Minnesota Personal Injury Demand Letter
PERSONAL INJURY DEMAND LETTER — MINNESOTA
FOR SETTLEMENT PURPOSES — MINN. R. EVID. 408
SETTLEMENT DEMAND
Date: [__/__/____]
VIA CERTIFIED MAIL — RETURN RECEIPT REQUESTED
SENDER (Attorney/Law Firm)
| Field | Details |
|---|---|
| Attorney Name | [________________________________] |
| Law Firm | [________________________________] |
| Bar Number | [________________________________] |
| Address | [________________________________] |
| City, State, ZIP | [________________________________], Minnesota [____] |
| Telephone | ([____]) [____]-[________] |
| Facsimile | ([____]) [____]-[________] |
| [________________________________] |
RECIPIENT (Insurance Adjuster/Claims Department)
| Field | Details |
|---|---|
| Adjuster Name | [________________________________] |
| Insurance Company | [________________________________] |
| Claims Department | [________________________________] |
| Address | [________________________________] |
| City, State, ZIP | [________________________________] |
| Claim Number | [________________________________] |
| Policy Number | [________________________________] |
| Date of Loss | [__/__/____] |
| Insured (Tortfeasor) | [________________________________] |
CLAIMANT INFORMATION
| Field | Details |
|---|---|
| Claimant Name | [________________________________] |
| Date of Birth | [__/__/____] |
| Address | [________________________________] |
| City, State, ZIP | [________________________________], Minnesota [____] |
| SSN (Last 4) | XXX-XX-[____] |
| No-Fault/PIP Carrier | [________________________________] |
| PIP Policy Number | [________________________________] |
| Health Insurance | [________________________________] |
I. INTRODUCTION AND PURPOSE
Dear [________________________________]:
This office represents [________________________________] ("Claimant") in connection with personal injuries sustained in a [☐ motor vehicle collision ☐ slip and fall ☐ premises liability incident ☐ other: ________________________________] that occurred on [__/__/____] in [________________________________], Minnesota. This letter constitutes a formal demand for settlement of all liability claims against your insured, [________________________________] ("Tortfeasor/Defendant"), arising from the above-referenced incident.
This demand is made under Minnesota tort law and, where the claim involves a covered automobile accident, the Minnesota No-Fault Automobile Insurance Act (Minn. Stat. §§ 65B.41-65B.71). This is an offer to resolve a disputed claim. Nothing in this letter waives any rights, claims, or causes of action.
Claimant has authorized this office to negotiate and settle all claims arising from this incident. A signed letter of representation is enclosed.
II. MINNESOTA NO-FAULT FRAMEWORK (Motor Vehicle Cases)
☐ This section applies — Motor vehicle accident case
☐ This section does not apply — Non-motor vehicle case (skip to Section III)
A. Minnesota No-Fault Act (Minn. Stat. § 65B.41-71)
Minnesota is a no-fault automobile insurance state. Under the Minnesota No-Fault Automobile Insurance Act, every automobile insurance policy must include basic economic loss benefits (Personal Injury Protection / "PIP"), regardless of fault.
B. PIP Benefits (Minn. Stat. § 65B.44)
Minnesota law mandates a minimum of $40,000 in PIP benefits per injured person:
| Benefit | Coverage | Statute |
|---|---|---|
| Medical Expenses | Up to $20,000 | Minn. Stat. § 65B.44, subds. 1(a)(1), 2 |
| Income Loss Benefits (85% of gross income, subject to max) | Up to $20,000 | Minn. Stat. § 65B.44, subd. 3 |
| Replacement Services | $200/week (included in $20,000 non-medical) | Minn. Stat. § 65B.44, subd. 5 |
| Funeral/Burial Expenses | Up to $5,000 (included in $20,000 non-medical) | Minn. Stat. § 65B.44, subd. 4 |
| Survivors Economic Loss | Included in $20,000 non-medical | Minn. Stat. § 65B.44, subd. 6 |
Claimant's PIP Benefits Status:
| Category | Amount Paid | Amount Pending | Amount Remaining |
|---|---|---|---|
| Medical Expenses | $[________________________________] | $[________________________________] | $[________________________________] |
| Income Loss | $[________________________________] | $[________________________________] | $[________________________________] |
| Replacement Services | $[________________________________] | $[________________________________] | $[________________________________] |
| Total PIP | $[________________________________] | $[________________________________] | $[________________________________] |
C. Tort Claim Coordination
For a covered motor vehicle negligence claim, identify economic loss not paid or payable as no-fault benefits under Minn. Stat. § 65B.51, subds. 1–2. The court deducts basic or optional economic loss benefits paid or payable from a tort recovery as the statute directs.
