Verdict/Settlement Reporting Form

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County: *

Cause/Case No:

Plaintiff(s): *

Defendant(s): *

Trial Date:

Length of Trial:

Settlement Date:

Trial Judge/Mediator:

Plaintiff Attorney: *

Plaintiff Attorney Firm:

Plaintiff Attorney City:

Defendant Attorney: *

Defendant Attorney Firm:

Defendant Attorney City:

Insurance Company:

Admitted Liability:

Yes

No

Summary Judgment:

Yes

No

Directed Verdict:

Yes

No

Plaintiff Doctors, Specialty, City:

Live Testimony

By Report

Defendant Doctors, Specialty, City:

Live Testimony

By Report

Plaintiff Experts, Specialty, City:

Live Testimony

By Report

Defendant Experts, Specialty, City:

Live Testimony

By Report

Age of Plaintiff/Decedent:

Survivors:

Gender:

Male

Female

Plaintiff Occupation:

Date of Loss:

Factual Description: *

Injuries (fractures,Surgeries, etc.): *

Permanent Injury?:

Yes

No

If no, length of treatment:

Medical Expenses $: *

Lost Wages $:

Property Damage $:

Miscellaneous $:

Days in Hosp.:

Days Work Lost:

Demand $:

Plaintiff Asked Jury For $:

Offer $:

Defendant Asked Jury For $:

Settlement Judge:

Recommended $:

Gross Verdict/Settlement $: *

Contributory Neg %:

Net $:

Or Defense Verdict?:

Yes

No

New Trial Pending:

Granted?:

Report Submitted By: *

Telephone: *

Email:

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