WPI 105.21 Special Verdict Form—Traditional Injury or Loss of Chance of [Survival] [Better Outc...
6 WAPRAC WPI 105.21Washington Practice Series TMWashington Pattern Jury Instructions--Civil
6 Wash. Prac., Wash. Pattern Jury Instr. Civ. WPI 105.21 (7th ed.)
Washington Practice Series TM
Washington Pattern Jury Instructions--Civil
April 2022 Update
Part IX. Particularized Standards of Conduct
Chapter 105. Health Care
WPI 105.21 Special Verdict Form—Traditional Injury or 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 the [death] [injury] of [(name of decedent)'s] [(name of plaintiff)'s]?
ANSWER: (Write “yes” or “no”)
If you answered “no” to Question 2, proceed to Question 3. If you answered “yes” to Question 2, do not answer Question 3 or 4; proceed to Question 5.
QUESTION 3: 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 3, do not answer any other questions; sign this verdict form and notify the bailiff. If you answered “yes” to Question 3, proceed to Question 4.
QUESTION 4: 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 5.
QUESTION 5: 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.]
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