California UM/UIM Seguro Denegación Carta de Demanda

[YOUR NAME] [YOUR ADDRESS] [CITY, STATE ZIP] [YOUR PHONE NUMBER] [YOUR EMAIL] [DATE] VÍA CORREO CERTIFICADO CON ACUSE DE RECIBO [INSURANCE COMPANY NAME] [CLAIMS DEPARTMENT] [INSURER ADDRESS] [CITY, STATE ZIP] Re: Demand for Payment of UM/UIM Benefits Insured: [YOUR NAME] Policy No.: [POLICY NUMBER] Reclamación No.: [CLAIM NUMBER] Date of Loss: [DATE OF ACCIDENT] Dear Claims Manager: I am writing to formally demand payment of Uninsured/Underinsured Motorist benefits under the above-referenced automobile seguro policy. As detailed below, [INSURANCE COMPANY NAME] has failed to fairly evaluate and pay my valid UM/UIM reclamación, in violación of California Seguro Code Section 11580.2 and the duty of buena fe and fair dealing. FACTUAL BACKGROUND On [DATE OF ACCIDENT], at approximately [TIME], I was operating my [YEAR, MAKE, MODEL] vehicle on [STREET/HIGHWAY] in [CITY], California. The at-fault driver, [AT-FAULT DRIVER NAME], operating a [DESCRIPTION OF OTHER VEHICLE], [DESCRIBE HOW ACCIDENT OCCURRED - e.g., ran a red light and collided with the driver's side of my vehicle / rear-ended my vehicle while I was stopped at a traffic light / crossed into my lane and struck my vehicle head-on]. The collision was caused solely by the negligencia of [AT-FAULT DRIVER NAME], as documented in the police report, Report No. [POLICE REPORT NUMBER]. The at-fault driver was cited for [VIOLATION, IF ANY]. Investigation has confirmed that the at-fault driver [was uninsured at the time of the accident / carried responsabilidad seguro with limits of only $[AMOUNT], which is insufficient to compensate me for my daños]. This triggers my UM/UIM coverage under my policy with [INSURANCE COMPANY NAME]. POLICY COVERAGE My automobile seguro policy, Policy No. [POLICY NUMBER], was in full force and effect on the date of the accident. I have paid all premiums and have complied with all policy conditions, including timely notice of the reclamación. The policy provides UM/UIM coverage with limits of [COVERAGE LIMITS - e.g., $100,000 per person / $300,000 per occurrence]. Under California Seguro Code Section 11580.2, UM coverage is mandatory in California and must be included in every automobile responsabilidad policy unless validly waived in writing on a form specified by the statute. No such waiver exists for my policy. MY INJURIES AND TREATMENT As a direct and proximate result of this collision, I sustained the following injuries: [LIST INJURIES - e.g., - Cervical disc herniation at C5-C6 - Lumbar strain/sprain - Left shoulder rotator cuff tear - Post-traumatic headaches - Anxiety and sleep disturbance] I received emergency treatment at [HOSPITAL NAME] on the date of the accident. Since then, I have undergone extensive medical treatment including: [DESCRIBE TREATMENT - e.g., - Orthopedic evaluation and treatment with Dr. [NAME] - MRI of cervical and lumbar spine - 36 sessions of physical therapy - Pain management with epidural steroid injections - Ongoing treatment for persistent symptoms] My treating physicians have documented that all of my injuries were caused by this accident and that I will require future medical treatment including [DESCRIBE EXPECTED FUTURE TREATMENT]. DAMAGES My documented daños are as follows: MEDICAL EXPENSES: Emergency room and ambulance: $[AMOUNT] [PROVIDER NAME] - Orthopedic care: $[AMOUNT] [IMAGING CENTER] - MRI studies: $[AMOUNT] [PHYSICAL THERAPY PROVIDER]: $[AMOUNT] [ADDITIONAL PROVIDERS]: $[AMOUNT] Prescription medications: $[AMOUNT] Future medical care (per Dr. [NAME]): $[AMOUNT] __________ TOTAL MEDICAL EXPENSES: $[TOTAL MEDICAL] LOST WAGES: I was unable to work from [START DATE] to [END