Form Interrogatories Disc 001 – Fill Out and Use This PDF

FORM INTERROGATORIES—GENERAL

Asking Party:

Answering Party:

Set No.:

CASE NUMBER:

Sec. 1. Instructions to All Parties

(a)Interrogatories are written questions prepared by a party to an action that are sent to any other party in the action to be answered under oath. The interrogatories below are form interrogatories approved for use in civil cases.

(b)For time limitations, requirements for service on other parties, and other details, see Code of Civil Procedure sections 2030.010–2030.410 and the cases construing those sections.

(c)These form interrogatories do not change existing law relating to interrogatories nor do they affect an answering party’s right to assert any privilege or make any objection.

Sec. 2. Instructions to the Asking Party

(a)These interrogatories are designed for optional use by parties in unlimited civil cases where the amount demanded exceeds $25,000. Separate interrogatories, Form Interrogatories— Limited Civil Cases (Economic Litigation) (form DISC-004), which have no subparts, are designed for use in limited civil cases where the amount demanded is $25,000 or less; however, those interrogatories may also be used in unlimited civil cases.

(b)Check the box next to each interrogatory that you want the answering party to answer. Use care in choosing those interrogatories that are applicable to the case.

(c)You may insert your own definition of INCIDENT in Section 4, but only where the action arises from a course of conduct or a series of events occurring over a period of time.

(d)The interrogatories in section 16.0, Defendant’s Contentions– Personal Injury, should not be used until the defendant has had a reasonable opportunity to conduct an investigation or discovery of plaintiff’s injuries and damages.

(c)Each answer must be as complete and straightforward as the information reasonably available to you, including the information possessed by your attorneys or agents, permits. If an interrogatory cannot be answered completely, answer it to the extent possible.

(d)If you do not have enough personal knowledge to fully answer an interrogatory, say so, but make a reasonable and good faith effort to get the information by asking other persons or organizations, unless the information is equally available to the asking party.

(e)Whenever an interrogatory may be answered by referring to a document, the document may be attached as an exhibit to the response and referred to in the response. If the document has more than one page, refer to the page and section where the answer to the interrogatory can be found.

(f)Whenever an address and telephone number for the same person are requested in more than one interrogatory, you are required to furnish them in answering only the first interrogatory asking for that information.

(g)If you are asserting a privilege or making an objection to an interrogatory, you must specifically assert the privilege or state the objection in your written response.

(h)Your answers to these interrogatories must be verified, dated, and signed. You may wish to use the following form at the end of your answers:

I declare under penalty of perjury under the laws of the State of California that the foregoing answers are true and correct.

(a)An answer or other appropriate response must be given to each interrogatory checked by the asking party.

(b)As a general rule, within 30 days after you are served with these interrogatories, you must serve your responses on the asking party and serve copies of your responses on all other parties to the action who have appeared. See Code of Civil Procedure sections 2030.260–2030.270 for details.

Words in BOLDFACE CAPITALS in these interrogatories are defined as follows:

(a)(Check one of the following):

(1) INCIDENT includes the circumstances and events surrounding the alleged accident, injury, or other occurrence or breach of contract giving rise to this action or proceeding.

(2) INCIDENT means (insert your definition here or on a separate, attached sheet labeled “Sec. 4(a)(2)”):

(b)YOU OR ANYONE ACTING ON YOUR BEHALF includes you, your agents, your employees, your insurance companies, their agents, their employees, your attorneys, your accountants, your investigators, and anyone else acting on your behalf.

(c)PERSON includes a natural person, firm, association, organization, partnership, business, trust, limited liability company, corporation, or public entity.

(d)DOCUMENT means a writing, as defined in Evidence Code section 250, and includes the original or a copy of handwriting, typewriting, printing, photostats, photographs, electronically stored information, and every other means of recording upon any tangible thing and form of communicating or representation, including letters, words, pictures, sounds, or symbols, or combinations of them.

(e)HEALTH CARE PROVIDER includes any PERSON referred to in Code of Civil Procedure section 667.7(e)(3).

(f)ADDRESS means the street address, including the city, state, and zip code.