Noneconomic damages require a separate threshold. Under § 65B.51, subd. 3, pain and suffering and other noneconomic loss may be recovered only if the statutory calculation of qualifying medical expenses exceeds $4,000, or the injury causes permanent disfigurement, permanent injury, death, or disability for 60 days or more. Diagnostic X-rays and rehabilitative treatment are excluded from that medical-expense calculation as the statute specifies. State the supported threshold here: [________________________________]. This gate applies to the motor vehicle negligence action described in subdivision 1; use the separate nonmotor vehicle analysis for other claims.
III. FACTUAL BACKGROUND
A. The Incident
On [__/__/____], at approximately [____:____ ☐ AM ☐ PM], Claimant was [________________________________] at or near [________________________________] (exact location), in [________________________________], [________________________________] County, Minnesota.
At that time, Tortfeasor was operating a [____] [________________________________] [________________________________] (year/make/model), bearing Minnesota license plate number [________________________________], traveling [☐ northbound ☐ southbound ☐ eastbound ☐ westbound] on [________________________________].
Description of the incident:
[________________________________]
[________________________________]
[________________________________]
[________________________________]
[________________________________]
B. Emergency Response
| Detail | Information |
|---|---|
| 911 Call Time | [____:____ ☐ AM ☐ PM] |
| Responding Agency | [________________________________] |
| Police Report Number | [________________________________] |
| Responding Officer(s) | [________________________________], Badge #[____] |
| EMS/Ambulance | [________________________________] |
| Transport Destination | [________________________________] Hospital |
| Claimant Transported | ☐ Yes, by ambulance ☐ Yes, by private vehicle ☐ No |
C. Police Report Summary
The police report [☐ does ☐ does not] indicate that Tortfeasor was cited for [________________________________] under Minnesota Statutes § [________________________________].
Contributing factors noted in report:
☐ Failure to yield right of way
☐ Following too closely (Minn. Stat. § 169.18, subd. 8)
☐ Improper lane change
☐ Running red light/stop sign (Minn. Stat. § 169.06)
☐ Excessive speed (Minn. Stat. § 169.14)
☐ Distracted driving (Minn. Stat. § 169.475)
☐ DWI/DUI (Minn. Stat. § 169A.20)
☐ Failure to signal (Minn. Stat. § 169.19)
☐ Careless driving (Minn. Stat. § 169.13)
☐ Other: [________________________________]
D. Witness Information
| Witness | Contact Information | Summary |
|---|---|---|
| [________________________________] | [________________________________] | [________________________________] |
| [________________________________] | [________________________________] | [________________________________] |
| [________________________________] | [________________________________] | [________________________________] |
E. Scene Evidence
☐ Photographs of the accident scene
☐ Photographs of vehicle damage
☐ Video/dashcam footage
☐ Surveillance camera footage
☐ Traffic signal/camera data
☐ Skid mark measurements
☐ Accident reconstruction report
☐ Weather and road condition reports (Minnesota DOT records)
☐ Property damage estimates/repair records
☐ Event data recorder (EDR/"black box") data
IV. LIABILITY ANALYSIS
A. Minnesota Negligence Standard
Under Minnesota law, to establish negligence, a plaintiff must prove: (1) the existence of a duty of care; (2) breach of that duty; (3) a causal connection between the breach and the injury; and (4) actual damages. Lubbers v. Anderson, 539 N.W.2d 398, 401 (Minn. 1995).
