Car Accident Settlement Valuation Form
Injury Factors to Consider Before Settling Your Claim
Below is a sample form we sometimes use to value our client’s car accident damages. This form includes factors such as lost wages, pain and suffering, loss of future earning capacity as well as medical expenses and special damages for expenses related to home modifications or the hiring of help to perform services that the injury victim was able to perform prior to the accident.
File # ____________
Client Name: ______________________________
Nature and Type of Injury: ___________________
Emergency Room: __________________________
Hospital Stay: ______________________________
Permanent Injuries: _________________________
Physical Limitations: _________________________
Psychological Limitations: _____________________
Past Medical Expenses: _______________________
Probable Future Medical Expenses: _____________
Past Lost Wages: ___________________________
Probable Loss of Future Earning Capacity ________
Additional Economic Damages:
Past Hired Services: ____________________
Future Hired Services: __________________
Home Modifications: ____________________
Other Expenses: _______________________
Total Economic Damages: ____________________
Pain & Suffering – (Loss of Enjoyment of Life, etc.)
Past Pain and Suffering –
# of weeks _____ @ ______ Total _____/_____
# of weeks _____ @ ______ Total _____/______
Future Pain and Sufferring: _______________
Total Non-Economic Damages: ________________
Mitigating Factors (Reductions)
Strength of Case, including Comparative Negligence: _____
No Fault Deduction (PIP and Other Set-Offs) ___________
Prior Injuries to Affected Areas: _____________________
Overall Health Conditions/Life Expectancy: ____________
Case Value: ___________
Within Reasonable Range ________
Quick Florida Car Accident Facts:
According to the Florida Department of Motor Vehicles, for example, in 2009 statewide there were 20,085 alcohol related traffic accidents resulting in 1,004 deaths and 14,130 injuries. Additionally, damages from auto crashes total $150 billion annually because compensation for a car accident, in most cases, includes recovery of medical expenses, property damage, lost wages and lost earning potential, pain and suffering, disfigurement, loss of consortium and emotional distress. Learn more from Alan Sackrin, an expert car accident lawyer.
Want to Know More?
Since 1982, Alan Sackrin has represented clients throughout Florida in recovering monetary damages for car accident injuries. Alan is a Board Certified Civil Trial Expert that strives to maximize the amount of compensation his clients’ receive for their claim. Alan brings a high-level of skill and knowledge to his client’s car accident cases and he offers a free initial consultation.
See: Sample Case Verdicts and Settlements
Related Car Accident Topics
- 8 important steps you should take at the time of an accident
- Car Accident FAQ
- Car Accident Insurance Claims and Coverage (PIP and Bodily Injury Coverage)
- Car Accident Damages
- Attorney Fees Are Negotiable
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Learn More: See Our Car Accident Resource Page