CONFIDENTIAL/SETTLEMENT WORK SHEET JUSTICE PAUL A. VICTOR, PRESIDING TITLE OF PROCEEDINGS1 INDEX NO.: ____________________________ --------------------------------------------------------------------x DATE NOTE OF ISSUE FILED: V. 2 ESTIMATED LENGTH OF TRIAL: CASE TYPE: _________________________ -------------------------------------------------------x ATTORNEYS OF RECORD & TRIAL COUNSEL3 COUNSEL FOR PLAINTIFF(S) 1. _____________________________________________________ ATTORNEY OF RECORD FOR ___________________________ 1. _____________________________________________________ OFFICE ADDRESS AND PHONE NUMBER ATTORNEY OF RECORD FOR ___________________________ ________________________________________________________ OFFICE ADDRESS AND PHONE NUMBER ________________________________________________________ ________________________________________________________ ________________________________________________________ TRIAL COUNSEL AND PHONE NUMBER TRIAL COUNSEL AND PHONE NUMBER ________________________________________________________ ________________________________________________________ 2. _____________________________________________________ ________________________________________________________ ATTORNEY OF RECORD FOR ___________________________ ________________________________________________________ 2. _____________________________________________________ OFFICE ADDRESS AND PHONE NUMBER ATTORNEY OF RECORD FOR ___________________________ ________________________________________________________ OFFICE ADDRESS AND PHONE NUMBER ________________________________________________________ ________________________________________________________ ________________________________________________________ TRIAL COUNSEL AND PHONE NUMBER TRIAL COUNSEL AND PHONE NUMBER ________________________________________________________ ________________________________________________________ ________________________________________________________ 3. _____________________________________________________ ________________________________________________________ ATTORNEY OF RECORD FOR ___________________________ 3. _____________________________________________________ OFFICE ADDRESS AND PHONE NUMBER ATTORNEY OF RECORD FOR ___________________________ ________________________________________________________ OFFICE ADDRESS AND PHONE NUMBER ________________________________________________________ ________________________________________________________ TRIAL COUNSEL AND PHONE NUMBER ________________________________________________________ _________________________________________________________ TRIAL COUNSEL AND PHONE NUMBER __________________________________________________________ CONFERENCE NOTES BEGIN ON THE NEXT PAGE COUNSEL FOR DEFENDANT(S) 1 IDENTIFY ALL PARTIES IN THE CAPTION. 2 AFTER TRIAL ASSIGNMENT PLEASE PROVIDE AND/OR CERTIFY THAT: THERE ARE NO OUTSTANDING MOTIONS G; ALL WITNESSES ARE AVAILABLE G ; WHETHER AN INTERPRETER IS NEEDED (YES ___ NO ___) AND IF YES , THE LANGUAGE _________________________ G. 3 ONLY ATTORNEYS OF RECORD AND TRIAL COUNSEL MUST BE IDENTIFIED ON THIS PAGE. “COVERING” COUNSEL SHALL ONLY BE IDENTIFIED IN THE PROGRESS NOTES, INFRA. 1 American LegalNet, Inc. www.FormsWorkflow.com SUMMARY SHEET4 PLAINTIFFS 1. 2. 3. ____________________________ 4. DOB ______ OCCUPATION LOST TIME ____________________________ OCCURRENCE: (PROVIDE PLAINTIFF’S VERSION) (TYPE OF ACTION) DATE: ___________ TIME: LOCATION: LIABILITY ISSUES AND DEFENDANT'S VERSION : INJURIES AND TREATMENT: PAST AND FUTURE DAMAGES: LIENS: ______________________________________________________________________________________ PLAINTIFF(S) DEMANDS: ______________________________________________________________________________________________ DEFENDANT(S) OFFERS: ______________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ SETTLEMENT CONFERENCE PROGRESS NOTES DATE AND ACTION TAKEN: COUNSEL FOR PLAINTIFF: ________________ DATE AND ACTION TAKEN: _____________ COUNSEL FOR PLAINTIFF:_______________ _________________________________________ __________________________________________ __________________________________________ __________________________________________ __________________________________________ _______________________________________ _______________________________________ _______________________________________ _______________________________________ _______________________________________ CONTINUED ON NEXT PAGE 4 _____ Here provide a simple and short summary only. Provide the details on pages 4 to 9, infra. 