County    Cause/Case #
Plaintiff(s)    Defendant(s)
Trial Date and Length    or Date Settled
Plaintiff's Attorney, Attorney's Firm, City

Defendant's Attorney, Attorney's Firm, City

Insurance Company
Doctors/Experts (Plff), Firm, City         By Report   Live Testimony

Doctors/Experts (Def), Firm, City         By Report   Live Testimony

Trial Judge/Mediator    Date of Loss
Admitted Liability? YN Dir. Verdict? YNSumm. Judgment? YN
Age of Plaintiff:
Date and Facts of Accident

Injuries

Permanent Injury?  YN
If No, approximate length of treatment
Medical Expenses $  Days in hospital
Lost Wages $   Days Work Lost
Demand $   Plaintiff Asked Jury For $  
Offer $   Defendant Asked Jury For $
Settlement Judge    Recommended $
Verdict?
Contributory neg. %      Net $
Defense Verdict? YN  
New Trial Pending?    Granted?
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