Claim compensation after being hit by a car

Allows you to restart the insurer of the person responsible for the road accident in the event of delay in compensation (pedestrian, cyclist, passenger...).

[Your first and last name]

[Your address]

[Postal Code – City]

[Phone / email]

[Name of the insurance company of the person in charge]

To the attention of the compensation department

[Address]

[Postal Code – City]

[Place, date]

Subject: Claim for compensation under the Act of 5 July 1985 (road traffic accident)

Madam, Sir,

I hereby inform you that I was the victim of a traffic accident on [date], at [place], during which I was hit by the vehicle insured with your company, registered [number] and driven by [name of driver, if known].

In accordance with the provisions of the Act of 5 July 1985 on compensation for victims of road traffic accidents, I would ask you to examine my case and to proceed with the examination of my claim for compensation.

I attach to this letter:

• a copy of the accident report,
• my medical certificates and documents establishing the nature of my injuries,
• proof of the costs incurred,
• any other material relevant to the consideration of my injury.

Thank you for informing me of the additional steps required, as well as the deadlines for the submission of your compensation offer, in accordance with your legal and contractual obligations.

I remain at your disposal for any additional information or document.

Pending your reply, please accept, Madam, Sir, the expression of my distinguished greetings.

[Signature]