[Your Name]
[Address]
[Email / Phone]
[Date]

[Adjuster / Company]
Re: Claimant [Name], Date of Loss [Date], Claim No. [Number]

This is an informational settlement demand template, not legal advice. I am requesting settlement of the bodily injury claim arising from [brief incident description]. Liability is supported by [police report / incident report / witness statements / photos / video]. My documented damages include medical expenses of $[amount], wage loss of $[amount], property loss of $[amount], and continuing effects described below.

Medical chronology:
- [Date]: [Provider], [diagnosis/treatment]
- [Date]: [Provider], [diagnosis/treatment]
- [Date]: [Provider], [diagnosis/treatment]

Impact statement:
[Describe pain, limitations, missed work, household help, scarring, future treatment, and daily-life effects factually.]

Demand:
Based on the documentation enclosed, I demand $[amount] to resolve the claim, subject to written confirmation of liens, subrogation claims, and release language. This demand does not extend any statute of limitations or waive any rights.