WRONGFUL DEATH DAMAGES CALCULATION WORKSHEET

CASE INFORMATION

Case Caption: [________________________________]

Decedent Name: [________________________________]

Date of Birth: [__/__/____]

Date of Death: [__/__/____]

Age at Death: [____]

Cause of Death: [________________________________]

Case Number: [________________________________]

Prepared By: [________________________________]

Date Prepared: [__/__/____]

PART I: JURISDICTIONAL FRAMEWORK

A. Applicable Law

State of Filing: [________________________________]

Type of Action:
☐ Wrongful Death Action (for benefit of survivors)
☐ Survival Action (on behalf of decedent's estate)
☐ Both Wrongful Death and Survival
☐ Federal Claim (specify): [________________________________]

B. Statutory Beneficiaries

State Statutory Scheme:
☐ Spouse and children only
☐ Spouse, children, and parents
☐ Next of kin based on intestate succession
☐ Dependents
☐ Other: [________________________________]

Statute of Limitations:
Wrongful Death: [____] years from date of death
Survival Action: [____] years from date of injury/death

C. Recoverable Damages Under State Law

Wrongful Death (Check all that apply):
☐ Pecuniary loss (economic contributions)
☐ Loss of services
☐ Loss of support
☐ Loss of inheritance
☐ Medical and funeral expenses
☐ Loss of consortium/companionship
☐ Mental anguish/grief
☐ Loss of guidance and nurturing
☐ Punitive damages (if allowed)

Survival Action (Check all that apply):
☐ Decedent's medical expenses before death
☐ Decedent's lost earnings before death
☐ Decedent's pain and suffering before death
☐ Decedent's property damage
☐ Punitive damages

D. Damage Caps

Wrongful Death Cap: $[____] ☐ No Cap
Medical Malpractice Cap (if applicable): $[____] ☐ No Cap
Punitive Damages Cap: $[____] ☐ No Cap
Source/Citation: [________________________________]

PART II: DECEDENT PROFILE

A. Personal Information

Full Legal Name: [________________________________]

Date of Birth: [__/__/____]

Date of Death: [__/__/____]

Age at Death: [____]

Gender: ☐ Male ☐ Female ☐ Other

Marital Status at Death:
☐ Married ☐ Single ☐ Divorced ☐ Widowed ☐ Domestic Partner

B. Education and Employment

Highest Education Level:
☐ Less than High School
☐ High School Diploma/GED
☐ Some College
☐ Associate's Degree
☐ Bachelor's Degree
☐ Master's Degree
☐ Doctoral/Professional Degree

Occupation at Death: [________________________________]

Employer: [________________________________]

Annual Income at Death: $[________________________________]

Years in Current Profession: [____]

C. Health and Life Expectancy

General Health Before Fatal Incident:
☐ Excellent ☐ Good ☐ Fair ☐ Poor

Pre-existing Conditions (if any): [________________________________]

Statistical Life Expectancy at Death: [____] years

Source of Life Expectancy Data: [________________________________]

Work Life Expectancy at Death: [____] years

PART III: STATUTORY BENEFICIARIES

A. Surviving Spouse

Name: [________________________________]

Date of Birth: [__/__/____]

Age: [____]

Date of Marriage: [__/__/____]

Length of Marriage: [____] years

Employment Status: ☐ Employed ☐ Unemployed ☐ Retired ☐ Homemaker

Annual Income: $[____]

Remarriage Status: ☐ Not Remarried ☐ Remarried on [__/__/____]

B. Surviving Children

C. Other Statutory Beneficiaries (if applicable)

PART IV: ECONOMIC DAMAGES - WRONGFUL DEATH

A. Lost Financial Support

Step 1: Calculate Decedent's Annual Gross Income

Step 2: Calculate Personal Consumption Deduction

Personal consumption is the portion of income decedent would have spent on themselves

Decedent's Estimated Personal Consumption: [____]%

Amount Deducted for Personal Consumption: $[____]

Step 3: Calculate Annual Net Support

Gross Annual Income: $[____] - Personal Consumption: $[____] = $[____] (Net Annual Support)

Step 4: Calculate Duration of Support

Work Life Expectancy: [____] years

Expected Retirement Age: [____]

Years of Support Remaining: [____]

Step 5: Calculate Present Value of Lost Support

Discount Rate Used: [____]%
Growth Rate Assumed: [____]%

TOTAL PRESENT VALUE OF LOST FINANCIAL SUPPORT: $[________________________________]

B. Lost Benefits

TOTAL LOST BENEFITS: $[________________________________]

