Free Proposed Jury Instructions - District Court of Colorado - Colorado

Case 1:00-cv-02098-REB-MJW

Document 254-9

Filed 09/14/2007

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Comp P-08 SPECIAL VERDICT FORM (Plaintiff Kelly Fincher) In answering these questions you should include the amount of all damages, which you find were caused, in whole or in part, by the conduct of Defendant. Damages and amounts for the Plaintiff should be entered on this Special Verdict Form. 1. Did Defendant breach the contract by failing to pay PIP benefits within

thirty days of when due, as more fully explained in Instruction ____? (YES ____ NO ____)

If your answer to question number 1 is "no," then you must all sign this Special Verdict Form on the signature lines provided at the end of the form and you should not fill in any part of the remainder of this Special Verdict Form. 2. a. If your answer to question number 1 is "yes": How much do you find Plaintiff has incurred in medical benefits, as defined in Instruction ____ from the date of the accident to today, that were not paid within 30 days of presentation? ANSWER: $___________ b. How much do you find Plaintiff will incur in the future for medical benefits, as defined in Instruction _____? ANSWER: $ 3. If your answer to question number 1 is "yes":

Case 1:00-cv-02098-REB-MJW

Document 254-9

Filed 09/14/2007

Page 2 of 3

a.

How much do you find Plaintiff has incurred in wage loss, as defined in Instruction _____, from the date of the accident to today, that was not paid within 30 days of when due? ANSWER: $

b.

How much do you find Plaintiff will incur in the future for wage loss, as defined in Instruction ___? ANSWER: $

4.

If your answer to question number 1 is "yes," was Defendant's breach of

the contract willful and wanton, as described in Instruction ____? (YES ____ 5. NO ____)

If your answer to question number 1 is "yes," was Defendant's

conduct in bad faith, as described in Instruction ____? (YES ____ 6. NO ____)

If your answer to question number 5 is "yes," what is the total

amount of the Plaintiff's damages, if any, for noneconomic losses or injuries related to Defendant's bad faith conduct? Noneconomic losses or injuries are those losses or injuries described in Instruction ____. You should answer "0" if you determine there were none. ANSWER: $ 7. If you answered "Yes" to question 5, was Defendant's failure to pay PIP

benefits when due or bad faith conduct sufficient to support an award of punitive damages, as described in Instruction ____?

Case 1:00-cv-02098-REB-MJW

Document 254-9

Filed 09/14/2007

Page 3 of 3

(YES ____ 8.

NO ____)

If your answer to question number 7 is "yes," what is the total amount of

punitive damages, if any, to be awarded to Plaintiff? Punitive damages are those damages described in Instruction _____. You should answer "0" if you determine there were none. ANSWER: $

______________________________ ______________________________ Foreperson ______________________________ ______________________________ _______________________________ ______________________________