Instructions
M Civ JI 67.01 Form of Verdict: No-Fault First-Party Benefits Action
M Civ JI 67.02 Form of Verdict: No-Fault Auto Negligence; Noneconomic Loss [Form of Verdict Deleted]
M Civ JI 67.02A Form of Verdict: No-Fault Auto Negligence; Noneconomic Loss (And Allocation of Fault) [Form of Verdict Deleted]
M Civ JI 67.03 Form of Verdict: No-Fault Auto Negligence; Economic Loss [Form of Verdict Deleted]
M Civ JI 67.03A Form of Verdict: No-Fault Auto Negligence; Economic Loss (And Allocation of Fault) [Form of Verdict Deleted]
M Civ JI 67.04 Form of Verdict: No-Fault Auto Negligence; Economic Loss and Noneconomic Loss [Form of Verdict Deleted]
M Civ JI 67.04A Form of Verdict: No-Fault Auto Negligence; Economic Loss and Noneconomic Loss (and Allocation of Fault) [Form of Verdict Deleted]
M Civ JI 67.15 Form of Verdict: No-Fault Auto Negligence: Economic Loss and Noneconomic Loss—Comparative Negligence Not an Issue [Form of Verdict Deleted]
M Civ JI 67.16 Form of Verdict: No-Fault Auto Negligence: Economic Loss and Noneconomic Loss—and Comparative Negligence/Multiple
Defendants/Allocation of Fault (To Be Used in Cases in Which 1995 PA 222 Applies) [Form of Verdict Deleted]
M Civ JI 67.17 Form of Verdict: No-Fault Auto Negligence: (As Applicable) Economic Loss and Noneconomic Loss—and Comparative Negligence/ Single or Multiple Defendants/Allocation of Fault
We, the jury, make the following answers to the questions submitted by the Court:
QUESTION NO. 1: Did the plaintiff sustain an accidental bodily injury?
Answer: ____(yes or no)
If your answer is “no,” do not answer any further questions.
QUESTION NO. 2: Did the plaintiff’s accidental bodily injury arise out of the ownership, operation, maintenance, or use of a motor vehicle as a motor vehicle [on [date] / during the period of [specify dates]?]
Answer: ____(yes or no)
If your answer is “no,” do not answer any further questions.
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ALLOWABLE EXPENSES |
QUESTION NO. 3: Were allowable expenses incurred by or on behalf of the plaintiff arising out of the accidental bodily injury referred to in Question No. 2?
(Allowable expenses consist of all reasonable charges for reasonably necessary products, services, and accommodations for the plaintiff’s care, recovery, or rehabilitation.)
A. Answer: ____ (yes or no)
B. If your answer is “yes,” what is the amount of allowable expenses owed to the plaintiff (include only expenses not already paid by the defendant)?
$____________
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WORK LOSS |
QUESTION NO. 4: Did the plaintiff sustain work loss arising out of the accidental bodily injury referred to in Question No. 2?
(Work loss consists of loss of income from work the plaintiff would have performed during the first three years after the date of the accident if the plaintiff had not been injured. *[Work loss for an injured person who is temporarily unemployed at the time of the accident or during the period of disability shall be based on earned income for the last month employed full time preceding the accident.] Work-loss benefits are computed at 85 percent of the plaintiff’s loss of gross income, but they may not exceed the sum of [applicable monthly maximum] per 30-day period nor may they be payable beyond three years after the date of the accidental bodily injury.)
A. Answer: ____ (yes or no)
B. If your answer is “yes,” what is the amount of work loss owed to the plaintiff (include only work loss not already paid by the defendant)?
$____________
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REPLACEMENT SERVICE EXPENSES |
QUESTION NO. 5: Were replacement service expenses incurred by or on behalf of the plaintiff arising out of the accidental bodily injury referred to in Question No. 2?
(Replacement service expenses consist of expenses not exceeding $20 per day reasonably incurred in obtaining ordinary and necessary services in place of those that, if the plaintiff had not been injured, the plaintiff would have performed during the first three years after the date of the accident, not for income, but for the benefit of the plaintiff or [his / her] dependent(s). Benefits for replacement service expenses may not exceed $20 per day nor may they be payable beyond three years after the date of the accidental bodily injury.)
