Loss of Consortium Demand Letter
RELATIONSHIP-LOSS / CONSORTIUM DEMAND PREPARATION PACKET
1. Claim activation record
Do not send this packet. Confirm that the jurisdiction recognizes the selected claimant and theory.
| Required item | Verified information |
|---|---|
| Governing jurisdiction | [________________________________] |
| Primary injured person and claim | [________________________________] |
| Proposed consortium / relationship-loss claimant | [________________________________] |
| Relationship and legally relevant dates | [________________________________] |
| Authority recognizing this claimant and claim | [________________________________] |
| Derivative, independent, or other classification | [________________________________] |
| Required primary liability and injury findings | [________________________________] |
| Defenses imputed from primary claim | [________________________________] |
| Claim-specific defenses | [________________________________] |
| Recognized damages elements | [________________________________] |
| Excluded, overlapping, or duplicative damages | [________________________________] |
| Proof and causation standard | [________________________________] |
| Accrual, limitation, notice, and pre-suit rules | [________________________________] |
| Joinder, pleading, and party requirements | [________________________________] |
| Survival, death, divorce, separation, or relationship-change effect | [________________________________] |
| Insurance coverage, limits, and allocation issue | [________________________________] |
| Settlement, release, lien, fee, and tax review | [________________________________] |
| Counsel | [________________________________] |
This packet supplies no default eligible relationship, damages category, claim status, response period, or settlement value.
2. Matter and claimant information
| Field | Entry |
|---|---|
| Primary claimant | [________________________________] |
| Consortium / relationship claimant | [________________________________] |
| Relationship | [________________________________] |
| Relationship began / marriage or other legal date | [________________________________] |
| Relationship status at incident and now | [________________________________] |
| Incident / loss date | [__/__/____] |
| Insured / responsible party | [________________________________] |
| Insurer / administrator | [________________________________] |
| Claim number(s) | [________________________________] |
| Litigation status | [________________________________] |
| Separate representation / conflict review | [________________________________] |
3. Primary claim dependency map
| Primary issue | Current status | Evidence | Effect on relationship claim |
|---|---|---|---|
| Duty / legal responsibility | [________________] | [________________] | [________________] |
| Breach / wrongful conduct | [________________] | [________________] | [________________] |
| Causation | [________________] | [________________] | [________________] |
| Primary injuries | [________________] | [________________] | [________________] |
| Comparative / contributory fault | [________________] | [________________] | [________________] |
| Releases, waivers, settlements, or adjudications | [________________] | [________________] | [________________] |
| Policy limits / collectability | [________________] | [________________] | [________________] |
Do not make admissions in the relationship claim that narrow or contradict the primary claim.
4. Governing element and damages matrix
Copy only elements and damages categories recognized for this claimant and jurisdiction.
| Element / damages category | Authority | Required showing | Supporting facts | Evidence | Overlap / objection risk | Include? |
|---|---|---|---|---|---|---|
| [________________] | [________________] | [________________] | [________________] | [________________] | [________________] | [____] |
| [________________] | [________________] | [________________] | [________________] | [________________] | [________________] | [____] |
| [________________] | [________________] | [________________] | [________________] | [________________] | [________________] | [____] |
Potential fact domains, if authorized, may include companionship, society, affection, services, care, assistance, intimacy, support, household contributions, or another specifically recognized interest. Do not treat the claimant's own emotional distress, medical condition, financial loss, children, or extended-family impact as part of the claim without authority.
5. Pre-incident baseline
| Relationship activity or contribution | Frequency / pattern before incident | Source / witness | Privacy concern |
|---|---|---|---|
| [________________] | [________________] | [________________] | [________________] |
| [________________] | [________________] | [________________] | [________________] |
| [________________] | [________________] | [________________] | [________________] |
Describe ordinary facts, not idealized or exaggerated conclusions. Identify preexisting limitations, relationship changes, caregiving duties, separations, or other facts that affect causation and credibility.
6. Post-incident change record
| Period | Specific change | Primary injury causing change | Frequency / duration | Corroboration | Current status |
|---|---|---|---|---|---|
| [________] | [________________] | [________________] | [________________] | [________________] | [________________] |
| [________] | [________________] | [________________] | [________________] | [________________] | [________________] |
| [________] | [________________] | [________________] | [________________] | [________________] | [________________] |
7. Services and economic-value analysis
Use only if the jurisdiction recognizes the category and avoid duplicating primary-claim economic damages.
| Service / contribution | Pre-incident frequency | Lost / reduced period | Replacement source | Actual cost | Valuation method | Claimed by whom |
|---|---|---|---|---|---|---|
| [________________] | [________________] | [________________] | [________________] | [________] | [________________] | [________________] |
| [________________] | [________________] | [________________] | [________________] | [________] | [________________] | [________________] |
Potential duplication with attendant care, household services, wage loss, medical expense, or primary claimant damages: [________________________________]
8. Duration and prognosis
| Item | Verified information / source |
|---|---|
| Primary injury prognosis | [________________________________] |
| Functional limitations affecting relationship | [________________________________] |
| Past loss period | [________________________________] |
| Future loss period and evidentiary basis | [________________________________] |
| Contingencies and uncertainty | [________________________________] |
| Life-expectancy or present-value evidence, if authorized | [________________________________] |
Do not select a future number of years from a generic table without admissible evidence and jurisdiction-specific review.
