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Whiplash Injury Claim

A completed fictional low-value road-traffic injury claim prepared for the Official Injury Claim process, without overstating prognosis or liability.

Jurisdiction: England and Wales - completed fictional worked example

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Important: This sample provides general legal information only and is not legal advice. Check the law, prescribed forms and signing requirements that apply to your exact jurisdiction and circumstances before use.

# WHIPLASH INJURY CLAIM

Date: 21 July 2035

Parties: Daniel Okafor and Severn Mutual Insurance

## 1. Purpose and parties

Claimant Daniel Okafor of 27 Fernbank Road, Coventry CV3 5LP makes this completed fictional claim concerning a collision on 16 February 2035 at 08:10 on Kenilworth Road, Coventry. The proposed defendant is Lucy Hale, insured by Severn Mutual Insurance under policy SM-77180.

## 2. Facts, scope and terms

I was driving a 2018 blue Alder hatchback within the speed limit when Ms Hale's vehicle struck my rear at stationary traffic. I say she failed to leave a safe distance; liability is not admitted by this document. The police incident reference is CV/2035/0216/44, and photographs and witness details are available.

## 3. Process and responsibilities

My neck and upper-back symptoms began that afternoon, including stiffness and headaches. I attended Coventry Walk-in Centre on 17 February, followed GP advice and had no fracture identified. The medical report dated 30 June records a provisional prognosis of 10 months from the accident, subject to review; I do not present it as a guaranteed outcome.

## 4. Evidence, records and safeguards

I used the Official Injury Claim service information and understand that eligibility, value limits, limitation and any tariff treatment must be checked on the facts. My claim is for the qualifying whiplash injury and any permitted minor psychological injury, not for an invented diagnosis. I will update the claim if recovery differs from the report.

## 5. Review, escalation and outcome

The current quantified losses are £240 for reasonable travel to two appointments, supported by receipts, and £180 for six physiotherapy sessions recommended by the clinician. The subtotal is £420 (£240 + £180); I make no claim for future treatment without evidence and reserve only losses properly established through the process.

## 6. Reservations and practical protections

I have not accepted a settlement, assigned the claim or received compensation from another source. I will provide medical evidence, employment information if a genuine earnings loss is alleged, and authority for relevant records. I understand that contributory negligence or disputed causation may affect recovery and that a representative must be authorised.

## 7. England and Wales law and completion

This fictional claim is dated 21 July 2035 and requests a reasoned response through the applicable claims portal. It is not a finding of fault or legal advice, and it does not waive procedural requirements, limitation rules or any non-excludable duty. I will preserve the vehicle, records and receipts while liability and valuation are considered.

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