PAIN AND SUFFERING VALUATION WORKSHEET

CASE INFORMATION

Case Caption: [________________________________]

Plaintiff Name: [________________________________]

Date of Birth: [__/__/____]

Date of Injury: [__/__/____]

Case Number: [________________________________]

Prepared By: [________________________________]

Date Prepared: [__/__/____]

PART I: INJURY PROFILE

A. Primary Injuries

B. Injury Severity Classification

Overall Injury Severity:
☐ Minor (Full recovery expected within 3-6 months)
☐ Moderate (Recovery within 6-12 months, minimal permanent effects)
☐ Serious (Extended recovery, some permanent impairment)
☐ Severe (Significant permanent impairment, chronic condition)
☐ Catastrophic (Life-altering, permanent disability)

C. Injury Severity Scoring

Rate each factor on a scale of 1-10 (1 = minimal impact, 10 = maximum impact)

PART II: TIMELINE OF SUFFERING

A. Acute Phase (Injury to Stabilization)

Start Date: [__/__/____]

End Date: [__/__/____]

Duration: [____] days

Description of Pain/Suffering During This Phase:

[________________________________]
[________________________________]
[________________________________]

Pain Level (0-10 scale): [____]

Activities Affected:
☐ Unable to work
☐ Unable to care for self
☐ Bedridden/hospitalized
☐ Required assistance with daily activities
☐ Unable to sleep normally
☐ Unable to participate in family activities
☐ Other: [________________________________]

B. Treatment/Recovery Phase

Start Date: [__/__/____]

End Date: [__/__/____] ☐ Ongoing

Duration: [____] days/months

Description of Pain/Suffering During This Phase:

[________________________________]
[________________________________]
[________________________________]

Average Pain Level (0-10 scale): [____]

Treatment Burden:
☐ Multiple surgeries ([____] procedures)
☐ Extensive physical therapy ([____] sessions)
☐ Painful injections/procedures
☐ Side effects from medications
☐ Inability to work during treatment
☐ Other: [________________________________]

C. Permanent/Chronic Phase (if applicable)

Start Date: [__/__/____]

Expected Duration: ☐ Remainder of Life ☐ [____] years

Life Expectancy: [____] years remaining

Chronic Pain Level (0-10 scale): [____]

Permanent Limitations:
☐ Chronic pain requiring ongoing management
☐ Permanent mobility restrictions
☐ Permanent disfigurement
☐ Loss of body function
☐ Ongoing medical treatment required
☐ Psychological condition (PTSD, depression, anxiety)
☐ Other: [________________________________]

PART III: IMPACT ON QUALITY OF LIFE

A. Physical Activities Impacted

B. Social and Recreational Impact

C. Emotional and Psychological Impact

Documented Psychological Conditions:
☐ Post-Traumatic Stress Disorder (PTSD)
☐ Major Depression
☐ Anxiety Disorder
☐ Adjustment Disorder
☐ Sleep Disorders
☐ Chronic Pain Syndrome
☐ Other: [________________________________]

Psychological Treatment:
☐ Psychiatrist: [____] visits
☐ Psychologist: [____] visits
☐ Counselor/Therapist: [____] visits
☐ Medication for psychological symptoms

Emotional Symptoms Experienced:
☐ Fear and anxiety
☐ Depression
☐ Anger and frustration
☐ Feelings of helplessness
☐ Grief over lost abilities
☐ Social isolation
☐ Relationship strain
☐ Loss of self-esteem
☐ Suicidal thoughts (documented)
☐ Other: [________________________________]

PART IV: CALCULATION METHODS

Method 1: Multiplier Method

Step 1: Calculate Total Economic Damages

Step 2: Select Appropriate Multiplier

Multiplier Range Guide:
- 1.0 - 1.5: Minor injuries, quick recovery, minimal impact
- 1.5 - 2.0: Moderate injuries, full recovery expected
- 2.0 - 3.0: Significant injuries, extended recovery, some permanent effects
- 3.0 - 4.0: Serious injuries, permanent impairment, substantial life impact
- 4.0 - 5.0: Severe/catastrophic injuries, major permanent disability

Factors Supporting Higher Multiplier:
☐ Clear liability/defendant fault
☐ Permanent injuries
☐ Visible scarring or disfigurement
☐ Significant impact on daily life
☐ Strong documentation/evidence
☐ Sympathetic plaintiff
☐ Egregious defendant conduct
☐ Young plaintiff with long life expectancy

Factors Supporting Lower Multiplier:
☐ Pre-existing conditions
☐ Disputed liability
☐ Quick recovery
☐ Minimal treatment
☐ Inconsistencies in medical records
☐ Delayed treatment
☐ Comparative fault issues

