How To Write a Great Settlement Injury Demand to the Liability Insurance Carrier

West Chester, Mason, and Cincinnati Ohio

As a Cincinnati personal injury attorney for over 32 years I have written hundreds of settlement demands to the insurance companies on behalf of my injured clients. The demand letter, often called a brochure, must be well documented. Any assertion you make regarding a loss must be backed up by documentary evidence. It is critical to get all the doctor's records and bills. You must get a letter from the employer to confirm lost wages, as well as having a statement from the doctor indicating the inability to perform the job. Often critical is a comprehensive doctor's report detailing the nature of the injuries and that they were likely caused by the car crash or other injurious event. 

I have reproduced an actual demand letter I made on behalf of my hurt client. Hopefully, this example will help the injured consumer as well as an aspiring injury attorney realize the complexity of seious injury cases. I can tell you this case settled for 6 figures and my client and I were both happy with the settlement. In this case no lawsuit was filed as the claim was resolved by negotiation. This letter formed the basis of the satisfactory settlement

 

 

Dear Ms. Claim’s Specialist:

As you know, Mr. Jones was horrendously injured as a result of the reckless and negligent conduct of your insured who drove directly into Mr. Jones who was standing in front of his parked truck with multiple flashing lights and hazard lights on.  The police report indicates that when they responded, Mr. Jones was clearly in pain and holding his left leg.  The police report bears out the fact that Mr. Jones had red flashers on the power unit and the motor vehicle carrier that it was pulling.  The rear flashers were in working order and there were also several loading lights shining from the rear of the power unit onto the vehicle carrier at the time of the collision.  The road surface was extremely icy at the time of the collision. 

Obviously, your insured was driving way too fast to avoid Mr. Jones.  When he applied his brakes, way late, he skidded into Mr. Jones.

Mr. Jones was responded to by the Sharonville Life Squad (Exhibit 2).  His pain was described as acute and severe, exacerbated by movement.  It was unknown if he had lost consciousness.  He was complaining of left lower pain and lower back pain.  A splint was applied to his left leg and ankle.  An IV was established, his pain was increasingly worse and they gave him 5 milligrams of Morphine.

At Bethesda Hospital, the injury to his left lower extremity was noted, also some low back pain.  There was questionable loss of consciousness with some retrograde amnesia.  He had a chest x-ray and x-rays of the left lower extremity. He had a fibula and tibia  and cuboid bone fracture.

He also was shown to have a compression fracture at L1.  He also had peroneal neuropathy. He was placed in a hyper-extension brace for his L1 compression fracture. He was placed in a walker boot for his lower leg injury

He had significant weakness of the extensor halluces, extensor digitorum and tibiales anterior tendons.  He had a CT scan of his brain and there was no intra-cranial hemorrhage.

A fracture to his lumbar spine was progressing during the hospitalization and on further CT scan, it was noted to have collapsed from 39 millimeters to 32 millimeters. 

Mr. Jones’ whole life was changed at that time.  He has worked diligently to recover from all of his injuries and get back to employment, but he has permanent impairment with arthritis of the lower extremity already setting in and a collapsed vertebrae.

Medical Report Gives Proximate Cause and Permanency of Injuries

We have previously submitted to you the report of Dr. Royce Van Gerpen dated 01/20/2009 which details what Mr. Jones’s permanent injuries and residuals that Mr. Jones will have for the rest of his life (Exhibit 8)

Dr. Van Gerpen detailed that it was a T12 compression fracture instead of an L1 compression fracture.   His other injuries involved multiple fractures of the left lower extremity below the knee.  This included two areas in the fibula as well as the anterior aspect of the tibia near the ankle.  There were also soft tissue bruises and lacerations in the lower extremity.

He was on crutches for over four months.  His rehabilitation progress was slow because of left ankle swelling and intermittent locking.

