Insurance Demand Letter

NOTE TO PRACTITIONER
This is a jurisdiction-neutral drafting form, not a statement of insurance,
tort, settlement, or evidence law. Before sending it, determine whether the
claimant is making a first-party claim under the claimant's own policy or a
third-party liability claim against an insured. Review the complete policy,
applicable endorsements, current controlling law, claim-handling rules,
limitation periods, pre-suit requirements, and any required form or delivery
method. Delete every bracketed option that has not been supported by the
record and approved by counsel.

INSURANCE CLAIM SETTLEMENT DEMAND

1. Claim and Law Profile — Complete Before Drafting

• Claim type: ☐ First-party policy claim ☐ Third-party liability claim ☐ Other: [TYPE]
• Governing jurisdiction(s): [STATE / TERRITORY / TRIBAL OR FEDERAL LAW]
• Potential forum(s): [COURT / ARBITRATION / ADMINISTRATIVE PROCESS / UNDETERMINED]
• Claimant: [NAME]
• Insured(s): [NAME(S)]
• Insurer and issuing entity: [FULL LEGAL NAME]
• Policy number and effective dates: [DETAILS]
• Claim number: [NUMBER]
• Date, place, and description of loss: [DETAILS]
• Coverage part(s) and endorsements reviewed: [IDENTIFY]
• Limits, deductibles, retentions, and exhaustion issues: [DETAILS / UNKNOWN]
• Relevant policy definitions, conditions, exclusions, and notice provisions: [DETAILS]
• Controlling legal authority checked as of [DATE]: [INSERT CURRENT OFFICIAL AUTHORITY]
• Contractual or statutory notice / proof-of-loss requirement: [DETAILS / NONE IDENTIFIED]
• Limitation, repose, claim-presentment, or pre-suit date: [DATE AND BASIS]
• Prior coverage position or reservation of rights: [DATE / SUMMARY / NONE]
• Required recipient, address, portal, form, and delivery method: [DETAILS]
• Proposed response date and basis for selecting it: [DATE / POLICY / LAW / OFFER TERM]
• Medicare, Medicaid, ERISA-plan, workers' compensation, hospital, child-support,
  attorney, subrogation, reimbursement, or other claimed interests: [DETAILS / UNKNOWN]

2. Delivery Header

[DATE]

Via [DELIVERY METHOD]

[INSURER / CLAIMS ADMINISTRATOR]
Attn: [ADJUSTER / DEPARTMENT]
[ADDRESS]
[EMAIL OR PORTAL, IF AUTHORIZED]

Re: Claimant: [NAME]

Insured: [NAME]

Policy No.: [NUMBER]

Claim No.: [NUMBER]

Date of Loss: [DATE]

Dear [ADJUSTER / CLAIM REPRESENTATIVE]:

I represent [CLAIMANT NAME] concerning the loss identified above. This letter
presents the available liability, coverage, injury, and damages information and
offers to resolve [DESCRIBE CLAIMS AND PARTIES WITH PRECISION] on the terms below.
Please direct claim communications to [CONTACT INFORMATION], subject to any
communication rules applicable to represented persons.

3. Incident and Liability Presentation

A. Factual chronology

[STATE THE MATERIAL EVENTS IN DATE ORDER. DISTINGUISH PERSONAL KNOWLEDGE,
DOCUMENTED FACT, WITNESS INFORMATION, AND CONTENTIONS.]

B. Liability position

[EXPLAIN THE CLAIMANT'S THEORY AND THE FACTS SUPPORTING EACH ELEMENT. ADDRESS
KNOWN DISPUTES, DEFENSES, COMPARATIVE OR CONTRIBUTORY FAULT QUESTIONS, AND
CAUSATION ISSUES UNDER THE SELECTED JURISDICTION'S CURRENT LAW.]

C. Supporting material

• ☐ Incident, crash, or agency report
• ☐ Photographs, video, measurements, or scene material
• ☐ Witness statements or contact information
• ☐ Relevant correspondence or admissions
• ☐ Expert material
• ☐ Other: [DESCRIBE]

Nothing in this section should state that liability is "clear," "established,"
or legally conclusive unless counsel has determined that the record supports
that characterization.

4. Coverage Position

Use the paragraph that matches the claim and revise it to track the policy.

Option A — First-party claim

The claimant requests payment under [COVERAGE PART]. The relevant policy
language is [QUOTE OR SUMMARIZE ACCURATELY], and the facts supporting the
claimant's coverage position are [FACTS]. The insurer's position, if known, is
[SUMMARY]. Any disputed condition, exclusion, valuation method, deductible,
limit, appraisal term, or other policy issue is addressed as follows: [DETAILS].

Option B — Third-party liability claim

This demand seeks settlement of claims asserted against [INSURED NAME]. Any
statement about available insurance, limits, defense, indemnity, or settlement
authority is based on [POLICY / DISCLOSURE / CORRESPONDENCE] and remains subject
to confirmation. The claimant does not represent that the policy creates a
direct payment right or direct cause of action unless counsel has verified that
result under controlling law.