A. Answer: ____ (yes or no)
B. If your answer is “yes,” what is the amount of replacement service expenses owed to the plaintiff (include only replacement service expenses not already paid by the defendant)?
$____________
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SURVIVOR’S LOSS; |
QUESTION NO. 6: Did [name of decedent]’s death result from the accidental bodily injury referred to in Question No. 2?
Answer: ____(yes or no)
If your answer is “no,” do not answer Question No. 7 or Question No. 8. Answer Question No. 9.
If your answer is “yes,” answer Question No. 7.
QUESTION NO. 7: Did the dependents of [name of decedent] incur survivor’s loss?
(Survivor’s loss consists of two categories of loss: (1) a loss of tangible things of economic value that the dependents would have received for their support during their dependency if [name of decedent] had not died. This includes the after-tax income of [name of decedent] plus the value of [his / her] lost fringe benefits, and (2) replacement service expenses not exceeding $20 per day reasonably incurred by the dependents during their dependency and after the death of [name of decedent] in obtaining ordinary and necessary services in place of those that [name of decedent] would have performed for their benefit if [he / she] had not died. The benefits payable for both categories of survivor’s loss may not exceed the sum total of [applicable monthly maximum] per 30-day period nor may they be payable beyond three years after the date of the accidental bodily injury.)
A. Answer: ____ (yes or no)
B. If your answer is “yes,” what is the total amount of survivor’s loss owed to the plaintiff (include only the loss not already paid by the defendant)?
$____________
QUESTION NO. 8: Were funeral and burial expenses incurred as a result of the death of [name of decedent]?
(Funeral and burial expenses may not exceed the lesser of the amount incurred or [insert policy maximum].)
A. Answer: ____ (yes or no)
B. If your answer is “yes,” what is the amount of funeral and burial expenses owed to the plaintiff (include only those expenses not already paid by the defendant)?
$____________
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INTEREST |
QUESTION NO. 9: Was payment for any of the expenses or losses to which the plaintiff was entitled overdue?
(Payment for an expense or loss is overdue if it is not paid within 30 days after the defendant receives reasonable proof of the fact and the amount of the claim. An overdue claim bears interest at the rate of 12 percent per annum from the date the expense or loss became overdue.)
A. Answer: ____ (yes or no)
B. If your answer is “yes,” what is the amount of interest owed to the plaintiff on overdue benefits (include only interest not already paid by the defendant)?
$____________
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Signed, |
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_______________________ |
_______________________ |
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Foreperson |
Date |
Note on Use
*The bracketed sentence in Question No. 4 should be used if the injured person is temporarily unemployed.
If the plaintiff is not the injured person, substitute the name of the injured person for the word “plaintiff” where necessary.
See MCL 500.3107(1)(a) for the statutory minimum and maximum for funeral and burial expenses.
Omit any questions that are not at issue, such as whether the injuries arose out of the ownership, operation, maintenance, or use of a motor vehicle, and any benefits that are not claimed by the plaintiff.
This Special Verdict Form may have to be modified where there are questions involving coordination of benefits, governmental setoffs, or other issues arising under the no-fault statutes that are not specifically addressed by the format set forth.
For applicable monthly maximum, see Note on Use to M Civ JI 35.01.
History
M Civ JI 67.01 was added February 1981.
Amended May 1999. TOP
Note on Use
This form of verdict, deleted by the Committee May 1998, was used for causes of action that arose before October 1, 1986. See 1986 PA 178, §3.
History
M Civ JI 67.02 was added November 1980.
Amended January 1984, January 1988, November 1995.
Deleted May 1998. TOP
Note on Use
See M Civ JI 67.17 Form of Verdict: No-Fault Auto Negligence: (As Applicable) Economic Loss and Noneconomic Loss—and Comparative Negligence/Single or Multiple Defendants/Allocation of Fault.
History
M Civ JI 67.02A was added October 1987.
Amended November 1995.
