Sample Demand Letter – Workplace Injury, No Worker’s Compensation

If you experience an injury while working on the job and wish to file a personal injury claim, it is usually covered by your employer’s Worker’s Compensation Insurance.

If you work for a small company that doesn’t have Worker’s Compensation, you will have to write a demand letter detailing the compensation you require, most likely from out of your employer’s pocket.

After your medical treatment for your work injury is complete, you or an attorney that you have hired will write a demand letter. You should be sure to include:

  • Copies of your medical records
  • Receipts for any expenses
  • Statements from witnesses
  • Any other related evidence

Writing a well-written and detailed demand letter will help you negotiate with your employer more successfully. Including all of the supporting documents and evidence will also help you win the damages you need and deserve for your workplace injury claim.

Sample Demand Letter in a Workplace Injury Claim with No Worker’s Compensation

The first step to you claim is your personal injury letter to your employer. Because of this, your letter to your employer needs to be specific and detailed. It will help set the tone of the claims process, so you need to remain professional in the injury letter.

Your demand letter should be typed and follow a block format. If you handwrite the letter to your employer, then something may be misread.

Before writing your demand letter to your employer, consult with a personal injury lawyer. A lawyer will make sure you include the necessary information and evidence.

Because a personal injury attorney has handled workplace injuries where there is no workers’ compensation before, the lawyer will know how to best present the information in the letter. Without a lawyer, you run the risk of incorrectly writing the demand letter to your employer or forgetting key information.

The following is a sample demand letter that includes the information you will need to include in a demand letter of your own.


[Your Name
[Your Address]
[Your City, State, and Zip Code]
[The Date]

[Name of the Claims Adjuster]
[Their Job Title]
[Address of the Insurance Company]
[City, State, and Zip Code of the Insurance Company]

Re: Your Insured, [Name of the Defendant]

Claimant: [Your Full Legal Name]

Claim Number: (Only include this number if a claim number has already been assigned to you, and you have already been contacted about the matter.)

Date of Loss: [Date of Accident or Incident in which the Workplace Injury Took Place]

Dear Mr./Mrs. [Name of Claims Adjuster] ,

As you were notified through mail on July 14, 2015, I suffered major injuries due to a workplace injury from your insured, Matt’s Lumber and Plywood, on March 18, 2015. On the date of the incident, I had been loading pallets of wood onto a forklift when the lift malfunctioned and pressed me against a wall, crushing my ribs and bruising my spine. Another worker on the clock was able to take control of the machine and turn it off, probably saving my life. I later found that the machine had not been properly inspected as per the guidelines, which was due to the negligence of my employer.

I was transported to the Emergency Room at New York General Hospital at [insert address], where I was stabilized and checked for internal bleeding. After an x-ray examination, I was found to have seven broken ribs, which were reset and dressed. I was given a medication for the severe pain: [insert medication name]. I also had to miss work for two months, from March 19 – May 23, 2015, as I could not perform any physical labor. This was in addition to physical rehabilitation at Boulder Spring Therapy at [insert address].

This experience was documented by the ER physician, Derek McDonald, M.D., as well as the rehab physician, Diane Romero, M.D.

I have since healed from my injuries. I am no longer employed at Matt’s Lumber and Plywood and have found a new place of employment in a similar field of work.

The costs for my medical expenses, as documented in the attached bills and receipts, are:

New York General Hospital Emergency Room: $650.00

Dr. Derek McDonald, ER Doctor: $488.00

Dr. Diane Romero, Rehab Doctor: $950.00

Prescription Medication: $73.00

TOTAL: $2,161.00

Over the course of two months of missed work, I also lost [insert dollar figure], as documented from my former employer at Matt’s Lumber and Plywood.

Due to the negligence of your insured, Matt’s Lumber and Plywood, I experienced pain and suffering over the course of at least three months. As a result of my medical expenses, lost wages, and general pain and suffering, I am seeking compensation in the amount of $10,000.00.

I hope for a timely response of no later than 30 days from the date of this letter.


[Your Signature]

[Your Name – printed]


Keep in mind that the total amount of damages that you request will be more than the actual amount of your medical expenses and lost wages. This is done on purpose, so that you have more room to negotiate a fair amount of compensation.

Getting Help with a Workplace Injury Claim with No Worker’s Compensation

Although writing a thorough demand letter is an important aspect of your claim, you should also consider hiring a personal injury attorney. An attorney will:

  • Help to negotiate your claim
  • Assist in writing your demand letter
  • Gathering required evidence
  • Make sure the claim process goes smoothly so that you receive the compensation you deserve