insurance claim (rough draft)

Lindsey Hartman
434 Northlake St
Bloomington, IL 10308
April 18th, 2011


Jim McCormick
Claims Adjuster
All State Insurance
850 7th Ave Bloomington, IL 10019
Re: Your Insured, Brain Carter
Claim No: G 568-12
Claimant: Lindsey Hartman
Date of Loss : February 18th, 2011
Dear Mr. McCormick,

On February 18, 2011, at 2:45 I was severely injured in a car accident with your insurer Brian Carter. I had the green light and as I proceeded to turn left onto Main Street I was struck by Brian Carter in a black escalade. The police report said that Brian was very intoxicated. The escalade smashed into my green cavalier directly from the rear at approximately 65 mph. On impact my car flipped several times in which I had no control of safety since I was violently pinballed inside the car. My car then landed in a ditch where I was thrown from my vehicle. My injuries were sever, as I suffered a broken neck, 3 broken ribs and a broken leg. Brian Carter is at fault here for he was very intoxicated, failed to stop on red, and slammed into my rear. I was rushed straight to the hospital in an ambulance where they took several x-rays and found my injuries. The total cost due to injury is:

Emergency Room $200
Ambulance
X-Rays $100
$110
Neck Brace $50
Prescription Medicine $90
Physical Therapy $400
Crutches $25
Total $975

My injuries made me miss a straight month of work. Because of your insurers negligence to follow the traffic safety laws, I have been in extreme pain and suffering for the last 2 months. My neck and leg are still not fully healed from the crash. The injuries have disrupted my lifestyle and have affected my productivity at work. As a result of these injuries and my continuing pain and suffering, I demand compensation in the amount of $5,000.
I hope to hear from you soon,
Sincerely, Lindsey Hartman