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In the Supreme Court of Florida In the matter of use by the trial courts of the Case No. Standard Jury Instructions (CIVIL CASES) / Supplemental Report (No. 01-1) of the Committee on Standard Jury Instructions (Civil) Re: 6.2f Parental Loss of Filial Consortium 8.1 Model Verdict Forms Itemizing Damages To the Chief Justice and Justices of the Supreme Court of Florida: Your Committee on Standard Jury Instructions (Civil) recommends that The Florida Bar be authorized to publish as revisions to Florida Standard Jury Instructions (Civil) the following: (1) Amended 6.2f regarding parental loss of filial consortium; (2) New Form of Verdict Itemizing Damages Introductory Comment ;

(3) Amended and renumbered 8.1a Model Form of Verdict Itemizing Personal Injury Damages (Tort Reform Act of 1986, 768.77, F.S. Fla. Stat. (1987)) ; (4) Amended and renumbered 8.21b Model Form of Verdict Itemizing Wrongful Death Damages (Tort Reform Act of 1986, 768.77, F.S. Fla. Stat. (1987)) ; (5) New 8.1c Model Form of Verdict Itemizing Personal Injury Damages With Past and Future Damages Separated (Tort Reform Act of 1986, 768.77, Fla. Stat. (1999)) ; (6) New 8.1d Model Form of Verdict Itemizing Wrongful Death Damages With Past and Future Damages Separated (Tort Reform Act of 1986, 768.77, Fla. Stat. (1999)) ; (7) New 8.1e Model Form of Verdict Itemizing Personal Injury Damages Without Past and Future Damages Separated (Tort Reform Act of 1986, 768.77, Fla. Stat. (1999)) ; (8) New 8.1f Model Form of Verdict Itemizing Wrongful Death Damages Without Past and Future Damages Separated (Tort Reform Act of 1986, 768.77, Fla. Stat. (1999)). The proposed revisions are attached at Appendix A to this supplemental report. A notice of the changes to 6.2f was published in The Florida Bar News on 2

November 15, 2000. A notice of the changes to 8.1 was published in The Florida Bar News on September 15, 2000. A copy of each notice is attached at Appendix B. Comments were received in response to each notice, copies being attached at Appendix C. The proposed revisions to 6.2f received committee approval after consideration at meetings held between July 2000 and February 2001. The proposed new and revised verdict forms received committee approval after consideration at meetings held between July 1998 and February 2001. Materials considered by the committee are attached at Appendix D. Pages 9-105 through 9-118 pertain to 6.2f, and pages 5-1 through 5-84 pertain to 8.1. Relevant excerpts from the committee's minutes are attached at Appendix E. The proposed amendment to 6.2f allows recovery in a common law action for a parent's loss of earnings or other economic loss reasonably resulting from the need to care for an injured child. Wilkie v. Roberts, 91 Fla. 1064, 109 So. 225 (1926). The proposed changes to the model verdict forms reorganize the current forms for itemizing personal injury damages and for itemizing wrongful death damages. Forms currently numbered 8.1 and 8.2 are renumbered as 8.1a and 8.1b, respectively. Paragraph 4 of the renumbered 8.1a also contains proposed changes, 3

and the Note on Use... for the renumbered 8.1b is reworded. New forms (8.1c, 8.1d, 8.1e, and 8.1f) are proposed as forms to be used under 1999 changes to sections 768.77 and 768.78, Florida Statutes. An introductory comment is added to explain the history and purpose of these forms. On behalf of the committee, the undersigned requests approval of these proposed revisions for publication as Florida Standard Jury Instructions for use in civil cases. Should the court conclude that oral argument would be beneficial, the undersigned would be pleased to appear. Respectfully submitted, Sylvia Walbolt Chair, Supreme Court Committee on Standard Jury Instructions (Civil) One Progress Plaza 200 Central Ave Ste 2300 Saint Petersburg, FL (727)821-7000 Florida Bar No. 33604 4