Deleted December 1999. TOP
Note on Use
This form of verdict, deleted by the Committee May 1998, was used for causes of action that arose before October 1, 1986. See 1986 PA 178, §3.
History
M Civ JI 67.03 was added November 1980.
Amended September 1989.
Deleted May 1998. TOP
Note on Use
See M Civ JI 67.17 Form of Verdict: No-Fault Auto Negligence: (As Applicable) Economic Loss and Noneconomic Loss—and Comparative Negligence/Single or Multiple Defendants/Allocation of Fault.
History
M Civ JI 67.03A was added October 1987.
Amended September 1989.
Deleted December 1999. TOP
Note on Use
This form of verdict, deleted by the Committee May 1998, was used for causes of action that arose before October 1, 1986. See 1986 PA 178, §3.
History
M Civ JI 67.04 was added November 1980.
Amended January 1984, January 1988, September 1989.
Deleted May 1998. TOP
Note on Use
See M Civ JI 67.17 Form of Verdict: No-Fault Auto Negligence: (As Applicable) Economic Loss and Noneconomic Loss—and Comparative Negligence/Single or Multiple Defendants/Allocation of Fault.
History
M Civ JI 67.04A was added October 1987.
Amended September 1989.
Deleted December 1999. TOP
Note on Use
See M Civ JI 67.17 Form of Verdict: No-Fault Auto Negligence: (As Applicable) Economic Loss and Noneconomic Loss—and Comparative Negligence/Single or Multiple Defendants/Allocation of Fault.
History
M Civ JI 67.15 was added June 1997.
Deleted December 1999. TOP
Note on Use
See M Civ JI 67.17 Form of Verdict: No-Fault Auto Negligence: (As Applicable) Economic Loss and Noneconomic Loss—and Comparative Negligence/Single or Multiple Defendants/Allocation of Fault.
History
M Civ JI 67.16 was added June 1997.
Deleted December 1999. TOP
M Civ JI 67.17 Form of Verdict: No-Fault Auto Negligence: (As Applicable) Economic Loss and Noneconomic Loss—and Comparative Negligence/Single or Multiple Defendants/Allocation of Fault
We, the jury, answer the questions submitted as follows:
QUESTION NO. 1: Was [ name of defendant A ] negligent?
Answer: ____ (yes or no)
If your answer is “yes” or “no,” go on to Question No. 2.
*QUESTION NO. 2: Was [ name of defendant B ] negligent?
Answer: ____ (yes or no)
If your answer is “yes,” go on to Question No. 3.
If your answer is “no” and your answer to Question No. 1 is “yes,” go on to Question No. 3.
If your answer is “no” and your answer to Question No. 1 is “no,” do not answer any further questions.
QUESTION NO. 3: Was the plaintiff injured?
Answer: ____ (yes or no)
If your answer is “yes” and your answer to Question No. 1 is “yes,” go on to Question No. 4.
If your answer is “yes,” your answer to Question No. 1 is “no,” and your answer to Question No. 2 is “yes,” go on to Question No. 5.
If your answer is “no,” do not answer any further questions.
QUESTION NO. 4: Was [ name of defendant A ] 's negligence a proximate cause of the plaintiff's [ injury / injuries ] ?
Answer: ____ (yes or no)
If your answer is “yes” and your answer to Question No. 2 is “yes,” go on to Question No. 5.
If your answer is “no” and your answer to Question No. 2 is “yes,” go on to Question No. 5.
If your answer is “yes” and your answer to Question No. 2 is “no,” go on to Question No. 6.
If your answer is “no” and your answer to Question No. 2 is “no,” do not answer any further questions.
*QUESTION NO. 5: Was [ name of defendant B ] 's negligence a proximate cause of the plaintiff's [ injury / injuries ] ?
Answer: ____ (yes or no)
If your answer is “yes,” go on to Question No. 6.
If your answer is “no” and your answer to Question No. 4 is “yes,” go on to Question No. 6.
If your answer is “no” and your answer to Question No. 4 is “no,” do not answer any further questions.
PLAINTIFF'S NEGLIGENCE
QUESTION NO. 6: Was the plaintiff negligent?