2 American LegalNet, Inc. www.FormsWorkflow.com SETTLEMENT CONFERENCE PROGRESS NOTES5 DATE AND ACTION TAKEN: COUNSEL FOR PLAINTIFF: ________________ DATE AND ACTION TAKEN:____________________ COUNSEL FOR PLAINTIFF: ____________________ ________________________________________ ________________________________________ ________________________________________ ________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ DATE AND ACTION TAKEN: COUNSEL FOR PLAINTIFF: ________________ DATE AND ACTION TAKEN:___________________ COUNSEL FOR PLAINTIFF: ___________________ ________________________________________ ________________________________________ ________________________________________ ________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ DATE AND ACTION TAKEN: COUNSEL FOR PLAINTIFF:________________ DATE AND ACTION TAKEN:_____________________ COUNSEL FOR PLAINTIFF: ___________________ ________________________________________ ________________________________________ ________________________________________ ________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ DATE AND ACTION TAKEN: COUNSEL FOR PLAINTIFF: ________________ DATE AND ACTION TAKEN: _____________________ COUNSEL FOR PLAINTIFF: ______________________ _________________________________________________ _________________________________________________ ________________________________________ ________________________________________ ________________________________________ ________________________________________ ____________________________________________ ____________________________________________ DATE AND ACTION TAKEN: COUNSEL FOR PLAINTIFF:________________ DATE AND ACTION TAKEN: ___________________ COUNSEL FOR PLAINTIFF: ____________________ ________________________________________ ________________________________________ ________________________________________ ________________________________________ _____________________________________________ _____________________________________________ _____________________________________________ _____________________________________________ DATE AND ACTION TAKEN: COUNSEL FOR PLAINTIFF:________________ DATE AND ACTION TAKEN: ___________________ COUNSEL FOR PLAINTIFF: ____________________ ________________________________________ ________________________________________ ________________________________________ ____________________________________________ ____________________________________________ ____________________________________________ DATE AND ACTION TAKEN: COUNSEL FOR PLAINTIFF:________________ DATE AND ACTION TAKEN:____________________ COUNSEL FOR PLAINTIFF: ____________________ ________________________________________ ________________________________________ ________________________________________ ____________________________________________ _____________________________________________ _____________________________________________ 5 For details regarding the occurrence, liability and damages - See pages 4 to 9. 3 American LegalNet, Inc. www.FormsWorkflow.com INFORMATION REGARDING THE INCIDENT 6 OCCURRENCE: DATE: _____________________; TIME: ________________; WEATHER ______________________________ LOCATION: ____________________________________________________________________________________ LIGHTING AND OTHER FACTORS: _____________________________________________________ _______________________________________________________________________________________ BRIEF DESCRIPTION OF INCIDENT: (PROVIDE PLAINTIFF’S AND DEFENDANT’S VERSION) _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ G AMBULANCE AT SCENE?; G POLICE AT SCENE? ; G OTHER WITNESSES: (PROVIDE NAME OF EACH WITNESS AND SYNOPSIS OF WITNESS'S STATEMENT) ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ G WRITTEN STATEMENT OBTAINED?; G EBT OF WITNESS CONDUCTED? WITNESSES: (PROVIDE NAME OF EACH WITNESS AND SYNOPSIS OF WITNESS'S STATEMENT) ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ G WRITTEN STATEMENT OBTAINED?; G EBT OF WITNESS CONDUCTED? . IDENTIFY ALL PERSONS, DEPARTMENTS AND/OR AGENCIES THAT INVESTIGATED INCIDENT AND STATE WHETHER REPORTS HAVE BEEN PREPARED AND FILED: ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ IDENTIFY ALL DISPUTED LEGAL AND FACTUAL ISSUES AND DISPUTES. ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ 6 All information requested herein is confidential and provides the Court with the ability to make a fair evaluation of the settlement value of the case. It is not the intention of the Court to compromise counsel’s trial strategy, and counsel is free to decline to provide any and all of other information requested. It is the Court’s experience that whenever each side is candid about the strengths and weaknesses of their respective positions, a fair and early settlement is usually achieved. In addition, reliance upon the assumed lack of preparedness of your adversary is usually an illusion that pays no dividends. In any event, your failure to be prepared and/or failure to provide the court with all essential information and documentation, will result in a failed negotiation and a delayed trial ! Please help the Court to help you settle this case in an expeditious fashion. 4 American LegalNet, Inc. www.FormsWorkflow.com PLAINTIFF’S PERSONAL INFORMATION7 NAME: ___________________________________; DOB ____________; MARITAL STATUS: _____________ OCCUPATION AND SALARY: (BOTH AT THE TIME OF INCIDENT AND AT PRESENT) ______________________________________________________________________________________________ ______________________________________________________________________________________________ IDENTIFICATION OF EMPLOYER(S): __________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ TIME LOST FROM WORK; AND THE PERIODS THEREOF: _______________________________ _______________________________________________________________________________________ TOTAL AMOUNT CLAIMED FOR LOST EARNINGS: PAST AMOUNT: $__________ PERIOD: (FROM) __________________ (TO) __________________ FUTURE AMOUNT: $__________ PERIOD: (FROM) __________________ (TO)__________________ DESCRIBE ALL LIENS AND/OR COLLATERAL SOURCES: _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ OTHER RELEVANT FACTORS: _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ 7 SEPARATE SHEETS MUST BE PROVIDED FOR EACH PLAINTIFF. 5 American LegalNet, Inc. www.FormsWorkflow.com MEDICAL ISSUES DESCRIPTION, NATURE AND EXTENT OF INJURIES: _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ AMBULANCE: YES G NO G _____________________________________________ HOSPITAL: YES G NO G _____________________________________________ SURGERY: YES G NO G _____________________________________________ DATE, PLACE AND NATURE OF EACH SURGERY: _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ FIRST MEDICAL TREATMENT: DATE: _____________________ 1. IDENTIFY HOSPITAL AND/OR MEDICAL PROVIDER: _________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ 2. DESCRIBE TREATMENT RENDERED:_________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ LAST MEDICAL TREATMENT AND REPORT: DATE __________________ 1. IDENTIFY HOSPITAL AND/OR MEDICAL PROVIDER:______________________ __________________________________________________________________________ ________________________________________________________ 2. DESCRIBE TREATMENT, COMPLAINTS, FINDINGS AND PROGNOSIS: ______________________________________________________________________________________ ______________________________________________________________________________________ _______________________________________________________________________________________ PRESENT MEDICAL COMPLAINTS AND CONDITIONS: _______________________________________________________________________________________ _______________________________________________________________________________________ 6 American LegalNet, Inc. www.FormsWorkflow.com MEDICAL ISSUES CONTINUED MEDICAL EXPENSES INCURRED TO DATE: $_______________________________________ ESTIMATED FUTURE MEDICAL EXPENSES: $_______________________________________ DESCRIBE THE NATURE OF ALL CLAIMED FUTURE MEDICAL TREATMENT: __________________________________________________________________________ __________________________________________________________________________ ____________________________________________________________________________ HOW WERE ABOVE MEDICAL EXPENSES PAID?