B. Tortfeasor's Negligence
Your insured was negligent in the following respects:
☐ Failed to maintain a proper lookout
☐ Failed to yield the right of way in violation of Minn. Stat. § [________________________________]
☐ Operated the vehicle at an excessive rate of speed in violation of Minn. Stat. § 169.14
☐ Followed too closely in violation of Minn. Stat. § 169.18, subd. 8
☐ Failed to obey a traffic control device in violation of Minn. Stat. § 169.06
☐ Operated the vehicle while distracted in violation of Minn. Stat. § 169.475
☐ Operated the vehicle under the influence in violation of Minn. Stat. § 169A.20
☐ Failed to signal before turning/changing lanes in violation of Minn. Stat. § 169.19
☐ Drove carelessly or recklessly in violation of Minn. Stat. § 169.13
☐ Failed to use due care and caution under the circumstances
☐ Negligent maintenance of premises (premises liability)
☐ Other: [________________________________]
C. Minnesota Comparative Fault (Minn. Stat. § 604.01)
Minnesota applies a person-specific comparative fault comparison under Minn. Stat. § 604.01, subd. 1:
- Contributory fault does not bar recovery against a person if the plaintiff's fault was not greater than that person's fault.
- Equal fault does not bar; recovery is barred against a person only when the plaintiff's fault is greater than that person's fault.
- If recovery is not barred, damages are reduced by the plaintiff's percentage of fault.
- The court may direct separate special verdicts on damages and fault percentages and must do so when any party requests them.
Claimant bears no fault for this incident. The evidence establishes that Tortfeasor was solely responsible:
[________________________________]
[________________________________]
[________________________________]
D. Joint and Several Liability (Minn. Stat. § 604.02)
Following the 2003 amendment, Minnesota applies the following rules for multiple tortfeasors:
- General Rule: Several liability — each defendant pays only their allocated percentage of fault
- Exception — Joint and Several Liability applies when:
- A defendant is found to be more than 50% at fault
- Two or more persons act in a common scheme or plan that results in injury
- A person commits an intentional tort
- Liability arises under subdivision 1(4)'s specified environmental or public-health statutes, ordinances, or programs
Uncollectible shares may be reallocated only through subdivision 2's motion filed no later than one year after judgment. Product-chain claims have the separate subdivision 3 rule.
V. INJURIES AND MEDICAL TREATMENT
A. Initial Emergency Treatment
Date: [__/__/____]
Facility: [________________________________] Hospital/Emergency Department
Treating Physician(s): [________________________________], M.D.
Chief Complaints Upon Presentation:
[________________________________]
[________________________________]
Emergency Diagnosis:
☐ Concussion / Traumatic brain injury (TBI)
☐ Cervical spine strain/sprain (whiplash)
☐ Thoracic spine strain/sprain
☐ Lumbar spine strain/sprain
☐ Herniated/bulging disc(s) at [________________________________]
☐ Fracture(s): [________________________________]
☐ Dislocation: [________________________________]
☐ Ligament tear(s): [________________________________]
☐ Meniscus/cartilage tear
☐ Rotator cuff tear
☐ Contusions/abrasions
☐ Lacerations requiring sutures
☐ Internal organ injury
☐ Rib fracture(s)
☐ Post-traumatic stress disorder (PTSD)
☐ Other: [________________________________]
Diagnostic Studies Performed:
☐ X-ray: [________________________________]
☐ CT Scan: [________________________________]
☐ MRI: [________________________________]
☐ Ultrasound: [________________________________]
☐ EEG/EMG/NCV: [________________________________]
Emergency Treatment Provided:
☐ Immobilization (cervical collar, splint, brace)
☐ Wound closure (sutures, staples, adhesive)
☐ Medications administered
☐ Admitted to hospital for [____] days
☐ Discharged with prescriptions and follow-up instructions
B. Hospitalization (If Applicable)
| Detail | Information |
|---|---|
| Admission Date | [__/__/____] |
| Discharge Date | [__/__/____] |
| Length of Stay | [____] days |
| Ward/Unit | [________________________________] |
| Attending Physician | [________________________________], M.D. |
| Procedures/Surgeries | [________________________________] |
C. Surgical Intervention (If Applicable)
| Surgery | Details |
|---|---|
| Date | [__/__/____] |
| Facility | [________________________________] |
| Surgeon | [________________________________], M.D. |
| Procedure | [________________________________] |
| Anesthesia Type | ☐ General ☐ Regional ☐ Local |
| Duration | [____] hours |
| Outcome | [________________________________] |
D. Follow-Up Medical Treatment
Primary Care Physician:
- Name: [________________________________], M.D.
