A demand letter template is only one piece of what an insurance adjuster reviews. The letter makes the request. The documents behind it, the medical expense summary, the wage verification, and the exhibits, are what support it. This guide gives you a complete set of fill-in templates for a slip and fall claim in California when a private owner, landlord, or business controlled the property: a demand letter organized around exhibits, a medical expense summary, a request to your employer to verify lost wages, and a follow-up letter for when the insurer doesn’t respond. It also explains how to assemble the package and the mistakes that weaken it.
These templates are general tools, not advice tailored to you, and using them doesn’t make you a client of the firm. If your injuries are significant, if more than one company may be responsible, or if the property is publicly owned, consider having a lawyer review your claim before you send anything.
How to Use This Demand Letter Template Package
- Wait until your condition is stable. Demanding a figure mid-treatment risks omitting care you’ll need later.
- Collect the records first. Medical records and itemized bills, wage information, photos, the incident report number, and witness names.
- Fill in the supporting documents (Templates B and C) before the letter. The letter should only state figures the attachments support.
- Number your exhibits. Refer to each one in the letter, so the adjuster can match every statement to a document.
- Send by a method that proves delivery, and keep a complete copy of exactly what you sent.
Ideally, a request asking the property owner to preserve video and inspection records went out much earlier, soon after the fall.
Template A: Demand Letter Template Organized by Exhibit
[Your Name]
[Mailing Address]
[Phone] | [Email]
[Date]
[Insurance Company]
Attn: [Adjuster Name]
[Address]
Re: Claimant: [Your Name]
Your Insured: [Exact legal name of property owner or business]
Claim No.: [Number]
Date and Place of Fall: [Date], [Property name and street address]
Dear [Adjuster Name]:
SUMMARY
I am presenting my claim for injuries from a fall at your insured's property on
[date]. This letter summarizes the facts, my injuries, and my documented losses.
Each statement below refers to an enclosed exhibit.
THE FALL (Exhibits 1–3)
At about [time], I fell at [exact spot] because of [factual description of the
hazard]. [Describe any missing warning, cone, rail, or lighting.] Photos taken
[when] are Exhibit 1. The incident report number is [number] (Exhibit 2).
Witness contact information is Exhibit 3.
WHY YOUR INSURED IS RESPONSIBLE (Exhibit 4)
[State only facts you can support, for example: an employee's statement about how
long the condition existed, earlier complaints, or what the photos show.]
[Copies of any such statements, complaints, or records are Exhibit 4.]
MY INJURIES AND TREATMENT (Exhibit 5)
My providers diagnosed [diagnoses as written in your records]. I was treated by
[providers] from [date] to [date]. [My treating provider discharged me on (date). /
My providers consider my condition stable.]
MY DOCUMENTED LOSSES
Medical expenses (summary at Exhibit 6, bills at Exhibit 7): $[total]
Lost wages (employer verification at Exhibit 8): $[total]
Other out-of-pocket costs (receipts at Exhibit 9): $[total]
How the injury has affected my daily life:
[Two or three specific, concrete examples]
SETTLEMENT REQUEST
To resolve this claim, I request $[amount]. Please respond in writing by
[calendar date].
Sincerely,
[Signature]
[Printed Name]
Enclosures: Exhibits 1–9 (copies)
Template B: Medical Expense Summary
Attach this as a one-page summary in front of the itemized bills. Adjusters compare it line by line against the bills, so every entry should match one.
MEDICAL EXPENSE SUMMARY – [Your Name] – Fall on [Date] Provider / Facility | Dates of Service | Type of Care | Amount Billed | Paid by (insurer/you) | Balance --------------------|------------------|--------------|---------------|-----------------------|-------- [Emergency room] | [date] | [ER visit] | $[ ] | [ ] | $[ ] [Imaging center] | [date] | [X-ray/MRI] | $[ ] | [ ] | $[ ] [Physician] | [dates] | [follow-up] | $[ ] | [ ] | $[ ] [Physical therapy] | [dates] | [therapy] | $[ ] | [ ] | $[ ] [Pharmacy] | [dates] | [medication] | $[ ] | [ ] | $[ ] TOTALS $[ ]
Listing who paid each bill matters. A health plan or government program that paid for care may have a right to be repaid from any recovery.