5. Injuries, Treatment, and Prognosis

• Initial symptoms and diagnosis: [DETAILS]
• Treatment chronology: [PROVIDERS, DATES, SERVICES]
• Current condition and functional limitations: [DETAILS]
• Prognosis and future care supported by provider evidence: [DETAILS]
• Prior or subsequent conditions relevant to causation or damages: [DETAILS]
• Records enclosed and any material records still outstanding: [DETAILS]

Use appropriate authorization, redaction, and secure-delivery procedures for
medical, financial, and other sensitive information. Do not imply that an
enclosure is complete if additional material is expected.

6. Damages Presentation

Total documented or supported amount presented: $[AMOUNT].

Confirm which categories are recoverable, how billed and paid amounts are
treated, whether collateral-source or damages limitations apply, and whether
interest, fees, costs, multipliers, or extra-contractual amounts may properly be
requested. Do not include any such item merely because it appears in this form.

7. Settlement Offer

Subject to the qualifications below, [CLAIMANT NAME] offers to resolve
[IDENTIFY CLAIMS] against [IDENTIFY RELEASED PERSONS OR ENTITIES] for
$[AMOUNT], payable as follows: [PAYMENT INSTRUCTIONS AFTER COUNSEL CONFIRMS
TRUST, LIEN, TAX, AND SETTLEMENT-HANDLING REQUIREMENTS].

The proposed consideration would be exchanged for [DESCRIBE THE PROPOSED
RELEASE, DISMISSAL, CONFIDENTIALITY, INDEMNITY, LIEN-HANDLING, OR OTHER TERMS;
DO NOT ASSUME ANY TERM]. No release or additional term is agreed merely by use
of this template. Attach a proposed release if acceptance depends on its exact
language.

This offer may be accepted only by [METHOD] so that acceptance is received by
[TIME, TIME ZONE, DATE]. The response period is a term selected for this offer;
it is not described as a statutory deadline or insurer default unless the law
profile above supplies current controlling authority. State whether the offer
is ☐ Withdrawn after that time ☐ Subject to later written withdrawal
☐ Governed by another rule: [DETAILS].

Please identify promptly any additional nonprivileged information reasonably
needed to evaluate the demand. A request for information does not extend or
modify the offer unless [CLAIMANT / COUNSEL] agrees in writing.

8. Matters Requiring Express Treatment

• Allocation among claimants, insureds, coverages, or claims: [DETAILS]
• Policy-limits demand, if intended and supported: [DETAILS]
• Minor, estate, guardianship, bankruptcy, or court-approval issue: [DETAILS]
• Government or plan reimbursement interests: [DETAILS]
• Structured settlement or annuity terms: [DETAILS]
• Tax reporting or withholding issue for counsel review: [DETAILS]
• Confidentiality or nondisparagement proposal: [DETAILS / NONE]
• Release scope, including unknown claims or additional parties: [DETAILS]
• Indemnity, hold-harmless, defense, or lien language requested: [DETAILS / NONE]
• Effect on derivative, consortium, subrogation, or other persons' claims: [DETAILS]

Do not promise lien resolution, authority to bind another person, assignment
restrictions, survival of representations, or a particular release effect
without confirming the facts and governing law.

9. Qualified Preservation Request — Optional

Because a dispute concerning [SUBJECT] is [PENDING / REASONABLY ANTICIPATED],
please take reasonable steps required by applicable law to preserve relevant
information within your possession, custody, or control, including [IDENTIFY
TARGETED CATEGORIES, CUSTODIANS, SYSTEMS, AND DATE RANGE]. This request does not
assert that every item in a claim file is discoverable, nonprivileged, or
required to be produced. Production and privilege issues are reserved for the
governing procedure and any later agreement or order.

10. Closing

Please send the written response and any acceptance to:

[NAME]

[FIRM, IF APPLICABLE]

[ADDRESS]

[EMAIL]

[PHONE]

Sincerely,

[CLAIMANT OR AUTHORIZED COUNSEL]

11. Enclosure Index

12. Final Review Checklist

• ☐ Correct claim type and all parties identified
• ☐ Complete policy and endorsements reviewed where available
• ☐ Every legal proposition checked against current official authority
• ☐ Every factual assertion supported and disputed facts labeled
• ☐ Damages math, records, duplicates, and future-loss support checked
• ☐ Liens, reimbursement interests, authority, and approval issues investigated
• ☐ Release and settlement terms stated precisely
• ☐ Response date is feasible and its legal significance is not overstated
• ☐ Sensitive information redacted and transmitted securely
• ☐ Delivery complies with policy, law, and any applicable pre-suit process
• ☐ Calendar preserves all independent filing and notice deadlines
• ☐ Qualified counsel in the governing jurisdiction approved the final letter