- Dates of Treatment: [__/__/____] through [__/__/____]
- Number of Visits: [____]
- Treatment Summary: [________________________________]
Orthopedic Specialist:
- Name: [________________________________], M.D.
- Dates of Treatment: [__/__/____] through [__/__/____]
- Number of Visits: [____]
- Treatment Summary: [________________________________]
Neurologist/Neurosurgeon:
- Name: [________________________________], M.D.
- Dates of Treatment: [__/__/____] through [__/__/____]
- Number of Visits: [____]
- Treatment Summary: [________________________________]
Pain Management:
- Name: [________________________________], M.D.
- Dates of Treatment: [__/__/____] through [__/__/____]
- Number of Visits: [____]
- Treatment Summary: [________________________________]
- Procedures: ☐ Epidural injections ☐ Facet joint injections ☐ Nerve blocks ☐ Trigger point injections ☐ Radiofrequency ablation ☐ Spinal cord stimulator
Chiropractic Care:
- Name: [________________________________], D.C.
- Dates of Treatment: [__/__/____] through [__/__/____]
- Number of Visits: [____]
- Treatment Summary: [________________________________]
Physical Therapy:
- Name/Facility: [________________________________]
- Dates of Treatment: [__/__/____] through [__/__/____]
- Number of Sessions: [____]
- Treatment Summary: [________________________________]
Psychological/Psychiatric Treatment:
- Name: [________________________________], [☐ Ph.D. ☐ Psy.D. ☐ M.D. ☐ LCSW ☐ LP]
- Dates of Treatment: [__/__/____] through [__/__/____]
- Number of Sessions: [____]
- Diagnoses: ☐ PTSD ☐ Anxiety disorder ☐ Depression ☐ Adjustment disorder ☐ Other: [________________________________]
E. Current Condition and Prognosis
Claimant's current condition as of [__/__/____]:
☐ Claimant has reached Maximum Medical Improvement (MMI)
☐ Claimant continues to require ongoing medical treatment
☐ Claimant has permanent impairment rated at [____]% whole person
Permanent Restrictions/Limitations:
[________________________________]
[________________________________]
Future Medical Treatment Anticipated:
☐ Continued physical therapy: estimated [____] sessions at $[____] per session
☐ Additional surgery: [________________________________], estimated cost $[________________________________]
☐ Long-term pain management: estimated $[____] per year for [____] years
☐ Long-term medication: estimated $[____] per month
☐ Assistive devices/DME: $[________________________________]
☐ Home modification: $[________________________________]
☐ Future diagnostic imaging: $[________________________________]
☐ Life care plan prepared by [________________________________], estimated lifetime cost: $[________________________________]
VI. DAMAGES CALCULATION
A. Economic Damages (Past)
Note: Check the defendant and claim before stating a recoverable amount. Minnesota limits state tort liability under § 3.736, subd. 4, and municipal tort liability under § 466.04, subd. 1. A state tort claim generally requires notice under § 3.736, subd. 5, within 180 days after discovery of the loss or injury; a municipal tort claim generally requires notice to the governing body under § 466.05, subd. 1, within the same period. Check each section's exceptions and actual-notice provisions. A motor-vehicle noneconomic claim must also meet the § 65B.51, subd. 3 threshold.