Selected Multiplier: [____]

Justification: [________________________________]

Step 3: Calculate Pain and Suffering (Multiplier Method)

Total Economic Damages: $[____] x Multiplier: [____] = $[________________________________]

Method 2: Per Diem Method

Step 1: Determine Daily Rate

Approaches for Setting Daily Rate:
☐ Plaintiff's daily wage: $[____]
☐ Minimum wage equivalent: $[____] ($7.25/hr x 8 hrs = $58/day federal; state may vary)
☐ Reasonable daily amount based on severity: $[____]
☐ Other basis: [________________________________]

Selected Daily Rate: $[____]

Justification: [________________________________]

Step 2: Calculate Days of Suffering

Note: For permanent conditions, calculate based on life expectancy

Step 3: Calculate Pain and Suffering (Per Diem Method)

Daily Rate: $[____] x Total Days: [____] = $[________________________________]

Method 3: Comparable Verdict/Settlement Analysis

Researched Comparable Cases:

Average of Comparables: $[____]

Adjusted for Current Case Factors: $[________________________________]

Method 4: Bracket/Range Analysis

Low Estimate (Conservative):

Method: [________________________________]

Amount: $[________________________________]

Mid-Range Estimate:

Method: [________________________________]

Amount: $[________________________________]

High Estimate (Aggressive):

Method: [________________________________]

Amount: $[________________________________]

PART V: PAIN AND SUFFERING SUMMARY

PART VI: ADDITIONAL NON-ECONOMIC DAMAGES

A. Emotional Distress (Beyond Pain and Suffering)

Description: [________________________________]

Documentation: ☐ Medical Records ☐ Expert Testimony ☐ Lay Testimony

Estimated Value: $[________________________________]

B. Loss of Enjoyment of Life (Hedonic Damages)

Activities/Pleasures Lost: [________________________________]

Impact on Life Satisfaction: [________________________________]

Expert Economist Valuation (if applicable): $[____]

Estimated Value: $[________________________________]

C. Disfigurement and Scarring

Location: [________________________________]

Size/Visibility: [________________________________]

Permanence: ☐ Permanent ☐ May Improve

Impact on Self-Image: [________________________________]

Estimated Value: $[________________________________]

D. Physical Impairment/Disability

Percentage of Disability: [____]%

AMA Impairment Rating: [____]%

Functional Limitations: [________________________________]

Estimated Value: $[________________________________]

E. Loss of Consortium (Spouse's Claim)

Spouse Name: [________________________________]

Impact on Marital Relationship:
☐ Loss of companionship
☐ Loss of affection
☐ Loss of sexual relations
☐ Loss of household services
☐ Caregiver burden

Estimated Value: $[________________________________]

PART VII: STATE DAMAGE CAPS (IF APPLICABLE)

State: [________________________________]

Non-Economic Damage Cap: $[____] ☐ No Cap

Applicable to This Case: ☐ Yes ☐ No

Cap Exceptions:
☐ Wrongful death
☐ Intentional torts
☐ Certain injury types: [________________________________]
☐ Other: [________________________________]

Adjusted Non-Economic Damages (if cap applies): $[________________________________]

PART VIII: TOTAL NON-ECONOMIC DAMAGES

PART IX: DOCUMENTATION AND EVIDENCE

Evidence Supporting Pain and Suffering Claim:
☐ Medical records documenting pain levels
☐ Prescription pain medication records
☐ Physical therapy records
☐ Psychological/psychiatric treatment records
☐ Plaintiff's pain diary/journal
☐ Photographs of injuries
☐ Video of plaintiff's limitations
☐ Testimony of family members
☐ Testimony of friends/coworkers
☐ Day-in-the-life video
☐ Expert medical testimony
☐ Expert economist testimony (hedonic damages)

Witnesses to Plaintiff's Pain and Limitations:

VERIFICATION

Prepared By: [________________________________]

Date: [__/__/____]

Reviewed By: [________________________________]

Date: [__/__/____]

Notes:

[________________________________]
[________________________________]
[________________________________]

SOURCES AND REFERENCES

• Jury Verdict Research/Thomson Reuters Jury Verdicts
• State-specific damage cap statutes
• American Academy of Economic and Financial Experts standards
• Comparable verdict databases (VerdictSearch, etc.)
• State pattern jury instructions on non-economic damages

This worksheet provides various methodologies for estimating pain and suffering damages. Actual values are subject to negotiation, jury determination, and applicable law. Consult with legal counsel regarding appropriate valuation in specific cases.