Sec. 5. Interrogatories

The following interrogatories have been approved by the Judicial Council under Code of Civil Procedure section 2033.710:

CONTENTS

1.0Identity of Persons Answering These Interrogatories

2.0General Background Information—Individual

3.0General Background Information—Business Entity

4.0Insurance

5.0[Reserved]

6.0Physical, Mental, or Emotional Injuries

7.0Property Damage

8.0Loss of Income or Earning Capacity

9.0Other Damages

10.0Medical History

11.0Other Claims and Previous Claims

12.0Investigation—General

13.0Investigation—Surveillance 14.0Statutory or Regulatory Violations

15.0Denials and Special or Affirmative Defenses

16.0Defendant’s Contentions Personal Injury

17.0Responses to Request for Admissions

18.0[Reserved]

19.0[Reserved]

20.0How the Incident Occurred—Motor Vehicle

25.0[Reserved]

30.0[Reserved]

40.0[Reserved]

50.0Contract

60.0[Reserved]

70.0Unlawful Detainer [See separate form DISC-003]

101.0Economic Litigation [See separate form DISC-004] 200.0Employment Law [See separate form DISC-002] Family

Law [See separate form FL-145]

DISC-001

1.0 Identity of Persons Answering These Interrogatories

1.1 State the name, ADDRESS, telephone number, and relationship to you of each PERSON who prepared or assisted in the preparation of the responses to these interrogatories. (Do not identify anyone who simply typed or reproduced the responses.)

2.0 General Background Information individual—

2.1 State:

(a)your name;

(b)every name you have used in the past; and

(c)the dates you used each name.

2.2 State the date and place of your birth.

2.3 At the time of the INCIDENT, did you have a driver's license? If so state:

(a)the state or other issuing entity;

(b)the license number and type;

(c)the date of issuance; and

(d)all restrictions.

2.4 At the time of the INCIDENT, did you have any other permit or license for the operation of a motor vehicle? If so, state:

(a)the state or other issuing entity;

(b)the license number and type;

(c)the date of issuance; and

(d)all restrictions.

2.5 State:

(a)your present residence ADDRESS;

(b)your residence ADDRESSES for the past five years; and

(c)the dates you lived at each ADDRESS.

2.6 State:

(a)the name, ADDRESS, and telephone number of your present employer or place of self-employment; and

(b)the name, ADDRESS, dates of employment, job title, and nature of work for each employer or self- employment you have had from five years before the INCIDENT until today.

2.7 State:

(a)the name and ADDRESS of each school or other academic or vocational institution you have attended, beginning with high school;

(b)the dates you attended;

(c)the highest grade level you have completed; and

(d)the degrees received.

2.8 Have you ever been convicted of a felony? If so, for each conviction state:

(a)the city and state where you were convicted;

(b)the date of conviction;

(c)the offense; and

(d)the court and case number.

2.9 Can you speak English with ease? If not, what language and dialect do you normally use?

2.10 Can you read and write English with ease? If not, what language and dialect do you normally use?

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2.11 At the time of the INCIDENT were you acting as an agent or employee for any PERSON? If so, state:

(a)the name, ADDRESS, and telephone number of that PERSON: and

(b)a description of your duties.

2.12 At the time of the INCIDENT did you or any other person have any physical, emotional, or mental disability or condition that may have contributed to the occurrence of the INCIDENT? If so, for each person state:

(a)the name, ADDRESS, and telephone number;

(b)the nature of the disability or condition; and

(c)the manner in which the disability or condition contributed to the occurrence of the INCIDENT.

2.13Within 24 hours before the INCIDENT did you or any person involved in the INCIDENT use or take any of the following substances: alcoholic beverage, marijuana, or other drug or medication of any kind (prescription or not)? If so, for each person state:

(a) the name, ADDRESS, and telephone number;

(b) the nature or description of each substance;

(c)the quantity of each substance used or taken;

(d)the date and time of day when each substance was used or taken;

(e)the ADDRESS where each substance was used or taken;

(f)the name, ADDRESS, and telephone number of each person who was present when each substance was used or taken; and

(g)the name, ADDRESS, and telephone number of any HEALTH CARE PROVIDER who prescribed or furnished the substance and the condition for which it was prescribed or furnished.

3.0 General Background Information—Business Entity

3.1 Are you a corporation? If so, state:

(a)the name stated in the current articles of incorporation;

(b)all other names used by the corporation during the past 10 years and the dates each was used;

(c)the date and place of incorporation;

(d)the ADDRESS of the principal place of business; and

(e)whether you are qualified to do business in California.