| Category | Provider/Description | Amount |
|---|---|---|
| Emergency Room/Hospital | [________________________________] | $[________________________________] |
| Surgical Costs | [________________________________] | $[________________________________] |
| Physician/Specialist Visits | [________________________________] | $[________________________________] |
| Diagnostic Imaging | [________________________________] | $[________________________________] |
| Physical Therapy | [________________________________] | $[________________________________] |
| Chiropractic Treatment | [________________________________] | $[________________________________] |
| Pain Management | [________________________________] | $[________________________________] |
| Psychological Treatment | [________________________________] | $[________________________________] |
| Prescription Medications | [________________________________] | $[________________________________] |
| Medical Equipment/Supplies | [________________________________] | $[________________________________] |
| Ambulance/Transport | [________________________________] | $[________________________________] |
| Total Past Medical Expenses | $[________________________________] |
| Category | Description | Amount |
|---|---|---|
| Lost Wages/Income | [________________________________] | $[________________________________] |
| Lost Employment Benefits | [________________________________] | $[________________________________] |
| Lost Overtime/Bonuses | [________________________________] | $[________________________________] |
| Replacement Services | [________________________________] | $[________________________________] |
| Property Damage | [________________________________] | $[________________________________] |
| Out-of-Pocket Expenses | [________________________________] | $[________________________________] |
| Total Past Economic Losses | $[________________________________] |
B. Economic Damages (Future)
| Category | Description | Amount |
|---|---|---|
| Future Medical Treatment | [________________________________] | $[________________________________] |
| Future Surgery | [________________________________] | $[________________________________] |
| Future Physical Therapy | [________________________________] | $[________________________________] |
| Future Medications | [________________________________] | $[________________________________] |
| Future Pain Management | [________________________________] | $[________________________________] |
| Future Wage Loss/Diminished Earning Capacity | [________________________________] | $[________________________________] |
| Life Care Plan Costs | [________________________________] | $[________________________________] |
| Total Future Economic Damages | $[________________________________] |
C. Non-Economic Damages
Claim the supported noneconomic loss, subject to any claim-specific liability limit and, for a covered motor-vehicle claim, the § 65B.51, subd. 3 threshold.
| Category | Description | Amount |
|---|---|---|
| Physical Pain and Suffering (past) | [________________________________] | $[________________________________] |
| Physical Pain and Suffering (future) | [________________________________] | $[________________________________] |
| Mental and Emotional Distress | [________________________________] | $[________________________________] |
| Loss of Enjoyment of Life | [________________________________] | $[________________________________] |
| Physical Impairment/Disability | [________________________________] | $[________________________________] |
| Disfigurement/Scarring | [________________________________] | $[________________________________] |
| Loss of Consortium (spouse) | [________________________________] | $[________________________________] |
| Embarrassment and Humiliation | [________________________________] | $[________________________________] |
| Total Non-Economic Damages | $[________________________________] |
D. Damages Summary
| Category | Amount |
|---|---|
| Past Economic Damages | $[________________________________] |
| Future Economic Damages | $[________________________________] |
| Non-Economic Damages | $[________________________________] |
| TOTAL DAMAGES | $[________________________________] |
VII. INSURANCE COVERAGE ANALYSIS
A. Tortfeasor's Liability Coverage
| Coverage | Details |
|---|---|
| Carrier | [________________________________] |
| Policy Number | [________________________________] |
| Bodily Injury Limits | $[________________________________]/$[________________________________] |
| Property Damage Limits | $[________________________________] |
| Umbrella/Excess Policy | ☐ Yes: $[________________________________] ☐ No ☐ Unknown |
Minnesota Minimum Requirements (Minn. Stat. § 65B.49, subd. 3):
- $30,000 per person / $60,000 per accident (bodily injury)
- $10,000 property damage
B. Claimant's UM/UIM Coverage
| Coverage | Details |
|---|---|
| Carrier | [________________________________] |
| Policy Number | [________________________________] |
| UM/UIM Limits | $[________________________________]/$[________________________________] |
| Stacking Available | ☐ Yes ☐ No |
☐ UM/UIM claim is being made or reserved
☐ UM/UIM claim is not applicable at this time
C. PIP/No-Fault Benefits Coordination
| Benefit | Amount Paid by PIP | Excess Amount Claimed in Tort |
|---|---|---|
| Medical Expenses | $[________________________________] | $[________________________________] |
| Wage Loss | $[________________________________] | $[________________________________] |
| Replacement Services | $[________________________________] | $[________________________________] |
| Total | $[________________________________] | $[________________________________] |
D. Additional Coverage
| Coverage | Details |
|---|---|
| MedPay Limits | $[________________________________] |
| MedPay Benefits Paid | $[________________________________] |
| Health Insurance Coverage | [________________________________] |
| Subrogation/Lien Amount | $[________________________________] |
VIII. PREJUDGMENT INTEREST (Minn. Stat. § 549.09)
Minn. Stat. § 549.09 provides a claim-specific preverdict-interest framework. Interest may run from commencement of the action, arbitration demand, or written claim notice, whichever is first, but an action must be commenced within two years for written-notice accrual. Settlement offers, the timing of special damages, statutory exclusions, judgment amount, and whether the defendant is the State or a political subdivision can change the calculation.
