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See the 60-second demo →Damages calculations make or break medical-malpractice case economics. Underestimate, and you take a case that loses money. Overestimate, and you reject cases that would have produced fee revenue. This worksheet is the framework experienced plaintiff attorneys use to build defensible damages numbers — at intake, in expert reports, and at trial.
Damages divide cleanly into four categories, three of which are economic (calculable from records) and one of which is non-economic (jury-determined within state-cap limits).
| Category | Includes | Calculation method |
|---|---|---|
| Past economic | Past medical expenses, past lost earnings, past out-of-pocket | Records-based; sum of bills + W-2/tax-return analysis |
| Future economic | Future medical expenses, future lost earnings, future loss of household services | Life care plan + economist; reduced to present value |
| Past non-economic | Past pain & suffering, mental anguish, loss of consortium | Jury determination; subject to state caps |
| Future non-economic | Future pain & suffering, future loss of consortium | Jury determination; subject to state caps |
Past economic damages are the easiest to prove and the hardest to inflate. Build them from primary records.
Sum every medical bill from the date of negligence through the date of trial (or settlement). Include:
Important: bill amount vs. paid amount. Most jurisdictions allow recovery of either "billed" amounts or "paid" amounts depending on case law. The collateral source rule has been narrowed in many states; check yours. The split between billed and paid is often 30-50% for hospital bills, so this question can change damages by hundreds of thousands of dollars.
Calculate from W-2s and tax returns spanning 3-5 years before the negligence date plus all years through trial. Include:
For self-employed plaintiffs, use accountant-prepared income statements and Schedule C/Schedule K-1 detail. For variable income (commission, freelance), use a 3-5 year average. Subtract any disability or unemployment benefits the plaintiff received during the loss period (these are usually deductible from damages even where the collateral source rule applies).
Often overlooked. The plaintiff's pre-injury contribution to household services (cooking, cleaning, child care, yard work, home maintenance) has economic value. The DOL Bureau of Labor Statistics publishes the going rate for each service category by region.
Calculate: hours per week × weeks since injury × hourly rate by service category. For a stay-at-home parent with three children, this can easily reach $30,000-$60,000/year.
Future economic damages require a life care planner and an economist. These are the highest-cost case-development line items but also where damages numbers concentrate.
The life care planner builds a multi-decade projection of all future medical needs:
For each line item, the planner specifies frequency, unit cost, and duration. Costs are projected forward using medical-inflation indices (typically 3-5%).
An economist calculates the present value of all future earnings the plaintiff would have earned but for the injury. Inputs:
The discount rate is heavily contested in court. Plaintiff economists typically use net discount rates of 1-2% (real wage growth net of risk-free rate). Defense economists use 3-5%. This single variable can change damages by 30-50%.
Non-economic damages — pain and suffering, mental anguish, loss of consortium — are jury-determined within the bounds set by state cap statutes. Cap structure varies dramatically.
| State | Med mal non-economic cap | Notes |
|---|---|---|
| California | $390K (2024) → $750K (2034) | MICRA expansion phase-in |
| Texas | $250K per defendant; $500K total | One of the strictest caps |
| Florida | No cap (Estate of McCall, 2014) | Cap struck as unconstitutional |
| Maryland | $905K (rises annually) | Combined economic + non-economic for some claims |
| Massachusetts | $500K (with exceptions) | Lifted for substantial / permanent disfigurement |
| New York | No cap on non-economic | Plaintiff-friendly; most generous in nation |
| Pennsylvania | No cap | Cap struck as unconstitutional |
| Illinois | No cap (Lebron, 2010) | Cap struck as unconstitutional |
| Wisconsin | $750K | Indexed for inflation |
| Indiana | $1.8M total | Caps total damages, not just non-economic |
Verify your state's current cap before settling — caps are amended frequently and judicially struck without warning. For a current state-by-state damages reference, see our damages calculator.
Available in most jurisdictions for the plaintiff's spouse (and in some, for parents/children of an injured plaintiff). Treated as the spouse's separate claim in most states; in others, included in the plaintiff's overall non-economic recovery.
Practice tip: many cap statutes apply per claim or per claimant, not per case. In jurisdictions where consortium is a separate claim, two cap allowances may stack.
Wrongful death claims have their own statutory damages structures, varying widely by state:
Many states have "non-economic" caps on wrongful death claims that interact with general med-mal caps in non-obvious ways. Get this analysis right at intake — the answer determines case viability.
Future economic damages must be reduced to present value at trial. The plaintiff economist does this by discounting the future cash flows back to the trial date using a net discount rate.
Net discount rate = anticipated investment return − anticipated growth rate of the cost being projected. For medical inflation projected at 4% with investment return at 3.5%, net discount rate is −0.5% (effectively no discount, slight premium). For wages projected at 3% with investment return at 5%, net discount rate is +2%.
Plaintiff economists routinely use net discount rates of 1-2%. Defense economists routinely use 3-5%. The court will not adopt a "split the difference" approach automatically — argue your net discount rate from underlying economic literature, and be prepared to defend each component (anticipated wage growth, anticipated medical inflation, risk-free rate, equity premium).
Use this 9-line template at intake and refine through case development:
Track this worksheet across every major case event (intake, after expert reports, post-deposition, mediation, pre-trial). The numbers move based on new evidence; document the moves.
Our free Damages Calculator handles economic + non-economic across all 50 states with cap rules and present-value reduction built in. No signup. Plus our paid platform automates life care plan integration + economist worksheets.
Use Damages Calculator →John Mahoney is the founder of MedLegal AI. He builds AI tools for medical-malpractice plaintiff attorneys. Questions? [email protected]