Answer: ____ (yes or no)
If your answer is “yes,” go on to Question No. 7.
If your answer is “no” and your answers to both Questions No. 4 and 5 are “yes,” do not answer Question No. 7; go on to Question No. 8.
If your answer is “no” and you answered “no” to either Question No. 4 or Question No. 5, do not answer Question No. 7 or Question No. 8; go on to Question No. 9.
QUESTION NO. 7: Was the plaintiff's negligence a proximate cause of the plaintiff's [injury / injuries ]?
Answer: ____ (yes or no)
If your answer is “yes,” go on to Question No. 8.
If your answer is “no” and your answers to Questions No. 4 and 5 are “yes,” go on to Question No. 8.
If your answer is “no” and you answered “no” to either Question No. 4 or Question No. 5, do not answer Question No. 8; go on to Question No. 9.
QUESTION NO. 8:
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A. |
If you answered “yes” to Question No. 4, then using 100 percent as the total, enter the percentage of negligence attributable to [name of defendant A] : |
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____ percent |
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*B. |
If you answered “yes” to Question No. 5, then using 100 percent as the total, enter the percentage of negligence attributable to [name of defendant B] : |
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____ percent |
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C. |
If you answered “yes” to Question No. 7, then using 100 percent as the total, enter the percentage of negligence attributable to the plaintiff: |
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____ percent |
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The total of these must equal 100 percent: |
TOTAL |
100 percent |
ECONOMIC LOSS CLAIM
QUESTION NO. 9: Did the plaintiff's injury result in damages for economic loss for [ For insured defendants, insert those applicable economic loss damages incurred by the plaintiff in excess of compensable no-fault benefits for which the plaintiff seeks recovery — e.g., work loss during the first three years in excess of no-fault benefits, all work loss beyond three years, excess replacement service expenses, etc. For uninsured defendants, insert any economic loss damages. ] to the present date?
Answer: ____(yes or no)
If your answer is “yes,” go on to Question No. 10.
If your answer is “no,” do not answer Question No. 10; go on to Question No. 12.
QUESTION NO. 10: What is the total amount of the plaintiff's damages for economic loss to the present date?
Answer: $________.____
[Please note that the judge will reduce the total amount of the plaintiff's damages for economic loss by the percentage of negligence attributable to the plaintiff, if any, entered in Question No. 8.]
QUESTION NO. 11: Will plaintiff sustain economic damages in the future for [ For insured defendants, insert those applicable economic loss damages incurred by the plaintiff in excess of compensable no-fault benefits for which the plaintiff seeks recovery — e.g., work loss during the first three years in excess of no-fault benefits, all work loss beyond three years, excess replacement service expenses, etc. For uninsured defendants, insert any economic loss damages. ]?
Answer: ____ (yes or no)
If your answer is “yes,” go on to Question No. 12.
If your answer is “no,” do not answer Question No. 12; go on to Question No. 13.
QUESTION NO. 12: Give the total amount for each year in which the plaintiff will incur economic damages in the future.
ANSWER:
$________.____ for [year]
$________.____ for [year]
$________.____ for [year]
$________.____ for [year]
$________.____ for [year]
$________.____ for [year]
$________.____ for [year]
$________.____ for [year]
$________.____ for [year]
$________.____ for [year]
$________.____ for [year]
$________.____ for [year]
$________.____ for [year]
$________.____ for [year]
$________.____ for [year]
$________.____ for [year]
$________.____ for [year]
$________.____ for [year]
$________.____ for [year]
$________.____ for [year]
NONECONOMIC LOSS CLAIM**[NOTE: If you determined in Question No. 8 that the plaintiff was more than 50 percent at fault, then do not answer any further questions. If you determined in Question No. 8 that the plaintiff was 50 percent or less at fault, then go on to Question No. 13.]
QUESTION NO. 13: Did the plaintiff's injury result in [death / serious impairment of ***[a body function] 1 [body function] 2 / or / permanent serious disfigurement] ?
Answer: ____ (yes or no)
If your answer is “yes,” go on to Question No. 14.
