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FORENSIC STATISTICS & LITIGATION SUPPORT

Phone: (702) 263-8044

Fax: (702) 263-8740


 

  


Wrongful death cases require similar analysis to personal injury cases but are broadened to also address how much an individual would have been expected to consume over his/her lifetime, leaving the net accumulations to an estate.

Wrongful Death Questionnaire
Wrongful Death cases require similar analysis to personal injury cases but are broadened to also address how much an individual would have been expected to consume over his/her lifetime, leaving the net accumulations to an estate.

Lost Earnings Evaluation: Wrongful Death

Client Information

First Name: Last Name:

Street Address:

City: State: Zip Code:

Phone: (i.e. 702-263-8044)

Email:

Decedent Information

First Name: Last Name:

Demographic Information

Date of Birth: (i.e. YYYY/MM/DD)

Race: Citizenship:

If Others, please specify:

Gender: Marital Status:

Highest grade of school completed/degrees received:

Children?

Occupation prior to incident:

Number of weeks employed year before death: Usual number of hours per week at job:

Rate of pay:

Last Day Working: (i.e. YYYY/MM/DD)

Additional Information

Earnings History

Did the employer pay health insurance:

If applicable, please specify:

Did the employer pay into retirement program:

If applicable, please specify:

Were there any pre-existing medical conditions or disabilities?

Does the medical conditions or disabilities restrict any type or amount of work the victim can perform?

Other Considerations

Hours of free time:

Hourly cost of replacement help: Past and or expected future medical expenses:

Lost quality of life:

Attachment1:

Attachment2:

Attachment3:

Attachment4:

Attachment5:

Please provide the following as attachments:

1. Earnings Report

2. Copy of complaint

3. Relevant expert reports

4. Relevant depositions