Bad Faith Insurance Claim Letter Drafter

Formal Notice of Breach and Demand for Extra-Contractual Damages

Target Insurer: Insurer Name

FORMAL NOTICE OF BAD FAITH CLAIM AND DEMAND FOR SETTLEMENT

RE: Claim No. --- | Policy No. ---

To: Insurer Name | From: Claimant Name

Claimant / Legal Counsel Signature

Claimant Full Name (Policy Holder)

Insurer / Company Name

Policy Number

Claim Number

Governing Jurisdiction (State/Circuit)

Policy Provision Violated Cite the specific part of the policy you believe obligates coverage.

Description of Insurer's Breach (The Denial/Delay)

Select all actions by the insurer that constitute an unreasonable breach of the duty of good faith:

Factual Detail Supporting Bad Faith

Contract Damages (Original Claim Value) $

Extra-Contractual Damages (Emotional Distress, Fees) $

TOTAL DEMAND: $0.00 Calculated total is the sum of Contract and Extra-Contractual damages.

Deadline for Settlement (Days) Standard deadline is often 10, 15, or 30 days before litigation commences.