"How much is your case really worth?"

PERSONAL INJURY CHECKLIST

Please refer to "Read Me First" for guidance on completing
the checklist information.

General

  1. Case name, number and attorney position (P/D).
  2. Attorney name.
  3. Please provide a copy of the complaint.
  4. Anticipated trial date.
  5. Describe the physical injury allegedly caused by the defendant.
    6.

Plaintiff Background
  1. Date of birth.
  2. Date of injury.
  3. Gender and race (white, african-american, other).
  4. Level of education attained (grade school, high school, college, graduate degree).
  5. Family status (S/M). Provide birthdates of children at home, if any.

Employment Background
  1. Name of employer prior to the injury.
  2. Position held.
  3. Date of original employment.
  4. What was the rate of income earned just prior to the injury?
  5. List calendar year income from all employers for 3 years prior to injury. Submit tax returns with W-2 forms, if available.
  6. Did employer provide employee benefits, such as vacation, insurance pension plan, etc? Please describe. What were the required employee contributions, if any, for these benefits.
  7. How has employer or position changed as a result of the injury?
  8. Please list the period and amount of calendar year unemployment benefit benefits received, if any.
  9. Name of each subsequent employer
  10. List calendar year income from all employers for all years subsequent to injury. Submit tax returns with W-2 forms, if available.
  11. Does current employer provide employee benefits, such as vacation, insurance pension plan, etc? Please describe. What are the required employee contributions, if any, for these benefits.
  12. Please provide any documentation of benefits available from previous and current employment including employee booklets, benefit statements, summary plan description, etc.
  13. If there is a current disability, is it expected to engender higher morbidity or mortality? If so, is ther a medical professional available for consultation?
  14. If not currently employed, when is re-employment anticipated? Enclose report from vocational expert, if available.
  15. Do not submit performance appraisals, medical records, health insurance coverages, attendance records or other information not pertaining to economic loss.


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