Treating doctors and health care after the crash.
Question 1
List the name and business addresses of each physician who has treated or examined you, and each medical facility where you have received any treatment or examination for the injuries for which you seek damages in this case; and state as to each the date of treatment or examination and the injury or condition for which you were examined or treated.
Question 1 List All Medical Providers that Treated you for this Crash
This one is very important to get correct. List every doctor, hospital, clinic, ambulance driver, fireman, X-Ray, MRI, and any labs that may have done any work, or looked or treated you in any way. I have listed the doctors we know about because you are treating with them for this accident, But, if we are missing any doctors, then we obviously don't know about them and need you to list them here. So please list each and every health care professional that you have seen, no matter how irrelevant it may seem
Did you ever go to any place outside of the doctors office just to get X-rays? If so, tell us where you went.
Where did you get your MRI's?
What other studies were done and where did you get them done?
If you saw your Primary Care Physician, we list this doctor in your answers. Please provide the name and location of your PCP.
Please help us list every medical professional you have seen. Nothing is too minor. Please tell us everything.
Employment information
Question 2
List the names, business addresses, dates of employment and rates of pay regarding all employers, including self-employment, for whom you have worked in the past ten years.
Question 2: List all prior employment and rates of pay for the past 10 years.
You want to list every employer, good ones and bad ones. This is important to the defense for two reasons, the first is to challenge your lost wages or earnings and second to look for any health insurance you may have had through your work or any workers compensation claims you have made. If you forget or leave out an employer, the Insurance Defense lawyer may suggest you are being dishonest. Please list all of your prior employment.
Loss Of Future Earnings Caused By Car Crash Injuries
Question 3
Do you contend that you have lost any income, benefits, or earning capacity in the past or future as a result of the incident described in the complaint? If so, state the nature of the income, benefits, or earning capacity, and the amount and method that you used in computing the amount
Question 3: Your Lost Wages and benefits in the past and any loss of future income.
This is basically 3 questions in one. First, Do you have lost wages caused by the car accident? Second, have you lost any employment benefits caused by the car accident? And Third will you have lost wages in the future caused by the car accident?
1) Past Lost Wages: We want to calculate every penny of lost wages that you suffered because of this car accident.
2) Lost Benefits are listed below and select any losses that apply to your particular situation.
3) Future Earnings addresses questions like, will you get raises like you used to get since you were hurt? We want to tell them how will lose money because of your injury and how you calculated the figure. Don't worry too much about the calculations, just tell them what you lost, and what you think you will lose in the future and we may have an accountant or an economist calculate this for you.
This is asking about what wages or earnings you have lost since the accident up to the date of answering this question.
How much per hour were you paid to work.
How many hours of work have you missed due to this accident. Taking time off of work due to your injuries, or treatments with doctors.
Pick the answer that best describes any loss of work you may have due to your injuries from this crash. Then in the paragraphs below, give us more details to support how you feel.
Some people when they are hurt, or miss work, they lose benefits that they otherwise would earn or be entitled to if they were not injured. Please select any benefits you have lost as a result of this incident.
Question 4
List all former names and when you were known by those names. State all addresses where you have lived for the past ten years, the dates you lived at each address, your social security number, your date of birth, and if you are or have ever been married, the name of your spouse or spouses.
Question 4: Addresses of where you have lived over the past 10 years.
They want every address, every name, and all other piece of information about you so that they can check on your history and lifestyle over the past 10 years.
Have you ever been known by any other names, such as maiden names, or legally changed your name for any reason, or ever used someone else's name. They don't want nicknames such as Mike for Michael.
Please provide the other names you have been know as and the circumstances of why you were known by that name and now are known by another name.
Have you ever been married?
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Provide the address where you lived before.
Fill in the approximate months and years you lived at this second address.
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Provide the address where you lived before.
Fill in the approximate months and years you lived at this address.
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Provide the address where you lived before.
Fill in the approximate months and years you lived at this address.
