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Submitted By :
Name: Phone: Fax:
Firm: E-mail   

Case Information :

Judge: Court: Cause No:
County: Date of Verdict/Settlement: Style:

Plaintiff's Firm
Counsel: Phone Fax
Address: City: Zip:
Plaintiff's Firm 2
Counsel: Phone Fax
Address: City: Zip:


Defendant's Firm
Counsel: Phone Fax
Address: City: Zip:
Defendant's Firm 2
Counsel: Phone Fax
Address: City: Zip:


Occupation/Age of Plaintiffs

Occupation/Age of Defendants

Type of Case

Summary of Case

Injury

Treatment: Chiro    Xray     MRI    CT    PT    Specialist
Other:

Plaintiff Auto Type

Damage to Vehicle

Defendant Auto Type

Damage to Vehicle

Insurance Carrier


Plaintiff/Defendant Experts (Mark P or D for each) - Describe how the expert testified (live, video, depo, records)

P/DNameTypeCityHow Testified
P   D
P   D
P   D
P   D
P   D
P   D
P   D
P   D

Specials: Medical past

Future
Wages past: Future Other
Amount prayed for: Demand Offer

Result of Case:

Plaintiff Verdict   Defense Verdict  
Settled   Confidential Settlement

Verdict:

Award Breakdown: Total Amount Awarded
  Medical Expenses
  Physical Pain
  Loss of Wages
  Physical Impairment
  Other

Length of Trial:
Jury Deliberation Length:

Jury Vote:
Jury Composition (gender/race):

Notes:
 
   
Please fill out this form as completely as possible, or use it as a guideline when submitting your information.

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