He was not able to stand on the left ankle for prolonged periods of time in the summer of 2008 because of prolonged pain and swelling.  He also had marked sensitivity of the nerve around the lateral aspect of the ankle and extending into the dorsum of the foot.  That was a significant part of his problems.  X-rays as of 05/05/2008 showed that he had lost of a small piece of bone off the tibia adjacent to the articular surface of the ankle (the joint area where arthritis can and did develop).

At this point Dr. olsen referred Mr. jones to an occupational medicine specialist Dr. Vsan Gerpen.he had a CT scan which confirmed traumatically induced arthritis at the tibular talur joint. This was exactly where one of the fractures occured.

            He had been most recently seen on 01/13/2009 by Dr. Van Gerpen.  Residual symptoms present at that time and still present included aching in the mid-back which would require him to get out and move around and stretch more frequently than he had in the past.  Continuous prolonged sitting was thus being interrupted.  He also noted aching in the left ankle with some swelling.  Frequent pushing on the clutch would cause discomfort in the ankle area.  However, he was able to discontinue all but over-the-counter medication.  He was determined to have reached maximum medical improvement at that point in time.  His compression fracture gave him an 8 percent impairment to the body as a whole. 

 

            The fractures of the fibula and distal tibula have resulted in permanent restrictions in mobility involving the left ankle and hind foot.  The continued swelling is documented on his physical examination.  The association loss of motion and swelling gave him a 3 percent whole-person impairment and his hind foot impairment was rated at 1 percent whole-person.  Thus, it was concluded that he a permanent partial impairment rating of 13 percent to the body as a whole.  (Dr. Van Gerpen report 01/20/2009, Exhibit 8 and attached hereto.)

 

Mr. Jones’s Day To Day Activity Restrictions and

Treatment To The  Present

 

When Mr. Jones got back to his home state, he was seen by Dr. Mark Wilson at the Northwest Orthopedic Specialists on 02/26/2008.  (Exhibit 5) 

Dr. Olson listed the diagnoses as follows:

 

  1. Fractured cuboid, left.
  2. Fracture distal anterior tibia, left.
  3. Fracture fibular shaft, left.
  4. T12 compression fracture.

.

The next physician that he saw was Dr. Raymond Sicilia, D.C.  The first visit there was 03/06/2008 (Exhibit 6).  He was at that time taking Hydrocodone and Ibuprofen.  His present complaint to the doctor was pain in his back.  As far as what he could do and what his pain was like, he felt that the pain comes and goes and was moderate.  Because of the pain, he was not able to some washing and dressing without help.  He could only lift very light weights, he could only walk while using a cane or on crutches.  Pain prevented him from sitting for more than a half hour.  He could not stand for longer than 10 minutes.  His normal night’s sleep was reduced.  Pain has restricted his social life to his home.  Essentially all of his activities were restricted.  He felt that his day-to-day activities were extremely limited.  He was not working at all due to his back and leg injury.  He indicated that during the past four weeks, his social activities had been interfered with all of the time. (Exhibit 6) 

 

He had to have other people help him because of his back.  He was only able to dress slowly.  He tried not to bend or kneel.  He could hardly turn over in his bed because of his back.  He had trouble putting on his socks.  He could only walk short distances.  His sleep was disturbed.  He was staying in bed most of the day because of his back.  He was on a regimen of regular chiropractic visits.  He had burning numbness and stiffness.  In describing his pain, even through October of 2008, his last visit with Dr. Sicilia was 11/19/2008.  His back was stiff.  His pain level was a 2 out of 10 and he had pain at least 10 percent of the time.  The doctor felt that he also had a lumbar strain, thoracic strain/sprain and sacroiliac joint dysfunction.  (Exhibit 6)

 

During this time, he, of course, went back to Dr. Olson, the orthopedic specialist and was seen there again on 03/25/2008.  The compression fracture at T12 was increasing.  There was still angulation of the segmental fracture of the fibula.  Dr. Olson thought that Mr. Jones should be started on physical therapy so that his range of motion of the ankle and foot could be increased.  He was still using a cast walking and would go without crutches if he were able. 