APPENDIX A PROPOSED REVISIONS

6.2 PERSONAL INJURY AND PROPERTY DAMAGES: ELEMENTS.... f. Parental loss of filial consortium; care and treatment of claimant's minor child; child's services, earnings, earning capacity; loss of filial consortium as a result of significant injury resulting in child's permanent disability: On the claim[s] of (parent(s)), you should award (parent(s)) an amount of money which the greater weight of the evidence shows will fairly and adequately compensate (parent(s)) for damages caused by the incident in question. You shall consider the following element[s] of damage: The reasonable [value] [or] [expense] of [hospitalization and] medical [and nursing] care and treatment necessarily or reasonably obtained by (parent(s)) for [his] [her] [their] child, (name), in the past [or to be so obtained in the future until (name) reaches the age of (legal age)]. [Any loss by (parent(s)) by reason of [his] [her] [their] child's injury, of the [services] [earnings] [or] [earning ability] of [his] [her] [their] child in the past [and in the future until the child reaches the age of (legal age)].] [Any economic loss sustained by (parent(s)) [including] [any earnings lost 6.2, page 1

in the past][and] [any loss of ability to earn money in the future] reasonably resulting from the need to care or provide for the child because of the child's injury [until (name) reaches the age of (legal age)].] Use the following paragraphs when there is a claim for loss of filial consortium as a result of significant injury resulting in the child's permanent total disability. See United States v. Dempsey, 635 So. 2d 961 (Fla. 1994): In addition, if you find by the greater weight of the evidence that (claimant child) sustained a significant injury resulting in (claimant child's) permanent total disability, you shall consider the following element of damage: Any loss by (parent(s)), by reason of that injury, of the child's companionship, society, love, affection, and solace in the past and in the future. If the greater weight of the evidence does not support the claim of (parent(s)) that the child sustained a significant injury resulting in permanent total disability, your verdict should be for (defendant(s)) on this element of damage. COMMENTS ON 6.2f 1. The Committee believes that United States v. Dempsey, 635 So. 2d 961 (Fla. 6.2, page 2

1994), which recognizes a parental right of recovery for loss of filial consortium, does not eliminate the common law right to recover for loss of the child's services or earnings. The common law also allows recovery for a parent's loss of earnings or other economic loss reasonably resulting from the need to care for an injured child. Wilkie v. Roberts, 91 Fla. 1064, 109 So. 225 (1926). Pending further development of the law, the committee has limited all common law elements to end when the child reaches legal age. 2. This instruction does not address the issue of a child with extraordinary income-producing abilities prior to the injury. See United States v. Dempsey, 635 So. 2d at 965. 3. A loss of filial consortium claim may require separate interrogatories on the verdict form on the issues of whether the child sustained a significant injury resulting in permanent total disability, and the amount of damages on such a claim..... 6.2, page 3

FORM OF VERDICT ITEMIZING DAMAGES INTRODUCTORY COMMENT Historically, a general verdict on compensatory damages was considered appropriate, and the only form of verdict provided in the Florida Rules of Civil Procedure is such a verdict. See Fla. R. Civ. P. Form 1.986(a). In 1986, the legislature adopted Florida Statute section 768.77 which required separate determinations by the trier of fact of economic damages, noneconomic damages and punitive damages, and further required designation of those damages which occurred prior to the verdict as well as those amounts intended to compensate for losses to be incurred in the future. A further requirement existed for future damages to be itemized both before and after reduction to present value and for a determination of the period of years over which future damages are intended to provide compensation. In 1986 the legislature also adopted section 768.78 providing for alternative methods of payment of damage awards when the trier of fact makes an award to compensate for future economic damages in excess of $250,000.00. In 1989, the committee submitted Model Verdict Forms 8.1a and 8.1b in an effort to design the leanest possible model conforming to a defensible interpretation of 768.77 and.78, F.S. 1987 and expressed no opinion as to 8.1, page 1

whether said statutes were constitutional. (See Comments following Model Verdict Form 8.1a.) Model Verdict Form 8.1a has been modified only to recognize that consortium damages may be both economic and noneconomic. In 1999, section 768.77, Florida Statutes, was amended to require itemization of only economic losses, noneconomic losses, and punitive damages. In 1999, the legislature also substituted the words the Court determines in place of the words trier of fact in section 768.78, Florida Statutes. In 1999, the legislature also enacted a provision stating that if the statutes are determined to be encroaching upon the authority of the Florida Supreme Court, the legislature requested a rule change under the provisions of article V, section 2 of the Florida Constitution consistent with the statutes. No court opinion has expressly determined whether section 768.77 or section 768.78 is constitutional under the provisions of article II, section 3 of the Florida Constitution. The committee now submits Model Verdict Forms 8.1c and 8.1d as forms intended to comply with the 1999 amendments to section 768.77, retaining the requirement for separately determining past and future damages. The committee takes no position as to whether such forms of verdict would apply to claims based on causes of action accruing before the effective date of the amendment to the 8.1, page 2