Key Provisions:
- Identify the legally operative accrual event and satisfy the written-notice two-year rule
- Apply the settlement-offer comparison and the statute's category exclusions
- Use the rate applicable to the judgment amount and defendant type
Should this matter proceed to litigation, Claimant will seek interest only as calculated under § 549.09's complete framework.
Projected prejudgment interest:
| Period | Rate | Estimated Interest |
|---|---|---|
| Filing date through present | [____]% | $[________________________________] |
| Additional accrual through trial | [____]% | $[________________________________] |
| Total Estimated Prejudgment Interest | $[________________________________] |
IX. PUNITIVE DAMAGES (Minn. Stat. § 549.20)
☐ Not applicable — The facts do not support a claim for punitive damages.
☐ Applicable — The following conduct supports a claim for punitive damages.
Under Minn. Stat. § 549.20, punitive damages may be awarded upon clear and convincing evidence that the defendant's acts show a deliberate disregard for the rights or safety of others. Do not demand punitive damages from the state or a municipality under §§ 3.736 and 466.04.
Required procedure (Minn. Stat. § 549.191): Plaintiff must seek leave of court to amend the complaint to add a claim for punitive damages, upon a showing of prima facie evidence to support the claim.
Factors the court considers in determining punitive damages amount:
☐ Seriousness of hazard to the public from defendant's misconduct
☐ Profitability of the misconduct to the defendant
☐ Duration of the misconduct and any concealment
☐ Degree of defendant's awareness of the hazard
☐ Attitude and conduct upon discovery of the misconduct
☐ Number and level of employees involved in the misconduct
☐ Financial condition of the defendant
☐ Total effect of other punishment likely imposed
Description of conduct supporting punitive damages:
[________________________________]
[________________________________]
[________________________________]
X. SETTLEMENT DEMAND
A. Demand Amount
Based upon the injuries sustained, the medical treatment required, the economic losses incurred, the non-economic damages suffered, and all applicable provisions of Minnesota law, Claimant hereby demands the sum of:
$[________________________________]
in full and final settlement of all third-party liability claims against your insured arising from the [__/__/____] incident.
B. Demand Components
| Component | Amount |
|---|---|
| Past Economic Damages (excess of PIP) | $[________________________________] |
| Future Economic Damages | $[________________________________] |
| Non-Economic Damages (subject to applicable limits) | $[________________________________] |
| Prejudgment Interest (estimated) | $[________________________________] |
| Total Demand | $[________________________________] |
C. Response Deadline
This demand shall remain open for thirty (30) calendar days from the date of receipt. If your office fails to respond with a reasonable settlement offer within this period, Claimant will proceed with filing a civil action in the appropriate Minnesota District Court without further notice.
