offset: The defendant may reduce or eliminate delay damages by making a timely written settlement offer to the plaintiff under the rule. If the verdict is less than the offer, delay damages are not recoverable.

In this case:

  • Expected filing/service date: [__/__/____]
  • Delay damages begin accruing from: [__/__/____] (one year after service)
  • Current prime rate plus 1%: [____]%
  • Estimated delay damages accrual: $[________]

The potential for delay damages at prime-plus-one creates significant ongoing exposure. A prompt and good-faith settlement offer is recommended.


VIII. PUNITIVE DAMAGES

This section is applicable to this claim.

Pennsylvania does not have a statutory framework for punitive damages in ordinary personal injury cases. Punitive damages are governed by common law and may be awarded where the defendant's conduct was outrageous due to the defendant's evil motive or reckless indifference to the rights of others. See Feld v. Merriam, 506 Pa. 383 (1984); Hutchison v. Luddy, 582 Pa. 114 (2005).

There is no statutory cap on punitive damages in Pennsylvania. However, the amount must bear a reasonable relationship to the compensatory damages awarded, and constitutional due process limitations apply.

Basis for Punitive Damages Claim:
[________________________________]
[________________________________]

This section is NOT applicable — Punitive damages are not being sought at this time but are reserved should evidence of outrageous conduct emerge.


IX. COLLATERAL SOURCE RULE — 75 Pa. C.S. § 1722

Pennsylvania follows the traditional collateral source rule for most tort claims: collateral source payments generally do NOT reduce damages. However, for motor vehicle accidents, an important exception applies:

Under 75 Pa. C.S. § 1722, a plaintiff in a motor vehicle case may NOT recover benefits receivable under the motor vehicle insurance act (first-party medical benefits, work loss benefits) from the tortfeasor's liability coverage. These first-party benefits are deducted from the tort recovery.

First-Party Benefit Offset:

Benefit Amount Paid Deducted from Tort Claim?
Medical Benefits (75 Pa. C.S. § 1711) $[________] ☐ Yes
Work Loss Benefits (75 Pa. C.S. § 1712) $[________] ☐ Yes
Funeral Benefits $[________] ☐ Yes
Health insurance payments $[________] ☐ No (collateral source rule applies)

X. SETTLEMENT DEMAND

Based upon the foregoing analysis of liability, injuries, damages, tort election, and applicable Pennsylvania law, the Claimant hereby demands the sum of:

$[________________________________]

This demand is supported by total economic damages of $[________] (net of first-party benefits under 75 Pa. C.S. § 1722) and non-economic damages of $[________] (no cap applies), and accounts for the Claimant's injuries, ongoing medical needs, and the impact on [his/her] quality of life.

Response Deadline: We respectfully request a substantive response to this demand within thirty (30) days of receipt, no later than [__/__/____].

This demand will remain open for the stated period. Failure to respond or to make a good-faith offer within the specified timeframe will result in the immediate filing of a Complaint in the Court of Common Pleas of [County] County, Pennsylvania.


XI. STATUTE OF LIMITATIONS NOTICE

The statute of limitations for this claim is TWO (2) YEARS from the date of loss under 42 Pa. C.S. § 5524.

  • Date of Loss: [__/__/____]
  • SOL Expiration Date: [__/__/____]

We will not permit the statute of limitations to expire pending resolution of this claim. A Complaint will be filed in advance of the expiration date regardless of the status of settlement negotiations.


XII. RESERVATION OF RIGHTS

The Claimant reserves all rights, claims, and causes of action available under Pennsylvania law, including but not limited to:

  • ☐ Negligence
  • ☐ Negligence per se (statutory violation)
  • ☐ Reckless conduct
  • ☐ Gross negligence
  • ☐ Punitive damages
  • ☐ Negligent entrustment
  • ☐ Respondeat superior / Vicarious liability
  • ☐ Dram shop liability (47 P.S. § 4-497)
  • ☐ Products liability (402A Restatement (Second) of Torts)
  • ☐ Premises liability
  • ☐ Loss of consortium (spouse)
  • ☐ Wrongful death (42 Pa. C.S. § 8301) / Survival action (42 Pa. C.S. § 8302)
  • ☐ Bad faith failure to settle (42 Pa. C.S. § 8371 — first-party claims)
  • ☐ Other: [________________________________]

The presentation of this demand does not constitute a waiver of any claim or right, nor does it limit the damages that may be sought in litigation.