C. Lost Household Services

Duration of Lost Services: [____] years (until youngest child reaches 18, or life expectancy)

TOTAL PRESENT VALUE OF LOST SERVICES: $[________________________________]

D. Loss of Inheritance (If Applicable)

Decedent's Net Worth at Death: $[____]

Expected Accumulation Rate: [____]%

Years Until Natural Death: [____]

Projected Estate at Natural Death: $[____]

Loss of Inheritance to Beneficiaries: $[________________________________]

PART V: NON-ECONOMIC DAMAGES - WRONGFUL DEATH

Note: Availability varies by state

A. Loss of Consortium/Companionship (Spouse)

Description of Relationship:
[________________________________]
[________________________________]

Factors:
☐ Length of marriage: [____] years
☐ Quality of relationship
☐ Dependence on decedent for emotional support
☐ Shared activities and interests
☐ Age of surviving spouse
☐ Likelihood of remarriage

Estimated Value: $[________________________________]

B. Loss of Parental Guidance (Minor Children)

Factors Considered:
☐ Decedent's involvement in child-rearing
☐ Educational guidance provided
☐ Moral and ethical instruction
☐ Participation in activities
☐ Future milestones missed (graduations, weddings, etc.)

TOTAL LOSS OF PARENTAL GUIDANCE: $[________________________________]

C. Loss of Companionship (Adult Children)

TOTAL LOSS OF COMPANIONSHIP (ADULT CHILDREN): $[________________________________]

D. Mental Anguish and Grief (If Recoverable)

TOTAL MENTAL ANGUISH/GRIEF: $[________________________________]

PART VI: SURVIVAL ACTION DAMAGES

Damages the decedent could have recovered had they survived

A. Pre-Death Medical Expenses

TOTAL PRE-DEATH MEDICAL: $[________________________________]

B. Pre-Death Lost Wages

Period from Injury to Death: [____] days

Daily Wage Rate: $[____]

TOTAL PRE-DEATH LOST WAGES: $[________________________________]

C. Pre-Death Pain and Suffering

Duration of Conscious Pain and Suffering: [____] (days/hours/minutes)

Description of Pre-Death Suffering:
[________________________________]
[________________________________]

Level of Consciousness: ☐ Fully Conscious ☐ Semi-Conscious ☐ Brief Consciousness ☐ Unknown

ESTIMATED PRE-DEATH PAIN AND SUFFERING: $[________________________________]

PART VII: FUNERAL AND BURIAL EXPENSES

TOTAL FUNERAL/BURIAL EXPENSES: $[________________________________]

PART VIII: PUNITIVE DAMAGES (IF APPLICABLE)

Basis for Punitive Damages:
☐ Gross negligence
☐ Reckless conduct
☐ Intentional misconduct
☐ Fraud
☐ Malice
☐ DUI/Impaired driving
☐ Other: [________________________________]

Evidence Supporting Punitive Damages:
[________________________________]
[________________________________]

Defendant's Financial Condition: [________________________________]

Ratio to Compensatory Damages: [____]:1

State Cap on Punitive Damages: $[____] or [____]x compensatory ☐ No Cap

PUNITIVE DAMAGES REQUESTED: $[________________________________]

PART IX: DAMAGES BY BENEFICIARY

Allocation of Damages

PART X: TOTAL DAMAGES SUMMARY

Wrongful Death Damages

Survival Action Damages

Other Damages

GRAND TOTAL

DOCUMENTATION CHECKLIST

Decedent Documentation:
☐ Death certificate
☐ Autopsy report
☐ Medical records (final illness/injury)
☐ Tax returns (3-5 years)
☐ W-2s and pay stubs
☐ Employment records
☐ Life insurance policies
☐ Retirement account statements

Beneficiary Documentation:
☐ Marriage certificate
☐ Birth certificates (children)
☐ Dependency evidence
☐ Photos/videos of family

Expert Reports:
☐ Economist report (lost earnings/support)
☐ Vocational expert report
☐ Life care planner (if applicable)
☐ Grief counselor testimony

VERIFICATION

Prepared By: [________________________________]

Date: [__/__/____]

Reviewed By: [________________________________]

Date: [__/__/____]

SOURCES AND REFERENCES

• State wrongful death statutes
• Bureau of Labor Statistics worklife tables
• Social Security Administration life expectancy tables
• State pattern jury instructions
• Jury verdict databases

This worksheet is for organizational purposes only. Wrongful death damages are highly jurisdiction-specific. Consult with qualified legal counsel and economic experts for accurate damage calculations.