D. Settlement Conditions
Any settlement is contingent upon:
☐ Full payment of the demanded amount
☐ Release of Claimant's third-party tort claims only (no-fault/PIP rights preserved)
☐ No admission of liability clause acceptable
☐ Resolution of all applicable liens (Medicare, Medicaid, ERISA, health insurance subrogation)
☐ Resolution of PIP/no-fault subrogation claims
☐ Other: [________________________________]
XI. RESERVATION OF RIGHTS
Claimant expressly reserves all rights, claims, and causes of action not specifically addressed in this demand, including but not limited to:
☐ Claims against additional tortfeasors or responsible parties
☐ UM/UIM claims against Claimant's own carrier
☐ First-party no-fault/PIP claims and disputes
☐ Dram Shop Act claims (Minn. Stat. § 340A.801); if applicable, serve the written notice required by § 340A.802. For a damages claim, the claimant's attorney generally must serve it within 240 days after entering the attorney-client relationship concerning the claim; the action generally must begin within two years after injury.
☐ Punitive damage claims
☐ Claims for bad faith insurance practices
☐ Claims for additional damages discovered after the date of this demand
☐ Any and all rights to proceed with litigation, including jury trial
NOTICE REGARDING STATUTE OF LIMITATIONS: Determine the period and accrual rule for the actual claim. Minn. Stat. § 541.05, subd. 1(5), generally allows six years for an injury to the person not otherwise enumerated; other claims can have shorter periods, including certain intentional torts (§ 541.07), health-care malpractice (§ 541.076), wrongful death (§ 573.02), and dram shop claims (§ 340A.802). The applicable period for this claim is [________________________________] and the calculated deadline is [__/__/____]. Claimant will file suit before that deadline if settlement is not reached.
XII. ENCLOSED DOCUMENTS AND EXHIBITS INDEX
Medical Records and Bills
☐ Emergency room records and billing — [________________________________]
☐ Hospital admission/discharge records — [________________________________]
☐ Surgical records and operative reports — [________________________________]
☐ Primary care physician records — [________________________________]
☐ Orthopedic specialist records — [________________________________]
☐ Neurological records — [________________________________]
☐ Pain management records — [________________________________]
☐ Chiropractic records — [________________________________]
☐ Physical therapy records — [________________________________]
☐ Psychological/psychiatric records — [________________________________]
☐ Diagnostic imaging reports (X-ray, MRI, CT) — [________________________________]
☐ Prescription records/pharmacy printout — [________________________________]
☐ Medical bills summary — [________________________________]
☐ Life care plan — [________________________________]
Liability/Investigation Documents
☐ Police/crash report — Report #[________________________________]
☐ Photographs of accident scene
☐ Photographs of vehicle damage
☐ Photographs of injuries
☐ Witness statements
☐ Accident reconstruction report
☐ Video/dashcam footage (available upon request)
☐ Traffic citation(s)
☐ MnDOT road condition/weather data
Income/Employment Documentation
☐ Employer verification of lost wages letter
☐ Tax returns ([____], [____], [____])
☐ Pay stubs (pre-accident and post-accident)
☐ Vocational assessment/rehabilitation report
☐ Disability determination
☐ Workers' compensation records (if applicable)
Insurance Documentation
☐ Declarations page — Tortfeasor's policy
☐ Declarations page — Claimant's UM/UIM/PIP policy
☐ PIP benefits ledger/payment history
☐ Health insurance Explanation of Benefits (EOBs)
☐ Medicare/Medicaid conditional payment letter
☐ ERISA lien documentation
Other
☐ Letter of representation
☐ HIPAA authorization
☐ Signed medical releases
☐ Property damage estimate/repair invoice
☐ Rental car receipts
☐ Other: [________________________________]
XIII. SIGNATURE AND CERTIFICATION
I certify that the information provided in this demand letter is true and accurate to the best of my knowledge and belief, based upon the medical records, documentation, and information obtained during our investigation of this matter.
Respectfully submitted,
______________________________________
[________________________________], Esq.
