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Submit Case
Here you can submit your jury verdicts to be published in Verdict Reporter.

 
 
Online Case Submission Form

Important Note: Please use the Tab key when moving between fields. Pressing the Enter key when entering information may Submit this form prematurely.

Important Note: Required Fields are indicated by Bolded Text and red boxes. The form will not permit you to submit with these fields empty.

Submitter Information
Your Name:
Date Submitted:
Your Firm:
Your Telephone with Area Code:
Extension:
This firm represents:

Case Information
Venue (Include City/County):
Claim Type:
Other Type of Claim (If not listed above):
Parties in Case:
Case Number:
Division:
Judge:

Plaintiff's Trial Counsel
Plaintiff's Attorney:
Plaintiffs Law Firm:
Address:
City:
State:
ZIP Code:
Telephone:
Extension:
Fax:
Email:
Represented which party?
Other Trial Counsel:

Defendant's Trial Counsel
Defendant's Attorney:
Defendant's Law Firm:
Address:
City:
State:
ZIP Code:
Telephone:
Extension:
Fax:
Email:
Represented which party?
Other Trial Counsel:

Case Details
Facts of Case (Describe claim, plaintiff's allegations and liability issues, street names and direction of travel for auto):
Plaintiff's Age at Time of Incident:
Facts of Case (Describe claim, defendant's allegations and liability issues, street names and direction of travel for auto):
Time of Day:
Weather Conditions:
Defendant's Insurer:
Plaintiff's Alleged Injuries and/or Damages:
Plaintiff's Medical Specials:
Plaintiff's Wage Loss:
Plaintiff's Property Damage:
Damages in Counterclaim:

Plaintiff's Expert Information
Plaintiff's Expert #1:
Specialty:
City:
State:
Expert or Treating:
Live Testimony or By Deposition:
Plaintiff's Expert #2:
Specialty:
City:
State:
Expert or Treating:
Live Testimony or By Deposition:
Plaintiff's Expert #3:
Specialty:
City:
State:
Expert or Treating:
Live Testimony or By Deposition:
Other Experts for Plaintiff (Include name, specialty, city, state, treating/expert and live/depo.)

Defendant's Expert Information
Defendant's Expert #1:
Specialty:
City:
State:
Expert or Treating:
Live Testimony or By Deposition:
Defendant's Expert #2:
Specialty:
City:
State:
Expert or Treating:
Live Testimony or By Deposition:
Defendant's Expert #3:
Specialty:
City:
State:
Expert or Treating:
Live Testimony or By Deposition:
Other Experts for Defendant (Include name, specialty, city, state, treating/expert and live/depo.)

Conclusions
Last Demand to Settle:
Last Offer to Settle:
Date of Verdict:
Verdict/Judgement/Settlement:
Apportioned Fault to Plaintiff:
%
Apportioned Fault to Defendant:
%
Award gross amount:
$
Award net amount:
$
Post Trial Motions:
Filed By:
Decision:
Appeal:
Editorial Comments:

 

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