statute. The committee also submits Model Verdict Forms 8.1e and 8.1f as forms complying with section 768.77, as amended in 1999, not requiring separate determination of past and future damages. The committee takes no position on how the court might comply with section 768.78 in cases tried by a jury under circumstances in which future economic damages might, under the evidence, exceed $250,000.00, if a party requested application of the provisions of the statute. The committee takes no position regarding whether verdict forms complying with the 1999 amendments may be used for cases in which the cause of action accrued before the effective date of those amendments. Depending on the evidence presented, certain elements of damages may be considered economic, noneconomic, or a mixture of both, thus requiring appropriate modification of the verdict form. 8.1, page 3

8.1a MODEL FORM OF VERDICT ITEMIZING PERSONAL INJURY DAMAGES (TORT REFORM ACT OF 1986, 768.77, FLA. STAT. (1987)) These or similar instructions should appear in the verdict form after findings on liability issues. If you find for (defendant), you need not proceed further except to sign and return your verdict. By answering the following questions you will determine the damages if any that (name claimant or claimants) sustained as a result of the incident in question. [In determining the amount of damages, do not make any reduction because of the negligence, if any, of (name). If you find that (name) was to any extent negligent, the court in entering judgment will make an appropriate reduction in the damages awarded.] 1. What is the amount of any damages sustained for [medical expenses] [and] [lost earnings or earning ability] in the past? $ 8.1, page 4

2. What is the amount of any future damages for [medical expenses] [and] [lost earning ability] to be sustained in future years? a. Total damages over future years? $ b. The number of years over which those future damages are intended to provide compensation? c. What is the present value of those future damages? $ 3. What is the amount of any damages for [pain and suffering] [, disability] [, physical impairment] 8.1, page 5

[, disfigurement] [, mental anguish] [, inconvenience] [, aggravation of a disease or physical defect] [or] [loss of capacity for the enjoyment of life], a. in the past? $ b. in the future? $ TOTAL DAMAGES OF (name claimant) (add lines 1, 2c, 3a, and 3b) $ 4. What is the amount of any damages sustained by (name spouse) in loss of [his wife s][her husband s] services, comfort, society and attentions, [a.] comfort, society and attentions, 8.1, page 6

a.(1) in the past? $ b.(2) in the future? $ [b. services (1) in the past? $ (2) in the future? $ ] TOTAL DAMAGES OF (name of claimant spouse) (add lines 4[a](1)[,] [and] 4[a](2)[, 4b(1), and 4b(2)]) $ Note on use of itemized verdict form The clarity of the verdict form and the accuracy of the TOTAL DAMAGES verdict depend on the form calling for item 2a, the total economic damages to be sustained over future years, to be inserted in the indented column as shown in the model rather than in the far column of figures to be added for a sum of TOTAL DAMAGES. If the verdict form available in a particular case cannot 8.1, page 7

clearly differentiate those columns, the Committee recommends that the TOTAL DAMAGES sum be omitted to avoid the possibility of the jury adding future economic damages twice. Comments on itemized verdict form 1. This verdict form represents the Committee's effort to design the leanest possible model conforming to a defensible interpretation of 768.77 and.78, F.S. 1987. Its publication does not imply any view of the constitutionality of 768.77 under Art. II, Sec. 3, Fla. Const., nor any view of whether or when the parties by agreement may dispense with verdict items that the Committee interprets the statute to require. 2. The Committee acknowledges but does not adopt certain interpretations of 768.77 and.78 that would require a materially different verdict form: the view that the statute requires only an undisclosed computation of present value, not the future total, as well, of future economic damages; the view that different types of economic damages must be itemized separately and reduced separately to present value; and the view that the number of years of future noneconomic damages must be set forth by the trier of fact. The Committee's rationale is discussed at greater length in The Florida Bar News, Vol. 15, No. 15 (August 1, 1988). 8.1, page 8

