Personal Injury Verdict

The below verdict form was filled out by an Ocala jury to the sum of over $550,000.00:
VERDICT FORM
1. What is the amount of any damages
sustained by Mr. ASH in the past,
a. for medical expenses? $_____________________________
b. for lost earnings or earning ability? $_____________________________
2. What is the present money value of any
damages to be sustained by Mr. ASH in
the future,
a. for medical expenses? $_____________________________
b. for lost earning ability? $_____________________________
3. What is the amount of any damages sustained by
Mr. ASH for pain and suffering, disability, physical
impairment, disfigurement, mental anguish,
inconvenience, aggravation of a disease or physical
defect and/or loss of capacity for the enjoyment of life,
a. in the past? $_____________________________
b. in the future? $_____________________________
TOTAL DAMAGES OF MR. ASH
(add lines 1a, 1b, 2a, 2b, 3a and 3b) $____________________________
SO SAY WE ALL, this ________ day of ____________, 2005.
________________________________
FOREMAN OR FOREWOMAN
VERDICT FORM
1. What is the amount of any damages
sustained for medical expenses and lost
earnings or earning ability in the past? $_____________________________
 
2. What is the amount of any future damages
for medical expenses and lost earning ability to
be sustained in future years?
a. Total damages over future years? $_____________________________
b. The number of years over which those
future damages are intended to provide
compensation? $_____________________________
c. What is the present value of
those future damages? $_____________________________
 
3. What is the amount of any damages for pain
and suffering, disability, physical impairment,
disfigurement, mental anguish, inconvenience,
aggravation of a disease or physical defect
and/or loss of capacity for the enjoyment of life,
a. in the past? $_____________________________
b. in the future? $_____________________________
TOTAL DAMAGES OF MR. ASH
(add lines 1, 2c, 3a and 3b) $____________________________
SO SAY WE ALL, this ________ day of ____________, 2005.
________________________________
FOREMAN OR FOREWOMAN
VERDICT FORM
1. What is the amount of any damages for lost
earnings in the past, loss of earning capacity in
the future, medical expenses incurred in the past,
medical expenses incurred in the past, and medical
expenses to be incurred in the future?
$_____________________________
 
2. What is the amount of any damages for pain
and suffering, disability, physical impairment,
disfigurement, mental anguish, inconvenience,
aggravation of a disease or physical defect
and loss of capacity for the enjoyment of life
sustained in the past and to be sustained in the
future?
$_____________________________
 
TOTAL DAMAGES OF KENNETH
ASH (add lines 1 and 2):
$_____________________________

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