DATE], a period of [NUMBER] weeks. My average weekly earnings were $[AMOUNT], as verified by my empleador. Total lost salarios: $[TOTAL LOST WAGES] PAIN AND SUFFERING: I have experienced and continue to experience significant physical pain, including daily discomfort rated [X]/10, difficulty sleeping, and limitations on my daily activities. I am no longer able to [DESCRIBE ACTIVITIES YOU CANNOT DO]. I have also suffered angustia emocional including anxiety about driving and depression related to my diminished quality of life. Based on the severity and permanence of my injuries, my pain and suffering daños are valued at $[AMOUNT]. TOTAL DAMAGES: $[GRAND TOTAL] [IF UIM CLAIM: Less amount received from at-fault driver's policy: ($[AMOUNT]) NET UIM CLAIM: $[NET AMOUNT]] YOUR COMPANY'S IMPROPER HANDLING OF MY CLAIM Despite my timely notice, complete documentation, and clear entitlement to UM/UIM benefits, [INSURANCE COMPANY NAME] has [denied my reclamación / offered only $[LOW AMOUNT] to settle my reclamación]. This conduct is unreasonable and constitutes mala fe. [DESCRIBE SPECIFIC mala fe CONDUCT - select and customize as applicable: - Your company denied my reclamación without conducting a reasonable investigation - Your company ignored the opinions of my treating physicians - Your company relied on a biased IME that contradicts my documented medical records - Your company failed to respond to my reclamación within the time required by California regulations - Your company offered an amount that no reasonable insurer would believe adequately compensates my injuries - Your company misrepresented the policy coverage to justify the denegación] This conduct violates California Seguro Code Section 790.03(h), which prohibits unfair claims acuerdo practices, and breaches the duty of buena fe and fair dealing established by the California Supreme Tribunal in Gruenberg v. Aetna Seguro Co. (1973) 9 Cal.3d 566 and Quintano v. Mercury Casualty Co. (1995) 11 Cal.4th 1049. DEMANDA I hereby demand payment of $[DEMANDA AMOUNT] within thirty (30) days of the date of this letter. This amount represents fair compensación for my injuries and losses, [less the offset for amounts received from the at-fault driver's insurer if applicable]. If I do not receive satisfactory payment by [DEADLINE DATE - 30 días from letter date], I will take the following actions: 1. Demand binding arbitraje de conformidad con California Seguro Code Section 11580.2(i) to recover my full UM/UIM benefits up to policy limits; 2. File a mala fe demanda judicial in the California Superior Tribunal seeking: - Brandt abogado fees de conformidad con Brandt v. Superior Tribunal (1985) 37 Cal.3d 813 - Consequential daños caused by your company's wrongful conduct - Daños por angustia emocional - Punitive daños de conformidad con código civil Section 3294 3. File a demanda with the California Department of Seguro documenting your company's unfair claims acuerdo practices. I urge you to reevaluate this reclamación fairly and make a reasonable acuerdo offer. Your company's continued mala fe handling of this reclamación will only increase your ultimate exposure. Please direct all further communications regarding this reclamación to the address above [or to my abogado: [ATTORNEY NAME, ADDRESS, PHONE]]. Atentamente, _______________________________ [YOUR NAME] Anexos: - Medical records and bills (Exhibit A) - Proof of lost salarios (Exhibit B) - Police report (Exhibit C) - Photos of injuries and vehicle damage (Exhibit D) - Correspondence with your company (Exhibit E) - Proof of at-fault driver's seguro status (Exhibit F) cc: [su abogado, IF APPLICABLE] California Department of Seguro (if demanda filed)