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WPI 105.20 Special Verdict Form—Loss of Chance of [Survival] [Better Outcome]

6 WAPRAC WPI 105.20Washington Practice Series TMWashington Pattern Jury Instructions--Civil

6 Wash. Prac., Wash. Pattern Jury Instr. Civ. WPI 105.20 (7th ed.)

Washington Practice Series TM

Washington Pattern Jury Instructions--Civil

April 2022 Update

Washington State Supreme Court Committee on Jury Instructions

Part IX. Particularized Standards of Conduct

Chapter 105. Health Care

WPI 105.20 Special Verdict Form—Loss of Chance of [Survival] [Better Outcome]

IN THE [DISTRICT] [SUPERIOR] COURT OF THE STATE OF WASHINGTON IN AND FOR THE COUNTY OF


,
	Plaintiff,
		NO.
vs.		SPECIAL
,		VERDICT FORM
	Defendants.

We, the jury, answer the questions submitted by the court as follows:

QUESTION 1: Was (name of defendant) negligent?

ANSWER: (Write “yes” or “no”)

If you answered “no” to Question 1, do not answer any other questions; sign this verdict form and notify the bailiff. If you answered “yes” to Question 1, proceed to Question 2.

QUESTION 2: Was (name of defendant)'s negligence a proximate cause of a reduction in [(name of decedent)'s] [(name of plaintiff)'s] chance to [survive the condition which caused [his] [her] death] [have a better outcome]?

ANSWER: (Write “yes” or “no”)

If you answered “no” to Question 2, do not answer any other questions; sign this verdict form and notify the bailiff. If you answered “yes” to Question 2, proceed to Question 3.

QUESTION 3: What do you find to be the percentage reduction in [(name of decedent)'s] [(name of plaintiff)'s] chance to [survive] [have a better outcome] proximately caused by the negligence of(name of defendant)?

ANSWER: % (cannot exceed 50%)

Proceed to Question 4.

QUESTION 4: What do you find to be the [(name of decedent)'s] [(name of plaintiff)'s] total amount of damages?

ANSWER: $

Sign this verdict form and notify the bailiff.

DATE:
	Presiding Juror

[Current as of September 2018.]

End of Document