MEDIATION CHECKLIST
(This document prepared in anticipation of mediation)
| I | Section I - Mediation Site | |
| a | Location | Client |
| Time & Date | Phone | |
| ADA Compliant/Special Needs Identified | ||
| Audio/Visual Equipment Needed | Fax | |
| Meeting Confirmed | Address | |
| b | Parties | |
| Party (Pl/Df) | Party (Pl/Df) | |
| Attorney/Adjuster | Attorney/Adjuster | |
| Party (Pl/Df) | Party (Pl/Df) | |
| Attorney/Adjuster | Attorney/Adjuster | |
| c | Other Contacts | |
| Mediator | Phone | |
| Experience | Fax | |
| Style | Address | |
| Training | ||
| Have you spoken with the mediator? | Sent requested information to the mediator? | |
| Expert (Pl/Df) | Expert (Pl/Df) | |
| Opinion | Opinion | |
| Expert (Pl/Df) | Expert (Pl/Df) | |
| Opinion | Opinion | |
| Provider | Provider | |
| Bill Amount | Bill Amount | |
| Lien Amount | Lien Amount | |
| Contact Name and Number | Contact Name and Number | |
| Provider | Provider | |
| Bill Amount | Bill Amount | |
| Lien Amount | Lien Amount | |
| Contact Name and Number | Contact Name and Number | |
| Lien (W/C) | Structured Settlement Expert (Pl/Df) | |
| Contact Name and Number | Contact Name and Number | |
| Other | Other | |
| Contact Name and Number | Contact Name and Number | |
| d | Case Status | Statute of Limitations |
| Date Filed | Petition | |
| Venue | Answer | |
| Venue | 3rd Party Claim | |
| Important Motions | ||
| Brief Statement of Case-Theme | ||
| II | Section II - Your Case | |
| b | Evidence Summary | |
| Statement Pl | ||
| Statement Df | ||
| Statement Wtns | ||
| Police Report | ||
| Photos of Injuries | ||
| Photos of Damages | ||
| Interrogatory Pl | ||
| Interrogatory Df | ||
| Deposition Pl | ||
| Deposition Df | ||
| Expert (Pl/Df) | ||
| Expert (Pl/Df) | ||
| Economist | ||
| Other | ||
| Voc/Rehab | ||
| Liability Issues | ||
| 1 | 2 | |
| 3 | 4 | |
| b | Itemization of Damages | |
| Item Amount Comments | ||
| Total Doctors | ||
| Total Hospital(s) | ||
| Other Medical | ||
| Chiropractic | ||
| Medical Subtotal | ||
| Past Wage Loss | ||
| Future Wage Loss | ||
| Property Damage | ||
| Other Damage/Loss/Pain&Suffering | ||
| TOTAL | ||
| Evaluation of Issues | ||
| Strengths | Concerns | |
| 1 | 1 | |
| 2 | 2 | |
| 3 | 3 | |
| 4 | 4 | |
| III | Section III - The Other Side | |
| a | Strengths | Weaknesses |
| 1 | 1 | |
| 2 | 2 | |
| 3 | 3 | |
| 4 | 4 | |
| IV | Section IV - Settlement Considerations | |
| a | What needs to be done before the mediation: | |
| Sent documents to the other side | ||
| 1 | 2 | |
| Obtained documents from the other side | ||
| 1 | 2 | |
| Obtained following information from the other side | ||
| 1 | 2 | |
| Case Law | ||
| Important Statute(s) | ||
| b | Jury Verdict Range (Venue Specific) | Most Likely Award |
| Average Low | Average High | |
| Settlement Brochure | ||
| Jury Verdict Reports | ||
| History of Offers and Demands | ||
| Your Costs: | Their Costs: | |
| Cost to Date | Cost to Date | |
| Cost Through Trial | Cost Through Trial | |
| Total Anticipated Costs | Total Anticipated Costs | |
| c | History of Offers and Demands: | |
| Offer Demand Date Comment | ||
| Schedule Client for Conference | ||
| Settlement Authority Amount | In Writing: Y/N | |
| d | Client Issues Regarding Settlement | |
| Non-Monetary Concerns/Demands | ||
| e | First Offer/Demand to be made at Session: | |
| f | Opening Statement (attached) | |
| V | Section V - Matters Discussed in the Mediation Session | |
| a | Issues Raised During the Session | Issues Not Previously Considered |
| 1 | 1 | |
| 2 | 2 | |
| 3 | 3 | |
| 4 | 4 | |
| b | Special Instructions to the Mediator | |
| Response from the Other Side | ||
| c | Offers & Demands Made During the Session | |
| Offer Demand Time | ||
| VI | Section VI - Post Mediation Activities | |
| Settlement | Y/N | |
| Special conditions and amount | ||
| a | Written Agreement Signed? | Y/N |
| b | Alternatives: Arbitration | Other |
| Continue Mediation Y/N | New Date | |
| Reason(s) Continued | ||