Attorney for Claimant
Minnesota Attorney Registration No. [________________________________]
[________________________________] (Firm Name)
[________________________________] (Address)
[________________________________], Minnesota [____]
Tel: ([____]) [____]-[________]
Fax: ([____]) [____]-[________]
Email: [________________________________]
Date: [__/__/____]
XIV. SOURCES AND REFERENCES
Minnesota Statutes
- Minn. Stat. § 541.05 — Six-Year Limit for Unenumerated Personal Injury Claims
- Minn. Stat. § 549.09 — Prejudgment Interest
- Minn. Stat. § 549.191 — Punitive Damages; Procedure for Motion
- Minn. Stat. § 549.20 — Punitive Damages; Standards and Factors
- Minn. Stat. § 573.02 — Wrongful Death Actions
- Minn. Stat. § 604.01 — Comparative Fault
- Minn. Stat. § 604.02 — Joint and Several Liability
- Minn. Stat. § 65B.41-71 — Minnesota No-Fault Automobile Insurance Act
- Minn. Stat. § 65B.44 — PIP Benefits Requirements
- Minn. Stat. § 65B.49 — Minimum Coverage Requirements
- Minn. Stat. § 169.09 — Duties Following a Collision
- Minn. Stat. § 169A.20 — DWI Offenses
- Minn. Stat. § 340A.801 — Dram Shop Civil Liability
- Minn. Stat. § 340A.802 — Dram Shop Notice and Limitation
- Minn. Stat. §§ 3.736, subd. 5, and 466.05 — State and Municipal Tort-Claim Notice
Key Minnesota Cases
- Lubbers v. Anderson, 539 N.W.2d 398 (Minn. 1995) — Elements of negligence
- Staab v. Diocese of St. Cloud, 813 N.W.2d 68 (Minn. 2012) — Comparative fault allocation
Minnesota Resources
- Minnesota Revisor of Statutes: https://www.revisor.mn.gov/statutes/
- Minnesota Judicial Branch: https://www.mncourts.gov
- Minnesota Department of Commerce (Insurance): https://mn.gov/commerce/
About this template
- Last updated
- November 1, 2026
- Jurisdiction
- Minnesota
- Category
- Personal Injury
Legal authority
- Minn. Stat. § 604.01 — Comparative Fault
- Minn. Stat. § 604.02 — Joint and Several Liability
- Minn. Stat. § 541.05 — Six-Year Limit for Unenumerated Personal Injury Claims
- Minn. Stat. § 549.09 — Prejudgment Interest
- Minn. Stat. § 549.20 — Punitive Damages
- Minn. Stat. § 573.02 — Wrongful Death Actions
- Minn. Stat. § 65B.41-71 — Minnesota No-Fault Automobile Insurance Act
- Minn. Stat. § 65B.44 — PIP Benefits Requirements
- Minn. Stat. § 65B.49 — Minimum Coverage Requirements
- Minn. Stat. § 65B.51 — Motor-vehicle tort recovery and noneconomic-damages threshold
- Minn. Stat. § 169.09 — Duties After a Collision
- Minn. Stat. § 466.05 — Municipal Tort-Claim Notice
- Minn. Stat. § 340A.802 — Dram Shop Notice and Limitation
- Minn. Stat. § 3.736, subd. 4 — State Tort Liability Limits
- Minn. Stat. § 466.04, subd. 1 — Municipal Tort Liability Limits
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.
Not legal advice
This template is provided for informational purposes. We recommend having an attorney review any legal document before signing, especially for high-value or complex matters.
Checked against the law it cites
The statutes this template relies on are listed under Legal authority.
Minn. Stat. § 65B.51, subd. 3 (checked October 31, 2026): "In an action described in subdivision 1, no person shall recover damages for noneconomic detriment unless: (a) The sum of the following exceeds $4,000:"
Minn. Stat. § 604.01, subd. 1 (checked November 1, 2026): "Contributory fault does not bar recovery in an action by any person or the person's legal representative to recover damages for fault resulting in death, in injury to person or property, or in economic loss, if the contributory fault was not greater than the fault of the person against whom recovery is sought, but any damages allowed must be diminished in proportion to the amount of fault attributable to the person recovering."
Minn. Stat. § 65B.44, subd. 1(a)(1) (checked November 1, 2026): "$20,000 for medical expense loss arising out of injury to any one person"
Minn. Stat. § 65B.44, subd. 2(a) (checked November 1, 2026): "Medical expense benefits shall reimburse all reasonable expenses for necessary: (1) medical, surgical, x-ray, optical, dental, chiropractic, and rehabilitative services, including prosthetic devices"
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