{Today’s Date}
DEMAND LETTER FOR
SETTLEMENT PURPOSES ONLY
Sent via facsimile: {(xxx) xxx-xxxx}
{Adjuster’s Name and Title}
{Insurance Company Name}
{Address – Line 1}
{Address – Line 2}
{City, State, Zip}
Re: Our Client: {Claimant’s Name}
Decedent: {Insured’s Name}
Claim No: {}
Your Insured: {Insured’s Name}
Date of Loss: {}
Dear [Adjuster’s Name]:
As previously discussed, [Client/claimant’s] is making a claim in the wrongful death of [her husband/his wife/his father/his mother/his minor child], the decedent, [], for the fatal car accident caused by your insured, []. We submit this demand letter as a good faith effort to settle this matter.
Factual Background
As you know, this fatal motor vehicle accident occurred on [day of week], [date] at approximately [00:00] [a.m./p.m.] on [street name] in [City], Arizona. [Decedent’s name], a restrained driver, operating a [year, make and model of vehicle], was traveling [north/south/east/west]bound in the [middle/curb] lane in [light/normal/rush hour] traffic. [Decedent’s name] began to slow [his/her] vehicle when [your insured], operating a [year, make and model of vehicle], slammed into the back of [client/claimant]’s vehicle.
[Your insured] admits that before the accident occurred, [he/she] attempted to stop but lost control of [his/her] vehicle. The rear-end impact was so intense that it caused [decedent’s] vehicle [describe the specific facts consistent with the accident report and photographic damage of vehicles] before coming to a resting point.
[Your insured] was issued a citation at the scene for violation of A.R.S. § [insert specific statute number as referenced on the accident report]. [Your insured] was arrested at the scene of the accident and found to have had a blood-alcohol level that well exceeded the legal limits [insert blood alcohol results listed on accident report or supplemental accident report] and was classified as an extreme DUI.
There were [insert number] witnesses to this accident. [Your insured] owed [decedent] a duty of care to not drive while under the influence and to drive prudently, safely and within the bounds of the law, including a duty to exercise reasonable care, reasonable and prudent under the circumstances, while driving a vehicle on a roadway including controlling the speed of the vehicle as necessary to avoid colliding with any object, person or vehicle.
Injuries and Damages:
As a result of the impact, [decedent’s name] was extricated from his vehicle and pronounced dead at the scene [or was transported to the nearest hospital and pronounced dead shortly therafter]. His fatal injuries included [list hospital record’s diagnoses/reports].
Past Medical Specials and Funeral Expenses:
Medical expenses for medical care and services for the injury that resulted in death:
[Ambulance/Air Evac] $
[Hospital]
[Emergency Room Physicians]
[Anesthesiologist]
[General or Other Surgeon]
[Diagnostic Testing / X-rays, CT Scan, MRI]
[Other Medical Providers]
[Memorial/Funeral]
[Burial/Mortuary] $
Medical/Funeral Expenses: $
Lost Income/Lost Earning Capacity:
[Calculate decedent’s wage loss or if decedent was self-employed include tax returns and expert opinion on amount lost per year multiplied by life expectancy.]
Lost Income/Lost Earning Capacity: $
General Damages:
Beneficiaries are entitled to compensation for the loss of love, affection, companionship, care, protection, and guidance as a result of this fatal accident caused your insured. Beneficiaries are further entitled to compensation for the pain, grief, sorrow, anguish, stress, shock, and mental suffering already experienced, and reasonably probable to be experienced in the future.
Pain and Suffering of Beneficiaries: $
Demand for Settlement
Given the clear liability by your insured for the wrongful death of [decedent’s name] the beneficiaries are willing to settle their claim for $____________.
We look forward to your response.
Sincerely,
{YOUR LAW FIRM NAME}
{attorney’s name}
Enclosure