Free Order - District Court of Arizona - Arizona

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Case 2:02-cv-02281-SMM Document 211 Filed 09/30/2005 Page 1 of 5

IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF ARIZONA

Brett D. LEAVEY,

) ) Plaintiff, ) ) v. ) ) UNUM/PROVIDENT CORP., et al., ) ) Defendants. ) _________________________________ )

No. CV-02-2281-PHX-SMM FINAL VERDICT FORMS

DATED this 29th day of September, 2005.

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Case 2:02-cv-02281-SMM

Verdict for Plaintiff on Claim for Breach of Duty of Good Faith and Fair Dealing

We the Jury, duly empanelled and sworn in the above-entitled action, upon our oaths, do find in favor of plaintiff Brett Leavey on his claim of breach of the covenant of good faith and fair dealing against defendants UnumProvident Corporation and Provident Life and Accident Insurance Company in the following amounts: 1. For mental, physical, and emotional pain and suffering experienced and which will be experienced in the future, in the amount of $____________________________. 2. For policy benefits (reduced to present value) for the period in which the plaintiff will be totally disabled in the future, in the amount of $___________________________.

DATED this ____ day of _____________, 2005.

____________________________________ Jury Foreperson

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Case 2:02-cv-02281-SMM

Verdict for Plaintiff on Claim for Punitive Damages

We the Jury, duly empanelled and sworn in the above-entitled action, upon our oaths, do find in favor of plaintiff Brett Leavey on his punitive damages claim against defendants UnumProvident Corporation and Provident Life and Accident Insurance Company in the amount of $_____________________.

DATED this ____ day of _____________, 2005.

____________________________________ Jury Foreperson

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Case 2:02-cv-02281-SMM

Verdict for Defendants on All Claims

We the Jury, duly empanelled and sworn in the above-entitled action, upon our oaths, do find in favor of defendants UnumProvident Corporation and Provident Life and Accident Insurance Company on all claims.

DATED this ____ day of ____________, 2005.

____________________________________ Jury Foreperson

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Case 2:02-cv-02281-SMM

Verdict for Defendants on Claim for Punitive Damages

We the Jury, duly empanelled and sworn in the above-entitled action, upon our oaths, do find in favor of defendants UnumProvident Corporation and Provident Life and Accident Insurance Company on the claim for punitive damages.

DATED this ____ day of _____________, 2005.

____________________________________ Jury Foreperson

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