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Provide the address where you lived before.
Fill in the approximate months and years you lived at this address.
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Provide the address where you lived before.
Fill in the approximate months and years you lived at this address.
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Provide the address where you lived before.
Fill in the approximate months and years you lived at this address.
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Provide the address where you lived before.
Fill in the approximate months and years you lived at this address.
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Provide the address where you lived before.
Fill in the approximate months and years you lived at this address.
Please list any other addresses where you have lived in the past 10 years that are not listed above.
Question 5
Do you wear glasses, contact lenses, or hearing aids? If so, who prescribed them, when were they prescribed, when were your eyes or ears last examined, and what is the name and address of the examiner?
Question 5: Do you wear glasses?
In other words, was the accident your fault because you did not see very well and you were not wearing your prescription glasses, or did you fail to hear something? Can they pin any fault on you?
Question 6
Have you ever been convicted of a crime, other than any juvenile adjudication, which under the law under which you were convicted was punishable by death or imprisonment in excess of 1 year, or that involved dishonesty or a false statement regardless of the punishment? If so, state as to each conviction the specific crime and the date and place of conviction.
Question 6: List any and all criminal convictions.
We want to accurately list any and all criminal convictions you may have as an adult. If you have any convictions and we tell the truth about them, this will prevent the insurance defense lawyer from telling the jury what your convictions were for. But if you get this wrong, the defense lawyer may get to talk all about your prior criminal convictions in great detail. Therefore, If you have any doubts about whether something resulted in a conviction, we can order a criminal history report from each state where you suspect a conviction may have been given to you. Also, if we know about them, we can usually get the judge to order the defense not to talk about any that are over 10 years old. But we have to know about this to protect you from this damaging testimony that can only be used against you if you don't answer this question correctly.
If you are not certain of a conviction, please let us know. What we will do with your answer is order a copy of your records and confirm if you were ever convicted. Please help us find this out accurately. It will save a lot of problems later if we know now of any and all convictions.
Describe any and all possible criminal conviction you have had. The more information you give us the easier it will be to make sure we answer this question accurately.
Question 7
Did you consume any alcoholic beverages or take any drugs or medication within twelve hours before the time of the incident described in the complaint? If so, state the type and amount of alcoholic beverages, drugs or medication which were consumed and when and where you consumed them.
Question 7: Were you drinking or taking drugs or medications?
Were you drinking? or did you take any medication before the accident? They want to suggest that you were intoxicated and therefore the accident is at least partially your fault.
Question 8
Describe in detail how the incident described in the complaint happened, including all actions taken by you to prevent the incident.
Question 8: What did you do to avoid the crash?
What did you do to avoid or reduce the severity of this accident? We want to make a list of everything you did right before the accident. The insurance company lawyer wants to place some blame on you for this accident.
Question 9
Describe in detail each act or omission on the part of any party to this lawsuit that you contend constituted negligence that was a contributing legal cause of the incident in question.
Question 9: What did the other people do wrong that led to or caused the crash?
What did the other people do wrong that caused this accident? Did anyone do anything to make it worse? Did they drive too fast? Did they turn when it was not safe to do so? Were they drinking alcohol or appear to be on drugs? The more clearly we can explain why it is the other driver's fault the easier it will be to win this part of your case, that is who is at fault.
If the at fault driver did anything that made the crash worse than it had to be, what did they do that makes you mad or upset about this collision?
Please add anything else that may apply that would cause a jury to find that the other driver was at fault for the collision. Or what aggravating circumstances would make a jury mad at the at fault person?
Question 10
Were you charged with any violation of law (including any regulations or ordinances) arising out of the incident described in the complaint? If so, what was the nature of the charge; what plea or answer, if any, did you enter to the charge; what court or agency heard the charge; was any written report prepared by anyone regarding this charge, and, if so, what is the name and address of the person or entity that prepared the report; do you have a copy of the report; and was the testimony at any trial, hearing, or other proceeding on the charge recorded in any manner, and, if so, what is the name and address of the person who recorded the testimony?
