Letter Header
[[Your Full Name]]
[[Your Street Address]], [[Your City]], [[Your State]] [[Your ZIP Code]]
[[Your Phone Number]] | [[Your Email Address]]
[[Date of Letter]]
VIA [[Certified Mail / Email / Insurer Online Portal]]
[[Insurance Company Name]]
Claims Department
[[Insurer Claims Address]]
RE: Claim Number [[Claim Number]] | Policy Number [[Policy Number]]
Insured: [[Your Full Name]]
Date of Loss: [[Date of Loss]] | Location of Loss: [[City, State Where Loss Occurred]]
Dear Claims Adjuster [[Adjuster Name - or "to Whom It May Concern"]]:
Section 1 - Purpose of This Letter
I am writing regarding the above-referenced claim for damage to my [[Vehicle Year]] [[Vehicle Make]] [[Vehicle Model]] (VIN [[Vehicle Identification Number]]), which occurred on [[Date of Loss]] at approximately [[Time of Loss]] near [[Location of Loss]]. This letter documents the facts of the loss, itemizes the damages, cites the coverage provision under which I am making this claim, and requests [[the enclosed repair estimate be approved / a supplemental payment / reconsideration of the settlement offer dated (Date)]].
Section 2 - Factual Narrative
On [[Date of Loss]], the following occurred: [[Factual, chronological description of the incident - what happened, in what order, who was involved]].
- Police report reference: [[Police Report Number]], filed with [[Law Enforcement Agency Name]] on [[Report Date]].
- Witnesses (if any): [[Witness Name(s) and Contact Information - or "None"]].
- Photos/video taken: [[Description of photo/video evidence and when it was captured]].
Section 3 - Coverage Provision Invoked
This claim is submitted under the following coverage on Policy Number [[Policy Number]]:
- [ ] Collision coverage - damage from impact with another vehicle or object, regardless of fault.
- [ ] Comprehensive coverage - damage from a non-collision event (theft, vandalism, weather, animal strike, fire, glass).
- [ ] Uninsured/Underinsured Motorist (UM/UIM) coverage - damage or injury caused by a driver with no insurance or insufficient limits.
- [ ] Property damage liability (third-party claim) - damage I am claiming against the at-fault driver's policy.
- [ ] Bodily injury liability / Medical payments - injury-related costs (if applicable, itemize separately from vehicle damage).
Deductible applicable to this claim: $[[Deductible Amount]] (per Section [[Policy Section Number]] of the policy).
Section 4 - Damage Description and Itemized Estimate
| # | Damaged Component | Repair / Replace | Estimated Cost |
|---|
| 1 | [[Component - e.g., Front Bumper]] | [[Repair/Replace]] | $[[Estimated Cost]] |
| 2 | [[Component]] | [[Repair/Replace]] | $[[Estimated Cost]] |
| 3 | [[Component]] | [[Repair/Replace]] | $[[Estimated Cost]] |
| 4 | [[Component]] | [[Repair/Replace]] | $[[Estimated Cost]] |
| Total Estimated Repair Cost | | $[[Total Estimated Repair Cost]] |
Enclosed with this letter: [[list attachments - e.g., "two independent body-shop repair estimates, 14 photographs of the damage, the police report, and the towing invoice"]].
Section 5 - Diminished Value Claim (if applicable)
Beyond the cost of repair, this vehicle will suffer a diminished resale value as a result of this loss, since a documented accident history reduces market value even after a complete, quality repair. [ ] I am requesting a diminished-value assessment and payment in addition to the repair costs above. A diminished-value claim is most commonly available for third-party (at-fault driver's insurer) claims; check your policy and state rules for first-party diminished-value eligibility.
Estimated diminished value (if independently appraised): $[[Diminished Value Estimate - or "To be determined by independent appraisal"]].
Section 6 - Disputed Point / Demand
[[State clearly what you are disputing or requesting - e.g., "The initial estimate submitted by your adjuster on (date) used aftermarket parts where the manufacturer's warranty requires OEM parts, and did not include the diminished-value component described above. I am requesting the claim be reevaluated using the enclosed independent estimate, and that a diminished-value payment be included in the final settlement."]]
Section 7 - Applicable Law and Response Deadline
Insurers are generally required by state unfair-claims-practices and prompt-pay statutes to acknowledge, investigate, and resolve claims within specific timeframes, and to explain in writing the basis for any denial or reduced payment. Please respond in writing within [[Number of Days - e.g., 14]] days of the date of this letter with your determination on the items above. If I do not receive a response by [[Response Deadline Date]], I will consider escalating this matter to my state insurance department's consumer complaint process and/or pursuing appraisal or legal remedies available under my policy and applicable state law.
Section 8 - Closing and Signature
Please contact me at [[Your Phone Number]] or [[Your Email Address]] with any questions or to discuss this claim further. I appreciate your prompt attention to this matter.
Sincerely,
___________________________
[[Your Full Name]]
Enclosures: [[List each enclosure - estimates, photos, police report, invoices, correspondence]]
cc: [[Your Insurance Agent Name - or "N/A"]], [[Attorney Name - if represented, or "N/A"]]
> ⚠️ Template example - not professional (legal/financial/medical) advice. Coverage terms, deductibles, prompt-pay deadlines, and diminished-value rules vary by policy and by state - review your specific policy language and your state insurance department's consumer guidance before sending. Sources verified as of June 2026: general first-party/third-party auto claims practice; state unfair-claims-practices and prompt-pay statutes vary by state - confirm the specific citation for your state's Department of Insurance.
