PERSONAL INJURY DAMAGES CALCULATION WORKSHEET

CASE INFORMATION

Case Caption: [________________________________]

Plaintiff Name: [________________________________]

Date of Incident: [__/__/____]

Date of Filing: [__/__/____]

Jurisdiction: [________________________________]

Case Number: [________________________________]

Prepared By: [________________________________]

Date Prepared: [__/__/____]

PART I: ECONOMIC DAMAGES (SPECIAL DAMAGES)

A. Medical Expenses (Past)

TOTAL PAST MEDICAL EXPENSES (Billed): $[________________________________]

TOTAL PAST MEDICAL EXPENSES (Paid/Adjusted): $[________________________________]

B. Medical Expenses (Future/Projected)

TOTAL FUTURE MEDICAL EXPENSES: $[________________________________]

Life Care Plan Attached: ☐ Yes ☐ No

Expert Economist Report Attached: ☐ Yes ☐ No

C. Lost Wages and Income (Past)

Employment Status at Time of Injury:
☐ Employed Full-Time ☐ Employed Part-Time ☐ Self-Employed ☐ Unemployed ☐ Other: [____]

Employer: [________________________________]

Position/Title: [________________________________]

Hourly Rate/Salary: $[____] per ☐ hour ☐ week ☐ month ☐ year

Average Weekly Hours: [____]

Lost Overtime: $[____]

Lost Bonuses/Commissions: $[____]

Lost Benefits Value: $[____]

TOTAL PAST LOST WAGES: $[________________________________]

D. Lost Earning Capacity (Future)

Plaintiff's Age at Injury: [____]

Expected Retirement Age: [____]

Work Life Expectancy (Years): [____]

Pre-Injury Annual Earnings: $[____]

Post-Injury Earning Capacity: $[____]

Annual Earnings Reduction: $[____]

Present Value Factor (Discount Rate: [____]%): [____]

TOTAL FUTURE LOST EARNING CAPACITY (Present Value): $[________________________________]

Vocational Expert Report Attached: ☐ Yes ☐ No

Economist Report Attached: ☐ Yes ☐ No

E. Property Damage

TOTAL PROPERTY DAMAGE: $[________________________________]

F. Other Economic Losses

TOTAL OTHER ECONOMIC LOSSES: $[________________________________]

PART II: TOTAL ECONOMIC DAMAGES SUMMARY

PART III: NON-ECONOMIC DAMAGES (GENERAL DAMAGES)

A. Injury Severity Assessment

Primary Injuries:
| Injury | Severity (1-5) | Permanent? | Treatment Duration |
|--------|----------------|------------|-------------------|
| [________________________________] | [____] | ☐ Yes ☐ No | [____] months/years |
| [________________________________] | [____] | ☐ Yes ☐ No | [____] months/years |
| [________________________________] | [____] | ☐ Yes ☐ No | [____] months/years |
| [________________________________] | [____] | ☐ Yes ☐ No | [____] months/years |

Severity Scale: 1 = Minor | 2 = Moderate | 3 = Serious | 4 = Severe | 5 = Catastrophic

B. Pain and Suffering Calculation

Method 1: Multiplier Method

Total Economic Damages: $[________________________________]

Multiplier Selected: [____] (Range: 1.5 - 5.0)

Factors supporting multiplier selection:
☐ Severity of injuries
☐ Length of recovery period
☐ Permanence of injury
☐ Impact on daily activities
☐ Clear liability
☐ Compelling evidence/documentation
☐ Aggravating circumstances

Pain and Suffering (Multiplier Method): $[________________________________]

Method 2: Per Diem Method

Daily Rate: $[____] (e.g., daily wage or reasonable daily amount)

Number of Days Affected: [____] days

Pain and Suffering (Per Diem Method): $[________________________________]

Selected Method: ☐ Multiplier ☐ Per Diem

PAIN AND SUFFERING VALUE: $[________________________________]

C. Additional Non-Economic Damages

TOTAL NON-ECONOMIC DAMAGES: $[________________________________]

PART IV: DAMAGE CAPS AND ADJUSTMENTS

A. Statutory Caps (Jurisdiction-Specific)

State: [________________________________]

Non-Economic Damage Cap: $[____] ☐ N/A

Medical Malpractice Cap: $[____] ☐ N/A

Punitive Damage Cap: $[____] ☐ N/A

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

B. Comparative/Contributory Negligence

Applicable Standard:
☐ Pure Comparative Negligence
☐ Modified Comparative Negligence (50% Bar)
☐ Modified Comparative Negligence (51% Bar)
☐ Pure Contributory Negligence
☐ Slight/Gross Negligence Comparison

Plaintiff's Percentage of Fault: [____]%

Reduction Amount: $[____]

PART V: TOTAL DAMAGES CALCULATION

PART VI: PUNITIVE DAMAGES (IF APPLICABLE)

Basis for Punitive Damages:
☐ Gross Negligence
☐ Willful/Wanton Conduct
☐ Fraud/Malice
☐ Other: [________________________________]

Evidence Supporting Punitive Damages: [________________________________]

Defendant's Financial Condition: [________________________________]

Ratio to Compensatory Damages: [____]:1

Punitive Damages Requested: $[________________________________]

PART VII: LIENS AND SUBROGATION INTERESTS

TOTAL LIENS: $[________________________________]

PART VIII: SETTLEMENT VALUE RANGE

Low Estimate: $[________________________________]

Mid-Range Estimate: $[________________________________]

High Estimate: $[________________________________]

Recommended Settlement Range: $[____] to $[____]

VERIFICATION AND NOTES

Calculation Verified By: [________________________________]

Date: [__/__/____]

Notes/Special Considerations:

[________________________________]
[________________________________]
[________________________________]
[________________________________]

SOURCES AND REFERENCES

• Restatement (Second) of Torts §§ 903-912
• State-specific damage cap statutes
• Jury verdict reporters and settlement databases
• Life care planning standards
• Economic loss calculation methodologies

This worksheet is intended for attorney use in organizing and calculating personal injury damages. All figures should be verified with supporting documentation and expert opinions where appropriate.