9. Evidence and privacy plan
| Evidence | Fact supported | Source / custodian | Admissibility / foundation | Privacy / privilege treatment | Include in demand? |
|---|---|---|---|---|---|
| Claimant statement | [________________] | [________________] | [________________] | [________________] | [____] |
| Primary claimant statement | [________________] | [________________] | [________________] | [________________] | [____] |
| Family / friend witness | [________________] | [________________] | [________________] | [________________] | [____] |
| Household / service records | [________________] | [________________] | [________________] | [________________] | [____] |
| Photograph / calendar / activity record | [________________] | [________________] | [________________] | [________________] | [____] |
| Expert or valuation evidence | [________________] | [________________] | [________________] | [________________] | [____] |
| Medical or treatment evidence | [________________] | [________________] | [________________] | [________________] | [____] |
Avoid unnecessary intimate, medical, mental-health, child, or third-party information. Use factual summaries, redactions, or separate confidential transmission when appropriate.
10. Valuation and settlement allocation
| Item | Primary claim | Relationship claim | Combined / shared | Notes |
|---|---|---|---|---|
| Past economic | $[________] | $[________] | $[________] | [________________] |
| Future economic | $[________] | $[________] | $[________] | [________________] |
| Non-economic | $[________] | $[________] | $[________] | [________________] |
| Other authorized category | $[________] | $[________] | $[________] | [________________] |
Valuation method and authority: [________________________________]
Policy-limit and allocation issue: [________________________________]
Separate versus combined demand decision: [________________________________]
Settlement allocation can affect releases, liens, fees, taxes, allocation among claimants, and court approval. Obtain separate advice before using nominal or strategic allocations.
11. Release and conflict control
| Issue | Approved treatment |
|---|---|
| Separate client and engagement | [________________________________] |
| Conflict between primary and relationship claimant | [________________________________] |
| Authority to negotiate and accept | [________________________________] |
| Separate settlement consent | [________________________________] |
| Release scope for each claimant | [________________________________] |
| Derivative-claim release effect | [________________________________] |
| Indemnity / hold-harmless | [________________________________] |
| Confidentiality / non-disparagement | [________________________________] |
| Minor, estate, guardian, probate, bankruptcy, or court approval | [________________________________] |
| Fee and cost allocation | [________________________________] |
12. Demand letter shell
[DATE]
VIA: [APPROVED METHOD]
[RECIPIENT]
Re: [PRIMARY CLAIMANT], [RELATIONSHIP CLAIMANT], [CLAIM NUMBER], [LOSS DATE]
Dear [________________________________]:
We represent [relationship claimant] concerning the relationship-loss claim recognized by [exact authority: ________________________________] arising from the injuries alleged by [primary claimant]. The claimant is eligible because [facts tied to authority: ________________________________].
Governing claim and elements
[________________________________]
Primary injury and causation
[________________________________]
Pre-incident relationship baseline
[________________________________]
Specific post-incident losses
[________________________________]
Duration and evidence
[________________________________]
Valuation and demand
Relationship claim demand: $[________________]
Combined resolution proposal, if authorized: $[________________]
Basis and allocation:
[________________________________]
Response
Please respond by [date selected for case reasons: ________________________________]. This date is not represented as a statutory deadline unless the activated authority record states otherwise.
This demand reserves only rights and claims available under the governing law and does not alter any applicable deadline.
Sincerely,
[COUNSEL]
13. Supporting-document index
| ID | Document | Supports | Date / pages | Redaction / confidentiality | Sent |
|---|---|---|---|---|---|
| [____] | [________________] | [________________] | [________________] | [________________] | [____] |
| [____] | [________________] | [________________] | [________________] | [________________] | [____] |
14. Final checklist
☐ Claimant eligibility and relationship verified
☐ Claim classification and dependency on primary claim confirmed
☐ Each damages category supported by current authority
☐ Pre- and post-incident facts are specific and credible
☐ Duplicate damages and claimant allocations reconciled
☐ Sensitive evidence minimized and protected
☐ Conflicts, separate consent, releases, fees, liens, and tax issues reviewed
☐ Limitations, notice, joinder, and litigation deadlines calendared
☐ Response date presented accurately
☐ Complete sent copy and delivery proof retained
This packet must be reactivated for every claimant and jurisdiction. Never carry an eligible relationship, damages category, derivative-claim rule, response period, valuation, or release effect from another case without current official authority.
About This Template
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.
Checked against the law it cites
A reviewer verified this template's legal citations against the official source on 2026-08-15.
Legal authority: Applicable consortium or relationship-loss authorities, claimant-eligibility law, primary-claim law, damages and evidence authorities, limitations rules, settlement and release law, and court rules: [INSERT CURRENT OFFICIAL SOURCES BEFORE USE]
Last updated: 2026-08-15
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