Personal Injury Litigation Support Questionnaire

When we prepare an economic loss evaluation in a personal injury case, we need to know all that we can about the plaintiff/victim (1) before injury, and (2) after injury.  We want to know a person’s characteristics – age, gender, ethnicity, education and occupation – all of which affect the amount that he/she would have earned, had (s)he not been injured.  We need similar information after injury.  Did the injury prevent the plaintiff from working, or did it reduce the amount of work they could perform?  What is the prognosis for recovery?  Has the plaintiff received any post-injury vocational training?  Even if the plaintiff has not returned to work, we can use statistics to forecast likely future earnings if the plaintiff is temporarily disabled, permanently and partially disabled, or totally disabled.  We also wish to know the amount of time the victim spent performing household services and whether there are any activities that (s)he can no longer perform.  Furthermore, are there any changes in the quality of life during time the plaintiff spent in leisure time or other pursuits?

Please understand that, unlike your attorney, we are not your advocate.  It is our job to provide accurate information that the jury can use to evaluate your damage claim.  Please fill out the following forms as completely and accurately as possible.

Plaintiff's Information

       
   
   
   

Defendant's Information

   
 
   
   

Attorney Information

   
 
A value is required.
   
 
   
   
   

Case Information

   
 
   
   
 
 
   

Demographic Information

   
 
   
 
 
 
 
If victim has children under the age of 18, please fill out their information below
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*If you have more than 5 children under the age of 18, please note that in the "summary of incident" area.

   
 
 
 
 
 

Prognosis for Recovery

 
 
 
 
 

Nature of Damage

 
A value is required.