Shedrick Northern
784 Fox River Rd.
Valparaiso, IN 46385-8776
(312) 292-1945
Date
Name of the Claims Adjuster
Job Title, Name of Insurance Company
Address of Insurance Company
City, State & ZIP Code of the Insurance Company
Dear Sir/Madam,
RE: DEMAND FOR COMPENSATION
On 11/26/19, I was involved in a collision whereby I was driving at 55 mph and was hit from behind by a person driving at 70 mph. At the time of the accident, I was looking straight ahead and was wearing my seatbelt. I felt shocked, frightened and was rushed to hospital. The other driver, Ms. Shirley Fields, is totally liable for the accident since she was following me too closely. Were it not for Ms. Fields negligence, I would not have suffered the pain, suffering, stress and lack of wages.
As a result of the accident, I sustained injuries accompanied by a lot of pain in my body, including in my neck, lumbar, sacral, buttocks, posterior leg region and lower back. I have also experienced a lot of discomfort which has had a detrimental effect on my day-to-day life. I incurred medical bills in the course of my treatment, which is ongoing. I am seeing a Chiropractor who helps me recover. I have suffered stress and mental anguish as a result of the accident. I also incurred costs of repairing my car.
The accident greatly reduced the quality of my life. My sleeping patterns have changed because I recount the accident every time I close my eyes to sleep. I have not been able to work because of the injuries, pain and discomfort as a result of the accident. I have also missed out on quality time with my family.
I would like to be compensated for the accident. My medical bills total $_____. I incurred $_____ while repairing my car. Taking into account my serious damages in this case, I demand $_____ to settle this case. I also expect the company to pay any future medical bills as a result of this accident. I have attached documents to prove all my claims.
I expect to hear back from you in a timely manner of no more than twenty-one (21) days from the date of this letter. If no response is received within this 30-day period, I will seek appropriate relief before a court of proper jurisdiction for full payment and all costs, damages and witness fees.
Sincerely,
______________________________
Shedrick Northern
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