Mr. Jones commenced physical therapy at this time. His chief complaint was decreased range of motion and function in the leg with burning pain swelling as well as numbness in the dorsal foot, lateral leg, and in the greater toe.  He was also telling them about his back pain.  They noted that he had had some periodic treatments for low back pain prior to the injury, but no other health problems noted.  (We can supplement the record with that information and documentation although it is inconsequential for the purposes of this claim.)  Mr. Jones describes this as treatment with Dr. Sicilia, D.C. 

Physical therapy records detailed that the functional goal was to ambulate with normal gait pattern and get some range of motion and strength back in the foot.  They were going to see him twice a week for at least 4 to 6 months.  Their examination confirmed his limited range of motion and the swelling in leg and the fact that it was so bad it was described as “pitting edema.”

As of 06/13/2008, he was limping less and progressing on his exercises.  His range of motion and strength continued to be restricted. On 7/8/2008 his pt prescription ran out but the therapist still wanted to see more progress. he was able to get a further prescription, but because of the short delay he had lost some range of motion. 

On 09/19/2008, Therapist Blakely stated Mr. Jones was having ongoing problems with a locking in the area just behind the lateral malleolus when walking.  He is tender in the back of malleolus as well as through the peroneus longus and brevis tendons.  The therapist thought he had some tendonitis with possible tendon subluxation occurring causing his locking sensation and inflammation.  The therapist was asking for advice from Dr. Gerpen.  He indicated that Mr. Pustovit continues to have limitations and discomfort in both the talocrural and subtalar joints. 

On 04/11/2008, Dr. Olson filled out a form indicating that the patient had been disabled from 02/12/2008 and was continuing to be disabled.  He was going to have a permanent defect due to the T12 vertebral change in shape.  (Exhibit 5)

On 05/05/2008, Dr. Olson saw Mr. Jones again.  He encouraged him weight bear without using his crutches.  He thought that he could progress to using one crutch.  He should not be lifting over 5 to 10 pounds.  His physical therapy was renewed.  The doctor thought it was going to be problematic for return to work with his combination of injuries.  He thought he would be best-served by an occupational medicine physician to take over his care.

His care was then taken over by Dr. Royce Van Gerpen, an occupational medicine specialist on 09/05/2008.  Mr. Jone’s chief complaints were left ankle pain swelling, weakness and the back pain from the compression fracture.  (Exhibit 8)

Dr. Van Gerpen felt that there was significant concern that the left distal tibia fracture may have a free fragment in the joint space or other intra-articular pathology.  Dr. Olson has raised concerns about a cuboid fracture.  The dysfunction of left ankle joint is clearly hindering the return to full duty and needs to be thoroughly investigated.  This will be further investigated by an MRI.  He was to remain off work.  A disability form was completed indicating continued complete disability.

The MRI of the left ankle was done on 09/15/2008 at Inland Imaging (Exhibit 9).  He now had distal anterior tibial osteoarthritis

Dr. Van Gerpen reviewed the MRI and indicated it identifies abnormality of the anterior distal tibia with subchondral cyst formation consistent with arthritis.  No foreign body was identified.

Diffused swelling of the left ankle persisted upon examination.  He had continued to have decreased range of motion.  He had major sensitivity extending into the great toe

They started a course of anti-inflammatory medication for the arthritis in the distal tibia which was affecting the ankle joint.  Dr. Van Gerpen also wanted to obtain a CT of the ankle continuing to search for intra-articular loose body.  There was consideration of referring him to a ankle specialist for arthroscopy if symptoms did not improve.

Igor was again seen on 10/02/2008 by Dr. Van Gerpen and his ankle was still locking.  He described a stabbing sensation near the lower posterior lateral malleolus. 

The CT scan had been obtained on 09/25/2008.  The impression was osteoarthritic changes anterior aspect anterior talus joint.  However, there was nothing bony that was causing the locking sensation. 

He was to continue physical therapy and remain off work.  He continued on Relafen. 

On 10/27/2008, he came back to Dr. Van Gerpen and noted that he was improving.  He is working on a balance board to stretch his ankle in all directions.  He still noted that the range of motion was decreased.  

