Letter Of Representation To Liability Carrier

“This form is a generic letter of representation form that I modify for a particular client’s needs. I frequently get contacted by other lawyers asking for my help or to refer a someone to me. This is only intended as a show and tell template for other lawyers. I modify the language for the individual claim as necessary. If you, a family member or friend has been injured in a car accident or slip/trip and fall please contact me or get my books to know how you should deal with the insurance company following an injury accident. Helping people is what I do every day and I’d love to hear from you.”

RE: Our Client:

Your Insured:

Date of Loss:



Dear Sir:

Please be advised that I have been retained to represent the interests of Ms. Espino-Perez for injuries sustained as a result of your insured’s negligence. We ask that all future correspondence or verbal communication be directed to our office and that there be no direct contact with our client in this matter.

Please provide the undersigned with the following information within the next fifteen (15) days with regard to each known policy of insurance, including excess or umbrella coverage, which may provide liability insurance for this claim.

  1. Name of the insurer (s);
  2. Name of each insured;
  3. Copy of limits of liability coverage;


    1. for personal injury;
    2. property damage;
    3. medical expense;
    4. uninsured motorist claim.


Please forward a Certified copy of any policies.

Please be advised our office does not grant recorded statements. If you have obtained a recorded statement of our client prior to our representation, we ask that a copy of the original tape or a transcribed copy of that statement be forwarded to our office on an immediate basis.

If you have written estimates on the damage to our client’s vehicle and/or taken photographs of the damage to our client’s vehicle, we ask that you provide our office with copies of those items on an immediate basis.

If you have obtained a medical authorization from our client prior to our representation, please be advised that authorization is hereby revoked, null and void.

Please disclose the Limits of Liability available from your policy insuring Ms. Wemhoff. This is information to which we would be entitled in the event of litigation; however, since we are sure it is as much your desire to ultimately negotiate this matter to a conclusion, we ask that you disclose that information at this time. In addition, we would appreciate your advising if there is more than one claimant presenting a bodily injury claim in this case.

During the pendency of this claim there will undoubtedly be medical and, perhaps, psychological information and documentation that you and your company will receive regarding our client. We expect, and require, that all information and all documentation will be kept strictly confidential and will not be revealed to anyone, including but not limited to other companies, computer repositories or other physicians, without express written and notarized permission from our client. If we do not hear from you to the contrary we will expect that this requirement of confidentiality has been acknowledged and accepted by you and your company.

Very Truly Yours,

D.J. Banovitz