VF 2801. Fraudulent Concealment of Injury (Lab. Code, § 3602(b)(2))

VF-2801. Fraudulent Concealment of Injury (Lab. Code, § 3602(b)(2)) Instruction No 1 Request by Plaintiff Given as Proposed Refused Withdrawn Request by Defendant Given as Modified Requested by Given on Court's Motion Judge Instruction No 1 We answer the questions submitted to us as follows: 1. Was [name of plaintiff/decedent] injured on the job? ____ Yes ____ No If your answer to question 1 is yes, then answer question 2. If you answered no, stop here, answer no further questions, and have the presiding juror sign and date this form. 2. Did [name of defendant] know [name of plaintiff/decedent] had suffered a job-related injury? ____ Yes ____ No If your answer to question 2 is yes, then answer question 3. If you answered no, stop here, answer no further questions, and have the presiding juror sign and date this form. 3. Did [name of defendant] conceal this knowledge from [name of plaintiff/decedent]? ____ Yes ____ No If your answer to question 3 is yes, then answer question 4. If you answered no, stop here, answer no further questions, and have the presiding juror sign and date this form. 4. Was [name of plaintiff/decedent]'s injury made worse as a result of this VF-2801. Fraudulent Concealment of Injury (Lab. Code, § 3602(b)(2)) Instruction No 1 Request by Plaintiff Given as Proposed Refused Withdrawn Request by Defendant Given as Modified Requested by Given on Court's Motion Judge Instruction No 1 concealment? ____ Yes ____ No If your answer to question 4 is yes, then answer question 5. If you answered no, stop here, answer no further questions, and have the presiding juror sign and date this form. 5. What are [name of plaintiff]'s damages? [a. Past economic loss [lost earnings [lost profits [medical expenses [other past economic loss Total Past Economic Damages: [b. Future economic loss [lost earnings [lost profits [medical expenses $ $ $ ] ] ] $ $ $ $ $ ] ] ] ] ] VF-2801. Fraudulent Concealment of Injury (Lab. Code, § 3602(b)(2)) Instruction No 1 Request by Plaintiff Given as Proposed Refused Withdrawn Request by Defendant Given as Modified Requested by Given on Court's Motion Judge Instruction No 1 [other future economic loss $ ] ] ] ] Total Future Economic Damages: $ [c. [d. Past noneconomic loss, including [physical pain/mental suffering:] Future noneconomic loss, including [physical pain/mental suffering:] TOTAL Answer question 6. 6. What are the damages that [name of plaintiff/decedent] would have sustained if [name of defendant] had not concealed the injury? [a. Past economic loss [lost earnings [lost profits [medical expenses [other past economic loss Total Past Economic Damages: [b. Future economic loss $ $ $ $ $ $ $ $ ] ] ] ] ] VF-2801. Fraudulent Concealment of Injury (Lab. Code, § 3602(b)(2)) Instruction No 1 Request by Plaintiff Given as Proposed Refused Withdrawn Request by Defendant Given as Modified Requested by Given on Court's Motion Judge Instruction No 1 [lost earnings [lost profits [medical expenses [other future economic loss $ $ $ $ ] ] ] ] ] ] ] Total Future Economic Damages: $ [c. [d. Past noneconomic loss, including [physical pain/mental suffering:] Future noneconomic loss, including [physical pain/mental suffering:] TOTAL Answer question 7. $ $ $ 7. Subtract the total amount in question 6 from the total amount in question 5. This is the amount [name of plaintiff] is entitled to recover. $ Signed: Dated: After [this verdict form has/all verdict forms have] been signed, notify the Presiding Juror VF-2801. Fraudulent Concealment of Injury (Lab. Code, § 3602(b)(2)) Instruction No 1 Request by Plaintiff Given as Proposed Refused Withdrawn Request by Defendant Given as Modified Requested by Given on Court's Motion Judge Instruction No 1 [clerk/bailiff/court attendant] that you are ready to present your verdict in the courtroom. __________________________________________________________________________ New September 2003; Revised April 2007, December 2010, December 2016