Worksheet: Damage Estimate

The following is intended to help you see how damages include easily identifiable costs in an effort to place a dollar value on your physical person and the way in which your life has changed since you were injured. Beyond an inventory of known costs, it does not attempt to calculate the value of your physical self or the quality of your life as it was before the injury.

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I.          Out-of-Pocket Damages a/k/a “Special Damages”

                                                     Damages Present               Amount Spent or
                                                     in Case (U)                            Estimated

Doctors’ bills                                 _____________                  $_________________

Ambulance bill                               _____________                  $_________________

Hospital bills                                  _____________                  $_________________

Private nurses                                _____________                  $_________________

Medicines/Drugs                           _____________                  $_________________

Medical supplies                            _____________                 $_________________

Travel/lodging arising from
need for medical treatment             _____________                  $_________________

Wheelchairs, walkers, prostheses,
handicapped-accessible vehicle,
other special implements                _____________                  $_________________

Future medical expenses                _____________                  $_________________

TOTAL MEDICAL DAMAGES   $_________________