Question 10: Did you get a ticket?
Did you get a ticket? If so, tell them what happened in court. The insurance company wants to know if they can use any traffic citation you got against you at trial.
Question 11
Describe each injury for which you are claiming damages in this case, specifying the part of your body that was injured, the nature of the injury, and, as to any injuries you contend are permanent, the effects on you that you claim are permanent.
Question 11: What still hurts that you are seeking damages for?
What still hurts? Cuts, scars, headaches, neck pain, back pain, can't sleep, numbness on a constant basis anywhere? This is important to list in writing all of the problems you have today. The defense has the right to know what you will tell a jury about your injuries. If you don't say much about them, then you can't say more at trial. Also, if you complain about every little tiny thing, then you may turn off a jury and sound like a complainer. I suggest you answer this question fully, and if you are not sure whether to include something or not, please include it so that we can talk about it later and possibly edit your answer to help your case.
Please explain any other physical or mental symptoms or problems you relate to this crash.
Question 12
List each item of expense or damage, other than loss of income or earning capacity, that you claim to have incurred as a result of the incident described in the complaint, giving for each item the date incurred, the name and business address to whom each was paid or is owed, and the goods or services for which each was incurred.
Question 12: What Property Damages are you claiming that have not been resolved yet?
Are you claiming any loss for the damages to your vehicle, loss of use, or depreciation in its value? Also, list any extra expenses you have from this incident, including: cleaning services, lawn maintenance, damages to your car, broken eye glasses, torn clothing, damaged things in your car, prescription drugs, bandages, aspirin, heating pads, crutches, etc. anything you have spent a penny on, that is related to your accident.
List every expense or debt you incurred that was caused by the car crash.
Please give us details regarding how much you have paid or owe for medications related to this car crash. The more detail we can provide to the defense, the easier it will be to get this reimbursed. Also, please send us any receipts you might have if you have not given them to us already.
Please give us details regarding how much you have paid or over the counter medications related to this car crash. The more detail we can provide to the defense, the easier it will be to get this reimbursed. Also, please send us any receipts or bills you may have not sent us already.
If you can tell us how many miles it is round trip to each of your doctors we can calculate the mileage, with the times you have been to each of them.
If your Property Damage claim has been resolved, say None. If not, list the losses you still have not been paid for.
If your car was damaged and you believe it has lost value because it is damaged, you can make a claim for this depreciation against a bad driver, but not your own UM insurance company. How much value do you believe you lost in your vehicle as a result of it being damaged in a crash?
Please tell us the amount of unreimbursed rental car expenses you have, and who you paid for this.
Please tell us the amount of unreimbursed towing you have, and who you paid for this.
Please tell us the amount of unreimbursed vehicle storage charges you have, and who you paid for this.
Please list as specifically as you can any other items of property damage that were damaged in this car crash. For example, I had an Apple Mac Book Pro worth $______ that was crushed by the collision.
Question 13
List the names and addresses of all persons who are believed or known by you, your agents or attorneys to have any knowledge concerning any of the issues in this lawsuit; and specify the subject matter about which the witness has knowledge.
Question 13: Who is a Fact Witness regarding the Crash or your injuries?
Usually, you, your family, all the witnesses to the accident, all of your doctors, any police officers, ambulance drivers, your employers, co-workers, and friends who know how bad you were hurt.
If you have the name of the eye witness, please let us know who they are so that we may contact them.
If you have the name of a co-worker that might be willing to help us with your case, please let us know who they are so that we may contact them.
If you know of anyone else that we might want to contact and see if they are willing to assist us with your case, please add their name, contact information and what they may know to help us with your case.
Question 14
Have you heard or do you know about any statement or remark made by or on behalf of any party to this lawsuit, other than yourself, concerning any issue in this lawsuit? If so, state the name and address of each person who made the statement or statements, the name and address of each person who heard it, and the date, time, place and substance of each statement.