Template C: Request to Your Employer to Verify Lost Wages
[Your Name] [Date] [Employer Name] Attn: [Payroll / Human Resources] [Address] Re: Wage and Time-Off Verification for [Your Name], Employee ID [if any] I was injured on [date] and missed work as a result. Please provide a letter on company letterhead confirming: - my position and rate of pay (hourly rate or salary) on [date of fall] - my usual scheduled hours per week - the dates I was absent because of the injury - any sick leave or vacation time I used for those absences - any bonuses, overtime, or shifts I was scheduled for and missed Please send it to me at [address/email]. Thank you. [Signature] [Printed Name]
Template D: Follow-Up When the Insurer Hasn’t Responded
[Date] [Insurance Company] Attn: [Adjuster Name] Re: Claim No. [Number] – Claimant [Your Name] Dear [Adjuster Name]: On [date], I sent my demand letter and Exhibits 1–9 by [delivery method] (confirmation enclosed). I have not received a written response. Please confirm receipt and tell me in writing: - whether any additional information is needed to evaluate the claim - when I can expect a response to my settlement request Sincerely, [Signature] [Printed Name]
California’s Fair Claims Settlement Practices Regulations (California Code of Regulations, title 10, beginning at section 2695.1) set standards for how insurers handle and respond to claims. If an insurer repeatedly fails to respond, the California Department of Insurance accepts consumer complaints.
Common Mistakes With Any Demand Letter Template
- Numbers the exhibits don’t support. A total that doesn’t match the bills invites a line-by-line challenge.
- Overstating the injury. Describing symptoms your records don’t mention can undermine everything else in the letter.
- Admissions about your own attention. Phrases such as “I wasn’t looking” give the insurer a shared-fault argument.
- Sending originals. Send copies only, and keep everything you send.
- Signing what comes back without reading it. Medical authorizations and releases can be much broader than needed.
- Assuming the letter stops the clock. It doesn’t. The two-year filing period in Code of Civil Procedure section 335.1 keeps running while you negotiate.
Falls on Public Property
These templates are for claims against private owners and businesses. A fall on a city sidewalk, at a public building, or on other government property follows the Government Claims Act. Under Government Code section 911.2, the written government claim is generally due within six months, often on a form the agency provides. A demand letter to an insurer doesn’t replace that claim. See our trip and fall lawyer page for sidewalk and public property falls.
After You Send the Demand Letter Template Package
The insurer may ask for more records, make an offer, or deny the claim. Offers and counteroffers often go back and forth. If the claim doesn’t resolve, a lawsuit may be needed before the deadline. See slip and fall settlements for how the process continues, and slip and fall lawsuit for what filing involves.
Help With a Demand Letter Template in San Mateo County
If you’d rather not handle the demand yourself, or you want someone to review your package before it goes out, Vaksman Khalfin, PC. The first conversation is free. If you hire the firm, the written contingency agreement sets out the fee percentage and lists case costs separately. Call (650) 250-0705.
Reviewed by Alan D. Khalfin, Partner and Managing Attorney, Vaksman Khalfin, PC (admitted in California). Last reviewed: 10/06/2026
Frequently Asked Questions
The claimant and insured's names, the claim number, how and where the fall happened, why the owner is responsible, your injuries and treatment, itemized losses tied to enclosed exhibits, a settlement request, and a response date.
Photos, the incident report, witness information, medical records and itemized bills, a medical expense summary, employer wage verification, and receipts for other costs. Send copies, not originals.
A letter from your employer confirming your pay rate, usual hours, the dates you missed, and any leave you used. Template C on this page is a request you can send to your employer.
Send a written follow-up asking the insurer to confirm receipt and say what else it needs. California's Fair Claims Settlement Practices Regulations set standards for how insurers handle claims, and the Department of Insurance accepts complaints.
No. The two-year period for filing an injury lawsuit under Code of Civil Procedure section 335.1 continues to run during negotiations.
Not on its own. Claims against public entities generally require a written government claim within six months under Government Code section 911.2, usually on the agency's form.