If your answer is “no,” do not answer any further questions.
QUESTION NO. 14: What is the total amount of the plaintiff's damages for noneconomic loss for [ Describe noneconomic damages claimed by the plaintiff such as M Civ JI 50.02 Pain and Suffering, Etc., M Civ JI 50.03 Disability and Disfigurement, and M Civ JI 50.04 Aggravation of Preexisting Ailment or Condition ] to the present date ?
Answer: $________.____
[Please note that the judge will reduce the total amount of the plaintiff's damages for noneconomic loss by the percentage of negligence attributable to the plaintiff, if any, entered in Question No. 8.]
QUESTION NO. 15: Will plaintiff sustain damages for noneconomic loss in the future for [Describe noneconomic damages claimed by the plaintiff such as M Civ JI 50.02 Pain and Suffering, Etc., M Civ JI 50.03 Disability and Disfigurement, and M Civ JI 50.04 Aggravation of Preexisting Ailment or Condition. ]?
Answer: ____ (yes or no)
If your answer is “yes,” go on to Question No. 16.
If your answer is “no,” do not answer any further questions.
QUESTION NO. 16: Give the total amount for each year in which the plaintiff will incur noneconomic damages in the future.
ANSWER:
$________.____ for [year]
$________.____ for [year]
$________.____ for [year]
$________.____ for [year]
$________.____ for [year]
$________.____ for [year]
$________.____ for [year]
$________.____ for [year]
$________.____ for [year]
$________.____ for [year]
$________.____ for [year]
$________.____ for [year]
$________.____ for [year]
$________.____ for [year]
$________.____ for [year]
$________.____ for [year]
$________.____ for [year]
$________.____ for [year]
$________.____ for [year]
$________.____ for [year]
[Please note that the judge will reduce the total amount of the plaintiff's damages for noneconomic loss by the percentage of negligence attributable to the plaintiff, if any, entered in Question No. 8.]
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Signed, |
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________________________________________ |
_______________________ |
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Foreperson |
Date |
Note on Use*Delete Questions No. 2 and 5 and subpart B of Question No. 8 if there is only one defendant.
This verdict form may also be adapted by deleting questions under headings such as “Plaintiff's Negligence,” “Economic Loss Claim,” and “Noneconomic Loss Claim” if they are not issues in the case.
Deleting questions will require renumbering remaining questions and the references to the deleted questions.
See MCL 500.3135 for economic and noneconomic losses.
**Include the bracketed instructional note for those cases that are controlled by 1995 PA 222. For cases not controlled by this statute, omit the bracketed note.
***In Question No. 13, use bracketed phrase number 2 for cases that are controlled by 1995 PA 222 and bracketed phrase number 1 for cases not controlled by this statute.
This form of verdict is appropriate in a case in which the evidence would allow an award of damages for a 20-year period in the future. The form must be modified by the court to add or delete lines in Questions No. 12 and 16 in cases where the evidence supports an award of damages for a period longer or shorter than 20 years.
CommentBoth insured and uninsured motorist tortfeasors have immunity from tort liability for noneconomic loss damages, except where the injured person has suffered death, serious impairment of body function, or permanent serious disfigurement. Auto Club Insurance Ass'n v Hill , 431 Mich 449; 430 NW2d 636 (1988). However, the uninsured motorist tortfeasor (unlike the insured motorist tortfeasor) has no tort immunity for economic loss damages. Hill .
In cases in which 1995 PA 222 applies, an uninsured plaintiff (who was operating his or her own vehicle at the time the injury occurred) is not entitled to noneconomic loss damages. MCL 500.3135(2)(c) , added by 1995 PA 222. This restriction on uninsured plaintiffs does not apply in cases not controlled by 1995 PA 222.
In cases in which 1995 PA 222 applies, a plaintiff who is more than 50 percent at fault is not entitled to noneconomic loss damages. MCL 500.3135(2)(b) , added by 1995 PA 222. This restriction does not apply in cases not controlled by 1995 PA 222.
HistoryM Civ JI 67.17 was added December 1999. Amended September 2008. TOP