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36.23 [1991 New] Form of Verdict-Combined Injury and Derivative Claims
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Description
Instruction No 1 36.23 [1991 New] Form of Verdict--Combined Injury and Derivative Claims VERDICT Note: Complete this form by writing in the name(s) required by your verdict. On the claim of plaintiff (state name of plaintiff with primary claim ) for personal injuries against defendant (state the name ), we, the undersigned jurors, find in favor of: (Plaintiff (state name of plaintiff with primary claim)) or (Defendant (state the name)) Note: Complete the following paragraphs only if [one or more of] the above finding(s) is in favor of plaintiff (state name of plaintiff with primary claim ). We, the undersigned jurors, assess the damages of plaintiff (state name of plaintiff (stating the amount ). with primary claim ) for personal injuries at $ Note: Complete the following paragraph by writing in the word(s) required by your verdict. On the claim of plaintiff (state name of plaintiff with derivative claim ) for damages due to injury to [his] [her] [husband] [wife] [child], we, the undersigned jurors, find that plaintiff (state name of plaintiff with derivative claim ) sustain damage as a direct result of injury ("did" or "did not") to [his] [her] [husband] [wife] [child]. Note: Complete the following paragraph only if the above finding is that plaintiff (state name of plaintiff with derivative claim ) "did" sustain such damage. We, the undersigned jurors, assess the damages of plaintiff (state name of plaintiff with derivative claim ) due to injury to [his] [her] [husband] [wife] [child] at $ (stating the amount). Note: All jurors who agree to the above findings must sign below.