Sample Premises Accident Insurance Demand Letter Template
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3Premises Accident Insurance Demand Letter
Jonathan Rosenfeld
145 Dearborn Avenue
Chicago, IL 60006
Cell Phone (123) 456-7890
Home Phone (234) 567-8901
Insurance Company
Contact Information
Adress
Date
FOR SETTLEMENT PURPOSES ONLY
Re: Claim No.A-123456
Your Insured: John Smith
Date of Loss 06.01.2016
Claimant: Jonathan Rosenfeld
Date of Birth: 02.14.1978
Dear Insurance Contact:
[state facts of premises accident]
Background:
[state background of incident including any relevant medical/work history]
My injuries: The immediate force of the accident:
List all injuries
•
[Discuss the immediate medical care given to you following the premises accident]
[Discuss any rehabilitative or subsequent care you received in the weeks and months following the
premises accident]
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Parent category: Letters