________________________________________ G YES G YES HAVE I.M.E.’s BEEN COMPLETED? HAVE I.M.E. REPORTS BEEN EXCHANGED? G NO G NO DESCRIBE RELEVANT FINDINGS & CONCLUSIONS _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ IDENTIFY ALL PRIOR AND SUBSEQUENT ACCIDENTS, INJURIES ,CLAIMS AND LAWSUITS WHICH MAY BE RELEVANT TO THE MEDICAL ISSUES IN THIS CASE: _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ LIENS G YES ARE THERE ANY LIENS? G NO PROVIDE THE FOLLOWING W ITH REGARD TO EACH LIEN: LIENOR _________________________ _________________________ _________________________ _________________________ _________________________ AMOUNT ____________________ ____________________ ____________________ ____________________ ____________________ 7 TYPE _____________________ _____________________ _____________________ _____________________ _____________________ American LegalNet, Inc. www.FormsWorkflow.com DOCUMENTS REQUIRED FOR SETTLEMENT CONFERENCES YOU MUST BRING TO COURT THE FOLLOWING DOCUMENTS (TO THE EXTENT THEY EXIST). FOR SETTLEMENT PURPOSES IT WOULD BE EXTREMELY HELPFUL TO THE COURT AS WELL AS OF ASSISTANCE TO THE PARTIES, IF THE FOLLOWING DOCUMENTS ARE BROUGHT TO THE COURT ON EACH CONFERENCE DATE. IF THESE DOCUMENTS ARE NOT PROVIDED THE COURT WILL FIND IT EXTREMELY DIFFICULT TO ASSIST IN A MEANINGFUL SETTLEMENT CONFERENCE. (1) FOR ALL CASES PROVIDE THE FOLLOWING REPORTS/RECORDS: DESCRIPTION OF DOCUMENT G G G G G EXPLANATION/ COMMENTS ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ PROOF OF PRIOR NOTICE NOTICE OF CLAIM 50-H TRANSCRIPT EBT’S CONDUCTED STATEMENTS OBTAINED G PHOTOGRAPHS (NOT PHOTOCOPIES) G OF LOCATION G OF INJURIES G OTHER DAMAGES ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ G INCIDENT, ACCIDENT REPORTS G BY POLICE G BY AGENCY, BOARD OR AUTHORITY G BY PLAINTIFF G BY DEFENDANT G OTHER ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ____________________________________________ G HOSPITALIZATIONS AND RECORDS G PROOF OF ECONOMIC LOSSES ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ G OTHER RELEVANT DOCUMENTS ___________________________________________ G G G G G AMBULANCE/EMS EMERGENCY ROOM/TRIAGE RADIOLOGY OPERATIVE OTHER G TREATING DOCTOR(S) G PHYSICAL THERAPY G EXPERT(S) - LIABILITY (PLAINTIFF) (DEFENDANT) G EXPERT(S) - MEDICAL (PLAINTIFF) (DEFENDANT) SEE NEXT PAGE FOR ADDITIONAL DOCUMENTS REQUIRED FOR SPECIFIC TORT ALLEGED 8 American LegalNet, Inc. www.FormsWorkflow.com REQUIRED DOCUMENTS CONTINUED8 DESCRIPTION EXPLANATION/COMMENTS (2) FOR TRIP & FALL G G G G BIG APPLE MAP WORK ORDERS CONTRACTS, PERMITS, CUT FORMS OTHER DOCUMENTS RELEVANT TO NOTICE _____________________________________ _____________________________________ _____________________________________ _____________________________________ (3) FOR PREMISES CLAIMS G OWNERSHIP G PRIOR COMPLAINTS G PHOTOGRAPHS _____________________________________ _____________________________________ _____________________________________ (4) FOR MOTOR VEHICLE ACCIDENT CLAIMS G DMV HEARING TRANSCRIPT G PHOTOGRAPHS OF VEHICLE G REPAIR BILL AND/OR ESTIMATE _____________________________________ _____________________________________ _____________________________________ (5) FOR POLICE MISCONDUCT CLAIMS G G G G G G G G G G CERTIFICATE OF DISPOSITION ALL RELEVANT POLICE REPORTS PHOTOGRAPHS WITNESS STATEMENTS CRIMINAL COURT COMPLAINT INDICTMENT TRANSCRIPT OF PROCEEDINGS PLAINTIFF’S ARREST/CONVICTION RECORD INVOICE FOR LEGAL DEFENSE FEES OTHER ECONOMIC DAMAGES INCURRED _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ (6) FOR PROPERTY DAMAGE CLAIMS G G G G G G PHOTOGRAPHS ORIGINAL PURCHASE RECEIPTS CANCELLED CHECKS APPRAISALS AND ESTIMATES INSURANCE AGREEMENTS OTHER _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ (7 ) FOR THIRD PARTY CLAIMS G INDEMNITY CONTRACTS G ALL APPLICABLE INSURANCE POLICIES 8 _____________________________________ _____________________________________ Provide a supplemental sheet for all other relevant documents. 9 American LegalNet, Inc. www.FormsWorkflow.com