Fill and Sign the Settlement Personal Injury Form

- 1 - RE: Name of injured party Dear___________ This letter is notify you that my client, _______________, a minor child, suffered physical and property damages in an automobile accident which occurred on the ______ day of __________, 20___ due to the negligence of your insured, _________________. As a result of this accident, my client has suffered both personal injuries and property damage. Prior to filing suit in this matter, I want to advise you that the injuries to date include $_______ damage/total loss to _____________’s vehicle as set out in the estimate/valuation prepared by _________________ repair company and attached to this correspondence. The personal injuries which have been sustained by __________________include the following, to date: Emergency Room _________ Hospital _________ Ambulance _________ Emerg. Physician _________ Office Visits: Dr.________ _________ Dr.________ _________ Dr.________ _________ Phys. Therapy _________ Prescriptions _________ Other _________ - 2 - Mileage to Med. Treatment x .45/mi. _________ Loss of Earnings _________ TOTAL _________ It is expected that continuing treatment will be required, according to the report of Dr._________, which is attached for your information, in order to improve ____________’s prospects to reach full medical recovery. As noted on that report, __________ has suffered damage to his _____________________, which will/may have detrimental impact on his future health/ability to __________. Additionally, __________has suffered mental distress and pain as a direct result of his injury(ies). If you desire to settle this matter without the necessity of our filing suit, we are prepared to settle this matter for _____________________. In the event this matter is not resolved to our satisfaction within fifteen (15) days from the date of this letter, this offer shall be deemed withdrawn and we shall have no alternative but to pursue all available legal reme dies in this regard. (Alternative provision: If you desire to settle this matter without the necessity of our filing suit, we are prepared to meet with you to discuss this matter further on the ______ da y of ____________, 20___, at ______________________________.) Please confirm your plan to attend this meeting by calling me at the tele phone number listed below. Thank you for your cooperation in resolving this matter. - 3 - Sincerely,_____________________________