XIII. ENCLOSED DOCUMENTS AND EXHIBITS INDEX

The following documents are enclosed with this demand for your review:

Medical Records and Bills

Exhibit Description Provider Dates Pages
☐ A Emergency department records and bills [________________________________] [__/__/____] [____]
☐ B Diagnostic imaging reports and bills [________________________________] [__/__/____] [____]
☐ C Primary care records and bills [________________________________] [__/__/____] [____]
☐ D Specialist records and bills [________________________________] [__/__/____] [____]
☐ E Physical therapy / Chiropractic records and bills [________________________________] [__/__/____] [____]
☐ F Surgical records and bills [________________________________] [__/__/____] [____]
☐ G Mental health records and bills [________________________________] [__/__/____] [____]
☐ H Prescription records [________________________________] [__/__/____] [____]
☐ I Permanency / IME report [________________________________] [__/__/____] [____]

Other Documentation

Exhibit Description
☐ J Pennsylvania Crash Report (AA-600)
☐ K Photographs of vehicle damage / injuries / scene
☐ L Employer verification letter / Lost wage documentation
☐ M Tax returns / W-2 forms (lost earnings)
☐ N Auto insurance declarations page (tort election, coverage limits)
☐ O First-party benefit explanation of benefits
☐ P Expert reports (vocational, life care plan, economist)
☐ Q Property damage estimate / repair records
☐ R Witness statements
☐ S Medical bills summary spreadsheet
☐ T Tort election verification
☐ U Other: [________________________________]

XIV. SIGNATURE BLOCK

We trust that your review of the enclosed documentation and this demand letter will confirm the full extent of the Claimant's injuries and the reasonableness of our demand. We look forward to a prompt and fair resolution of this claim.

Should you have any questions or require additional documentation, please do not hesitate to contact our office.

Very truly yours,

[________________________________]

[________________________________], Esq.
Attorney for Claimant
Pennsylvania Bar I.D. No. [________________________________]

[Law Firm Name]
[________________________________]
[________________________________], PA [__________]
Tel: [________________________________]
Fax: [________________________________]
Email: [________________________________]


XV. SOURCES AND REFERENCES

Pennsylvania Statutes and Rules

  • 42 Pa. C.S. § 7102 — Modified Comparative Fault / Fair Share Act (51% Bar; 60% J&S Threshold)
  • 42 Pa. C.S. § 5524 — Statute of Limitations for Personal Injury (2 years)
  • 75 Pa. C.S. § 1705 — Full Tort vs. Limited Tort Election
  • 75 Pa. C.S. § 1711-1722 — Motor Vehicle Financial Responsibility Law (First-Party Benefits)
  • 75 Pa. C.S. § 1722 — Preclusion of Recovery for Benefits Available (Collateral Source Offset)
  • 75 Pa. C.S. § 1786 — Minimum Auto Insurance Requirements (15/30/5)
  • 75 Pa. C.S. § 1731 — UM/UIM Coverage (Optional — Waivable)
  • 75 Pa. C.S. § 1738 — Stacking of UM/UIM (Waivable)
  • 42 Pa. C.S. § 8301 — Wrongful Death
  • 42 Pa. C.S. § 8302 — Survival Action
  • Pa. R.C.P. 238 — Delay Damages (Prime + 1%, from 1 year post-service)
  • 42 Pa. C.S. § 8371 — Bad Faith Insurance Practices

Key Cases

  • Merlini v. Gallitzin Water Authority, 934 A.2d 100 (Pa. 2007) — Elements of negligence
  • Washington v. Baxter, 553 Pa. 434 (1998) — Limited tort / serious injury threshold
  • Feld v. Merriam, 506 Pa. 383 (1984) — Punitive damages standard
  • Hutchison v. Luddy, 582 Pa. 114 (2005) — Punitive damages standard
  • Spencer v. Johnson, 249 A.3d 529 (Pa. Super. 2021) — Fair Share Act scope

This template is provided by ezel.ai for use by licensed attorneys. It does not constitute legal advice. All statutory citations should be verified before use. Pennsylvania law requires that demand letters in personal injury cases be prepared or reviewed by a licensed attorney.

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Personal injury cases are brought by people who were hurt because of someone else's carelessness: car crashes, slip and falls, defective products, and more. Demand letters, settlement agreements, and court filings in these cases have to document the injuries, the medical treatment, the lost income, and the exact legal basis for holding the other side responsible. Well-prepared paperwork is what drives higher settlements and forces insurers to take the claim seriously.

Important Notice

This template is provided for informational purposes. It is not legal advice. We recommend having an attorney review any legal document before signing, especially for high-value or complex matters.

Last updated: March 2026