He was still seeing a chiropractor about once every 10 days.  He was continuing to use anti-inflammatory medication, Relafen. 

 

Mr. Jones returned on 11/20/2008 to Dr. Van Gerpen.  He had continued range of motion restriction and was having less locking and less sharp pain and wanted to be released to try to return to work.  He had met with his employer and a return-to-work program was being outlined since the volume of workload is low in December but usually picks up in January.  He was having grating as he goes through circumduction of the ankle and wanted release to return to work on 12/08/2008 and was to continue with home exercise over the next two weeks to strengthen his ankle and leg. His last formal visit with physical therapy was on 11/24/2008.

 

On 01/13/2009, Dr. Van Gerpen noted that Mr. Jones still had left ankle pain and swelling and mid-back pain.  He had an occasional pain in the mid-back which interrupts his long-distance driving.  He needs to get out and move around and stretch more frequently than he did in the past.  He is also continuing to have aching discomfort in the left ankle.  He notes continued daily swelling of the left ankle that is not entirely resolved.  He has not yet returned to driving the car-hauler.  The reason for that is because that required a lot more dexterity, balance and strength than he had in his foot.

 

In terms of medical bills, we are documenting total to you of $29,579.62.  This include his hotel and airline expense to fly back to Seattle.

The lien from Country Financial remains for medicals paid is in the amount of $28,103.28.  Their wage loss lien, which was paid at only a fraction of his wage loss, is $18,212.33. 

In addition, Midwest National Life Insurance Company of Tennessee paid medical bills in the amount of $6,379.95. 

This documentation is included under the subrogation tab, so actual medicals total $34,483.23.  Adding in the plane fare and hotel of $1,366.62, the total non-wage specials are $35,848.85.

 

Lost Wages

 

Based upon the tax returns that we sent you in the year 2007, his business income was $47,475.  This equates to approximately $4,000 per month.  He was released to return to work on 12/08/2008.  This would be exactly 10 months he was unemployed.  If you multiply $4,000 by 10, you come up with $40,000 in lost wages.

 

I am enclosing his trip payment for 01/08/2008 in the amount of $4,841.85 and his trip payment for 01/24/2008 in the amount of $3,818.77.  This totals over $8,600 in a one-month period in further support of how he was doing immediately before his injury.  So, total past specials are $35,848.85 plus $40,000.00 equals $75,848.85.

 

Permanent Injuries

Mr. Jones continues to have problems with his foot if he is on it too long.  He obviously has arthritis in the ankle joint that is not going to get any better and only get worse.   He is planning to follow up with Dr. Van Gerpen to see if anything can be done.

During the time of his convalescence, he was pretty much totally disabled and on crutches for four months.  He could not go to church since there were steps.  He loved to do camping and fishing and visit both sets of parents which was impossible to do. 

He has two children, ages 4 and 8, and he could not play with them as he wanted to.  Also, his marital relationship was disturbed.

Life Expectancy Loss of Enjoyment and Pain and Suffering

Mr. Jones’s date of birth is 08/14/1976.  He is only 33 years old.  He has a 50-year life expectancy to live with the arthritis in his ankle and a collapsed vertebrae.  If he were awarded $2,000 per year, which equates to approximately $40.00 per week, for the ravages of arthritis and the collapsed vertebrae, there would be future pain and suffering and loss of enjoyment of life in the amount of $100,000.

His significant pain and suffering and loss of enjoyment of life for close to a year would certainly be worth $50,000 given the total impact on his life.  Thus, there would be $150,000 for past and future pain and suffering and loss of enjoyment of life.  Add in past medical and flight of $35,848.85 and lost wages of $40,000, add in another $8,649 for future medicals, and the total is $235,000.  Therefore, I have his authority to resolve his claim for $235,000.

I await to hear from you as we have provided full and complete documentation.

Very truly yours,                                                                                                                                        

Anthony D. Castelli

 

About The Author Cincinnati Attorney Anthony Castelli

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Cincinnnati, Ohio

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