Free 01-105 Case Management Conference Memorandum - Pennsylvania


File Size: 317.0 kB
Pages: 3
Date: September 30, 2005
File Format: PDF
State: Pennsylvania
Category: Court Forms - Local
Word Count: 414 Words, 2,689 Characters
Page Size: Letter (8 1/2" x 11")
URL

http://courts.phila.gov/pdf/forms/civil/01-105-case-management-conference-memorandum.pdf

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Preview 01-105 Case Management Conference Memorandum
IN THE COURT OF COMMON PLEAS OF PHILADELPHIA COUNTY FIRST JUDICIAL DISTRICT OF PENNSYLVANIA CIVIL TRIAL DIVISION : : : : :

CASE MANAGEMENT CONFERENCE MEMORANDUM
Filing party: By: , Esq.

Counsel's address and telephone number (IMPORTANT)

Part A
(to be completed in personal injury cases)
1. Date of accident or occurrence: 1(a). Age of Plaintiff(s): 2. Most serious injuries sustained:

3. Is there any permanent injury claimed? If yes, indicate the type of permanent injury:

Yes

No

4. Dates of medical treatment: 5. Is medical treatment continuing? 6. Has there been an inpatient hospitalization? Yes Yes No No

This form shall be presented to the Case Manager and copies served upon all parties at the Case Management Conference by counsel prepared to discuss its contents.
01-105 (Rev. 10/99) (1)

7. Has there been any surgery? If yes, indicate the type of surgery: 8. Approximate medical bills to date: $ Approximate medical bills recoverable in this case: $

Yes

No

9. Are there any existing liens (Workers Compensation, DPW, Medical, etc.)? If yes, what type and approximate amount? 10. Time lost from work: 11. Approximate past lost wages: 12. Is there a claim for future lost earning capacity? If yes, approximate future lost earning capacity: 13. Are there any related cases or claims pending? If so, list caption(s) or other appropriate identifier: Yes No Yes No

Yes

No

14. Do you anticipate joining additional parties? 15. Plaintiff's factual position as to liability:

Yes

No

16. Defense factual position as to liability:

17. Defense position as to causation of injuries alleged: 18. Identify all applicable insurance coverage: Defendant Insurance Carrier Coverage Limits

Are there issues as to the applicability of the above insurance coverage: 19. Demand: $
01-105 (Rev. 10/99) (2)

Yes Offer: $

No

Part B
(to be completed in all cases other than personal injury)
1. Date of contract of transaction: 2. Is there a writing? If yes, is there an allegation that the writing does not contain the entire agreement of the parties? 3. Is the Uniform Commercial Code applicable to this case? Yes No

Yes Yes

No No

4. Describe the nature of the conduct alleged as giving rise to the cause of action:

5. State the amount of damages claimed by Plaintiff: (a) Direct (b) Consequential (c) Other (specify) 6. Defense position as to alleged nature of conduct giving rise to cause of action and any counterclaim:

7. If there is a counterclaim, state the amount of damages sought: (a) Direct (b) Consequential (c) Other (specify) 8. Identify all applicable insurance coverage: Defendant Insurance Carrier Coverage Limits

9. Demand: $
01-105 (Rev. 10/99) (3)

Offer: $