3. Although 768.77 may well be read as requiring specification of the number of years of future noneconomic damages, the complexity added to the verdict is to no end: that information serves no purpose in 768.79, Alternative methods of payment of [economic] damage awards. The questioned language in 768.77 apparently is a remnant of statutes effective from 1976 to 1985 requiring itemization in medical malpractice verdicts. 768.48 F.S. (1976 Supp.), repealed by Ch. 85-175, Sec. 1. Former 768.51, however, authorized extended payout of future noneconomic as well as economic damages, a purpose absent from present 768.78. Verdicts itemized as required by those former statutes were commonly waived, accounting for the absence of judicial decisions and a recommended model form of verdict appropriate to the former statutes. 4. As is apparent, the Committee's strategy is to preserve the characteristics of a general verdict insofar as the statute may be interpreted to grant that latitude, and to avoid any elaboration whose general acceptance would tend to preempt questions requiring a judicial decision that additional itemization is or is not necessary. 5. Parent's damages for loss of child's services and earnings. The Committee expresses no opinion of whether such future damages are economic within the meaning of 768.78(2) and require itemization of years and reduction to 8.1, page 9

present value. 8.1, page 10

8.21b MODEL FORM OF VERDICT ITEMIZING WRONGFUL DEATH DAMAGES (TORT REFORM ACT OF 1986, 768.77, FLA. STAT. (1987)) These or similar instructions should appear in the verdict form after findings on liability issues. If you find for (defendant), you need not proceed further except to sign and return your verdict. By answering the following questions you will determine the damages if any that (name claimant or claimants) sustained as a result of the incident in question. [In determining the amount of damages, do not make any reduction because of the negligence, if any, of (name). If you find that (name) was to any extent negligent, the court in entering judgment will make an appropriate reduction in the damages awarded.] 1. What is the amount of any earnings lost by the estate from the date of injury to the date of death? (Do not include amount of any support lost by a survivor in that period.) $ 8.1, page 11

2. What is the amount of any net accumulations lost by the estate? $ 3. What is the amount of any medical or funeral expenses resulting from (name's) injury and death charged to the estate or paid by someone other than a survivor? $ 4. What is the amount of any medical or funeral expenses paid by (name), a survivor? $ 5. What is the amount of any loss by (name survivor) of the decedent's support and services, 8.1, page 12

a. from the date of injury to the present? $ b. in the future? $ What is the number of years over which those future damages are intended to provide compensation? What is the present value of those future damages? $ 6. What is the amount of any damages sustained by (name spouse) in the loss of [his wife's] [her husband's] companionship and protection and in pain and suffering as a result of the decedent's injury and death, a. in the past? $ 8.1, page 13

b. in the future? $ 7. What is the amount of any damages sustained by (name minor child) in the loss of parental companionship, instruction and guidance, and in the child's pain and suffering as a result of the decedent's injury and death, a. in the past? $ b. in the future? $ 8. What is the amount of any damages sustained by (name parents) in pain and suffering as a result of the injury and death of (name minor child), a. in the past? $ b. in the future? $ 8.1, page 14

Note on Use and Comments See Note on Use and Comments supra, SJI 8.1 accompanying Model Verdict Form 8.1a and see the Form of Verdict Itemizing Damages Introductory Comment. 8.1, page 15

8.1c MODEL FORM OF VERDICT ITEMIZING PERSONAL INJURY DAMAGES WITH PAST AND FUTURE DAMAGES SEPARATED (TORT REFORM ACT OF 1986, 768.77, FLA. STAT. (1999)) These or similar instructions should appear in the verdict form after findings on liability issues. If you find for (defendant), you need not proceed further except to sign and return your verdict. By answering the following questions you will determine the damages if any that (name claimant or claimants) sustained as a result of the incident in question. [In determining the amount of damages, do not make any reduction because of the negligence, if any, of (name). If you find that (name) was to any extent negligent, the court in entering judgment will make an appropriate reduction in the damages awarded.] 1. What is the amount of any damages sustained by (name claimant) in the past, 8.1, page 16

[a. for medical expenses? $ ] [b. for lost earnings or earning ability? $ ] 2. What is the present money value of any damages to be sustained by (name claimant) in the future, [a. for medical expenses? $ ] [b. for lost earning ability? $ ] 3. What is the amount of any damages sustained by (name claimant) for [pain and suffering] [, disability] 8.1, page 17