Question 14: What Admissions did the at fault party make that will help prove they were at fault for this crash?
Did any driver or and defendant say anything about what happened? Did they make any admissions that we can tell the jury about? If so, we have to let the defense know now about any admissions or statements their client made that helps your case and hurts the defendants case.
If you heard the bad driver say anything that might be an admission by them regarding liability please let us know. Things like drinking, taking drugs, admitting to speeding, who owned the car, that they were working. Anything you heard might be helpful
Question 15
State the name and address of every person known to you, your agents, or your attorneys, who has knowledge about, or possession, custody, or control of, any model, plat, map, drawing, motion picture, videotape, or photograph pertaining to any fact or issue involved in this controversy; and describe as to each, what item such person has, the name and address of the person who took or prepared it, and the date it was taken or prepared.
Question 15: Who has any evidence or photographs of what happened?
Usually, just the police, their insurance company, your insurance company, the defendant is all that I would know who may have photos, etc.
Please send us any photographs that you have that may help your case in any way.
Question 16
Do you intend to call any expert witnesses at the trial of this case? If so, state as to each such witness the name, and business address of the witness, the witness's qualifications as an expert, the subject matter upon which the witness is expected to testify, the substance of the facts and opinions to which the witness is expected to testify, and a summary of the grounds for each opinion.
Question 16: Who might be your expert witnesses to prove your case?
Usually you will not know what “Experts” you will use beyond your treating doctors.
Question 17
Have you made an agreement with anyone that would limit that party's liability to anyone for any of the damages sued upon in this case? If so, state the terms of the agreement and the parties to it.
Question 17: Confirm that you have not made any side agreements with any defendants to limit your recovery.
Usually you have not made any such agreements.
Question 18
Please state if you have ever been a party, either plaintiff or defendant, in a lawsuit other than this one, and if so, state whether you were a plaintiff or defendant, the nature of the action, and the date and court in which such suit was filed.
Question 18: What prior Lawsuits have you been involved in?
They want to know about any lawsuits you have ever been involved in, divorce included.
Question 19
List your prior automobile and health insurance companies you have had over the past 10 years.
Question 19: List your prior insurance companies.
They just want to know where else you have had insurance so that they can subpoena their records about you and find any claims you have made, or lists of any doctors or treatment you may have obtained in the past 10 years.
Question 20
List all activities that you used to do but now you cannot do them at all, and list all activities that you used to do that are now hard to do because of your injuries.
Question 20: List activities that are harder for you to do because of the crash that you used to do before the crash.
This is a pretty straight forward question about what activities you used to do, but are now limited or impossible for you to do. The tricky part of this question that they will ask later is "how often did you do these activities before the accident?" They hope to show that you did not do that activity much, or it has been many years before this accident that you did that activity. So, try to list things that you did often, or at least once per year but now you cannot do them at all because of the injuries from this car crash.
If you absolutely cannot do something that you used to do before, check it. If you can do the activity but it is hard to do now, do not check the item, it will be asked next.
If you absolutely cannot do something that you used to do before, check it. If you can do the activity but it is hard to do now, do not check the item, it will be asked next.
Please add any other activities that you have great difficulty doing now because of the crash, and tell us why this crash has made these activities harder to do now.
Question 21
List all gyms and or health clubs you were a member over the past 5 years:
Question 21: List all gym memberships for the past 5 years.
Please give us a list of all health clubs you were a member of over the past 5 years. This information will help show how active and healthy you were before the car crash.
Question 22
What was your cell phone number, carrier, and name of the account for your cell phone on the date of the accident?
Question 22: Who was your cell phone carrier at the time of the crash?
The insurance defense lawyer may subpoena your cell phone records to see if you were using your cell phone at the time of the accident.
What name was the cell phone bill in at the time of the crash?
Please give us your cell phone account number so that we can order your phone record for the day of the crash if we need it.
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