2(a). Model Form of Verdict for Personal Injury Damages [These or similar damage questions should appear in the verdict form after findings on liability issues.] [In determining the amount of damages, do not make any reduction because of the negligence, if any, of (name). If you find that (name) was to any extent negligent, the court in entering judgment will make an appropriate reduction in the damages awarded.] Please answer question[s] [*]. [*]. What is the total amount of (claimant)'s damages for lost earnings in the past, loss of earning capacity in the future, medical expenses incurred in the past, medical expenses to be incurred in the future, and (list any other economic damages)? [*]. What is the total amount of (claimant)'s damages for pain and suffering, disability, physical impairment, disfigurement, mental anguish, inconvenience, aggravation of a disease or physical defect (list any other noneconomic damages) and loss of capacity for the enjoyment of life sustained in the past and to be sustained in the future? Total Damages of (claimant) (add lines [1] and [2]) [*]. What is the total amount of damage sustained by (spouse) in loss of [his wife's] [her husband's]: [a.] comfort, society, and attention? [b.] services? Total Damages of (spouse) (add lines [a*] and [b*]) $ $ $ $ $ $ *Insert appropriate numbers.