[, physical impairment] [, disfigurement] [, mental anguish] [, inconvenience] [, aggravation of a disease or physical defect] [or] [loss of capacity for the enjoyment of life], a. in the past? $ b. in the future? $ TOTAL DAMAGES OF (name of claimant) (add lines [1a,] [1b,] [2a,] [2b,] 3a and 3b) $ 4. What is the amount of any damages sustained by (name spouse) in loss of [his wife s] [her husband s] [a.] comfort, society and attentions, (1) in the past? $ (2) in the future? $ 8.1, page 18

[b. services (1) in the past? $ (2) in the future, reduced to present value? $ TOTAL DAMAGES OF (name claimant spouse) ] (add lines 4[a](1)[,] [and] 4[a](2)[, 4b(1) and 4b(2)]) $ Comment See the Form of Verdict Itemizing Damages Introductory Comment. 8.1, page 19

8.1d MODEL FORM OF VERDICT ITEMIZING WRONGFUL DEATH DAMAGES WITH PAST AND FUTURE DAMAGES SEPARATED (TORT REFORM ACT OF 1986, 768.77, FLA. STAT. (1999)) These or similar instructions should appear in the verdict form after findings on liability issues. If you find for (defendant), you need not proceed further except to sign and return your verdict. By answering the following questions you will determine the damages if any that (name claimant or claimants) sustained as a result of the incident in question. [In determining the amount of damages, do not make any reduction because of the negligence, if any, of (name). If you find that (name) was to any extent negligent, the court in entering judgment will make an appropriate reduction in the damages awarded.] DAMAGES OF THE ESTATE 8.1, page 20

1. What is the amount of any earnings lost by the estate from the date of injury to the date of death? (Do not include amount of any support lost by a survivor in that period). $ 2. What is the amount of any net accumulations lost by the estate? $ 3. What is the amount of any medical or funeral expenses resulting from (decedent s) injury and death charged to the estate or paid by someone other than a survivor? $ TOTAL DAMAGES OF THE ESTATE (add lines 1, 2 and 3) $ DAMAGES OF (name surviving spouse) 4. What is the amount of any medical or funeral 8.1, page 21

expenses paid by (name surviving spouse)? $ 5. What is the amount of any loss by (name surviving spouse) of the decedent s support and services, from the date of injury to the present? $ 6. What is the present value of any loss by (name surviving spouse) of decedent s support and services in the future? $ 7. What is the amount of any damages sustained by (name surviving spouse) in the loss of [his wife s][her husband s] companionship and protection and in pain and suffering as a result of the decedent s injury and death? $ 8.1, page 22

TOTAL DAMAGES OF (name surviving spouse) (add lines 4, 5, 6, and 7) $ DAMAGES OF (name surviving child) 8. What is the amount of any medical or funeral expenses paid by (name surviving child)? $ 9. What is the amount of any loss by (name surviving child) of the decedent s support and services, from the date of injury to the present? $ 10. What is the present value of any loss by (name surviving child) of decedent s support and services in the future? $ 8.1, page 23

11. What is the amount of any damages sustained by (name surviving child) in the loss of parental companionship, instruction and guidance, and in the child s pain and suffering as a result of the decedent s injury and death? $ TOTAL DAMAGES OF (name surviving child) (add lines 8, 9, 10, and 11) $ DAMAGES OF (name surviving mother) 12. What is the amount of any medical or funeral expenses paid by (name surviving mother)? $ 8.1, page 24

13. What is the amount of any damages sustained by (name surviving mother) in pain and suffering as a result of the injury and death of (name minor child)? $ TOTAL DAMAGES OF (name surviving mother) (add lines 12 and 13) $ DAMAGES OF (name surviving father) 14. What is the amount of any medical or funeral expenses paid by (name surviving father)? $ 15. What is the amount of any damages sustained by (name surviving father) in pain and suffering as a result of the injury and death of (name minor child)? $ 8.1, page 25

TOTAL DAMAGES OF (name surviving father) (add lines 14 and 15) $ Note on Use 1. The selection of applicable portions of this form depends upon determination of the survivors under the Wrongful Death Act. 2. Questions 3, 4, 8, 12 and/or 14 should be included as appropriate, based on the evidence presented. 3. See the Form of Verdict Itemizing Damages Introductory Comment. 8.1, page 26

