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Sample Issue
Contact Us
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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