Damages Estimate Worksheet

When you suffer injuries that you believe are the fault of another party (or parties), you may file a claim for "damages." In legal terms, damages are the costs associated with an injury that are claimed when filing a lawsuit. If the defendant is found liable for your injuries, then you will be awarded damages. Many personal injury attorneys work on a contingency basis, which means they don't get paid unless you win your case (and are thus awarded damages).

Damages are not always easy to calculate, and in many cases your attorney will be able to point out additional damages that are indirectly related to the claim. For example, travel to physical therapy clinics and loss of wages. Also, you may require long-term or even lifelong medical assistance stemming from the injury. See Economic Recovery for Accidents and Injuries for a more complete list with detailed explanations or FindLaw's Injury Damages section for more articles and resources.

The following worksheet 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.

Get a Free Consultation to Learn More About Your Case

This worksheet should give you a general idea of the damages involved in your case. But to get a complete understanding of the strength of your claim and damages involved, you should consult a lawyer. Fortunately, you can do so by contacting an experienced personal injury attorney for a free claim evaluation.

Damages Estimate Worksheet

I. Out-of-Pocket Damages aka “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 $_________________

Household help _____________ $_________________

Lost wages _____________ $_________________

Other work losses _____________ $_________________

Future losses _____________ $_________________

Loss of earning capacity _____________ $_________________

Increased cost of living _____________ $_________________

Special training/occupational therapy _____________ $_________________

Property damage _____________ $_________________

TOTAL OUT-OF-POCKET DAMAGES $_________________

To get a sense of how an insurance company might value your case, make the following
calculations:

  • Method No. 1 Multiply your total by 3 $________________
  • Method No. 2 Multiply your “medical” damages by 5 $________________

II. Damages for Physical Injury

Check all that apply, then rate the severity of each checked injury on a scale of 1 (not serious) to
5 (catastrophic) -- don’t worry about dollar amounts for these items:

Pain and suffering _____________ 1 2 3 4 5

Future pain and suffering _____________ 1 2 3 4 5

Total disability _____________ 1 2 3 4 5

Partial disability _____________ 1 2 3 4 5

Future disability _____________ 1 2 3 4 5

Loss of enjoyment of life _____________ 1 2 3 4 5

Your spouse’s loss of your services _____________ 1 2 3 4 5

Lost limbs:

Dominant hand/arm _____________ 1 2 3 4 5
Nondominant hand/arm _____________ 1 2 3 4 5
Foot _____________ 1 2 3 4 5
Leg below knee _____________ 1 2 3 4 5
Leg mid-thigh _____________ 1 2 3 4 5
Leg at hip _____________ 1 2 3 4 5

Lost organs:

Kidney _____________ 1 2 3 4 5
Lung _____________ 1 2 3 4 5
Other: __________ _____________ 1 2 3 4 5
Back/Neck injury _____________ 1 2 3 4 5
Head injury/brain damage _____________ 1 2 3 4 5
Other: _________________ _____________ 1 2 3 4 5

III. Intangibles--How Your Life Has Changed

The following questions are intended to help you get a feel for the kinds of facts that a jury may
consider when deciding what to award in damages:

1. Which of your injuries are visible? Which are invisible?
___________________________________________________________________
___________________________________________________________________
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2. What physical pain did you experience when you were first injured?
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________

3. What physical pain did you experience as you recovered from your injury?
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________

4. Do you still feel physical pain from your injury? _______Yes _______No

5. If you answered “Yes” to Question 5, please elaborate.
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________

6. When you think about your injury and how it has affected you, what/how do you feel?
(check all that apply)?

Sorrow _______
Anxiety _______
Humiliation _______
Anger _______
Fear _______
Frustration _______
Defeated _______
Resigned _______
Other _______

7. What physical activities and hobbies did you enjoy that now cause you pain?

Participating in sports _______ Which sports?________________________
Gardening _______
Woodworking/Crafts _______
Sewing/Embroidery/
Needlework _______
Playing a musical instrument _______ Which instrument?_____________________
Playing with children _______
Cooking _______
Other _______

8. What household chores now cause you pain?
Cooking _______
Laundry _______
Cleaning _______
Ironing _______
Washing the car _______
Yard work/Snow removal _______

9. What social activities have you had to reduce or abandon?
Entertaining guests _______
Club activities _______
Charitable/social
organizations _______
Dancing _______
Concerts/plays _______
Going to museums _______
Going out with friends _______

10. Are you still able to help people when they need help? For example, can you still babysit your grandchildren? Can you still visit people from your church, temple, or mosque who were sick and unable to attend services? Take a few minutes to think about this question and then write a little bit about these sorts of changes:
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________

11. What plans for the future have you had to modify or abandon?
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________

12. Are there any other changes in your day-to-day life resulting from your injury?
___________________________________________________________________
___________________________________________________________________

Learn More About Your Claim with a Free Attorney Review

Putting a dollar amount on your injuries is not as simple as adding up your medical care receipts, since injuries typically affect your life (and finances) in indirect ways as well. For instance, an injury may have kept you from earning a wage for several days. Let an attorney evaluate your claim today, at no cost to you.

Next Steps

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