8.1e MODEL FORM OF VERDICT ITEMIZING PERSONAL INJURY DAMAGES WITHOUT PAST AND FUTURE DAMAGES SEPARATED (TORT REFORM ACT OF 1986, 768.77, FLA. STAT. (1999)) These or similar instructions should appear in the verdict form after findings on liability issues. If you find for (defendant), you need not proceed further except to sign and return your verdict. By answering the following questions you will determine the damages if any that (name claimant or claimants) sustained as a result of the incident in question. [In determining the amount of damages, do not make any reduction because of the negligence, if any, of (name). If you find that (name) was to any extent negligent, the court in entering judgment will make an appropriate reduction in the damages awarded.] 1. What is the amount of any damages for lost earnings in the past, loss of earning capacity in the future, medical 8.1, page 27

expenses incurred in the past, medical expenses to be incurred in the future, and (list any other economic damages)? $ 2. What is the amount of any damages for pain and suffering, disability, physical impairment, disfigurement, mental anguish, inconvenience, aggravation of a disease or physical defect (list any other noneconomic damages) and loss of capacity for the enjoyment of life sustained in the past and to be sustained in the future? $ TOTAL DAMAGES OF (name claimant) (add lines 1 and 2) $ 3. What is the total amount of damage sustained by (name spouse) in loss of [his wife s][her husband s] 8.1, page 28

[a.] comfort, society, and attention? $ [b. services $ ] TOTAL DAMAGES OF (name spouse) [(add lines 3a and 3b)] $ Comment See the Form of Verdict Itemizing Damages Introductory Comment. 8.1, page 29

8.1f MODEL FORM OF VERDICT ITEMIZING WRONGFUL DEATH DAMAGES WITHOUT PAST AND FUTURE DAMAGES SEPARATED (TORT REFORM ACT OF 1986, 768.77, FLA. STAT. (1999)) These or similar instructions should appear in the verdict form after findings on liability issues. If you find for (defendant), you need not proceed further except to sign and return your verdict. By answering the following questions you will determine the damages if any that (name claimant or claimants) sustained as a result of the incident in question. [In determining the amount of damages, do not make any reduction because of the negligence, if any, of (name). If you find that (name) was to any extent negligent, the court in entering judgment will make an appropriate reduction in the damages awarded.] DAMAGES OF THE ESTATE 1. What is the total amount of any damages lost by the 8.1, page 30

estate for [any earnings of the decedent lost from the date of injury to the death not including any amount of support lost by a survivor in that period] [,] [the amount of any medical or funeral expenses resulting from (decedent s) injury and death charged to the estate or paid by someone other than a survivor] [,] [and] [loss of net accumulations] [,] [(list other damages sustained by estate)]? $ DAMAGES OF (name surviving spouse) 2a. What is the amount of any damages sustained by (name surviving spouse) for [loss of the decedent s support] [and] [services] [, and] [medical or funeral expenses resulting from (decedent's) injury and death paid by (name surviving spouse)]? $ 2b. What is the amount of any damage sustained by (name surviving spouse) in the loss of [his wife s] 8.1, page 31

[her husband s] companionship and protection and in pain and suffering as a result of (decedent s) injury and death? $ TOTAL DAMAGES OF (name surviving spouse) (add lines 2a and 2b) $ DAMAGES OF (name surviving child) 3a. What is the amount of any damages sustained by (name surviving child) for [loss of the decedent s support] [and] [services] [, and] [medical or funeral expenses resulting from (decedent's) death paid by (name surviving child)]? $ 3b. What is the amount of damages sustained by (name 8.1, page 32

surviving child) in the loss of parental companionship, instruction and guidance and the child s pain and suffering as a result of the decedent s injury and death? $ TOTAL DAMAGES OF (name surviving child) (add lines 3a and 3b) $ DAMAGES OF (name surviving mother) 4. What is the amount of any damages sustained by (name surviving mother) for [pain and suffering as a result of the injury and death of (name minor child)] [and] [medical or funeral expenses resulting from (decedent's) injury and death paid by (name surviving mother)]? TOTAL DAMAGES OF (name surviving mother) $ 8.1, page 33

DAMAGES OF (name surviving father) 5. What is the amount of any damages sustained by (name surviving father) for [pain and suffering as a result of the injury and death of (name minor child)] [and] [medical or funeral expenses resulting from (decedent's) injury and death paid by (name surviving father)]? TOTAL DAMAGES OF (name surviving father) $ Note on Use In general, see the Form of Verdict Itemizing Damages Introductory Comment. The selection of applicable portions of this form depends upon determination of the survivors under the Wrongful Death Act. 8.1, page 34