3.2 Are you a partnership? If so, state:

(a)the current partnership name;

(b)all other names used by the partnership during the past 10 years and the dates each was used;

(c)whether you are a limited partnership and, if so, under the laws of what jurisdiction;

(d)the name and ADDRESS of each general partner; and

(e)the ADDRESS of the principal place of business.

3.3 Are you a limited liability company? If so, state:

(a)the name stated in the current articles of organization;

(b)all other names used by the company during the past 10 years and the date each was used;

(c)the date and place of filing of the articles of organization;

(d)the ADDRESS of the principal place of business; and

(e)whether you are qualified to do business in California.

DISC-001

3.4 Are you a joint venture? If so, state:

(a)the current joint venture name;

(b)all other names used by the joint venture during the past 10 years and the dates each was used;

(c)the name and ADDRESS of each joint venturer; and

(d)the ADDRESS of the principal place of business.

3.5 Are you an unincorporated association? If so, state:

(a)the current unincorporated association name;

(b)all other names used by the unincorporated association during the past 10 years and the dates each was used; and

(c)the ADDRESS of the principal place of business.

3.6 Have you done business under a fictitious name during the past 10 years? If so, for each fictitious name state:

(a)the name;

(b)the dates each was used;

(c)the state and county of each fictitious name filing; and

(d)the ADDRESS of the principal place of business.

3.7 Within the past five years has any public entity registered or licensed your business? If so, for each license or registration:

(a)identify the license or registration;

(b)state the name of the public entity; and

(c)state the dates of issuance and expiration.

4.0Insurance

4.1 At the time of the INCIDENT, was there in effect any policy of insurance through which you were or might be insured in any manner (for example, primary, pro-rata, or excess liability coverage or medical expense coverage) for the damages, claims, or actions that have arisen out of the INCIDENT? If so, for each policy state:

(a)the kind of coverage;

(b)the name and ADDRESS of the insurance company;

(c)the name, ADDRESS, and telephone number of each named insured;

(d)the policy number;

(e)the limits of coverage for each type of coverage contained in the policy;

(f)whether any reservation of rights or controversy or coverage dispute exists between you and the insurance company; and

(g)the name, ADDRESS, and telephone number of the custodian of the policy.

4.2 Are you self-insured under any statute for the damages, claims, or actions that have arisen out of the INCIDENT? If so, specify the statute.

5.0[Reserved]

6.0Physical, Mental, or Emotional Injuries

6.1 Do you attribute any physical, mental, or emotional injuries to the INCIDENT? (If your answer is “no,” do not answer interrogatories 6.2 through 6.7).

6.2 Identify each injury you attribute to the INCIDENT and the area of your body affected.

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6.3 Do you still have any complaints that you attribute to the INCIDENT? If so, for each complaint state:

(a)a description;

(b)whether the complaint is subsiding, remaining the same, or becoming worse; and

(c)the frequency and duration.

6.4 Did you receive any consultation or examination (except from expert witnesses covered by Code of Civil Procedure sections 2034.210–2034.310) or treatment from a HEALTH CARE PROVIDER for any injury you attribute to the INCIDENT? If so, for each HEALTH CARE PROVIDER state:

(a)the name, ADDRESS, and telephone number;

(b)the type of consultation, examination, or treatment provided;

(c)the dates you received consultation, examination, or treatment; and

(d)the charges to date.

6.5 Have you taken any medication, prescribed or not, as a result of injuries that you attribute to the INCIDENT? If so, for each medication state:

(a)the name;

(b)the PERSON who prescribed or furnished it;

(c)the date it was prescribed or furnished;

(d)the dates you began and stopped taking it; and

(e)the cost to date.

6.6 Are there any other medical services necessitated by the injuries that you attribute to the INCIDENT that were not previously listed (for example, ambulance, nursing, prosthetics)? If so, for each service state:

(a)the nature;

(b)the date;

(c)the cost; and

(d)the name, ADDRESS, and telephone number of each provider.

6.7 Has any HEALTH CARE PROVIDER advised that you may require future or additional treatment for any injuries that you attribute to the INCIDENT? If so, for each injury state:

(a)the name and ADDRESS of each HEALTH CARE

PROVIDER;

(b)the complaints for which the treatment was advised; and

(c)the nature, duration, and estimated cost of the treatment.

7.0Property Damage

7.1 Do you attribute any loss of or damage to a vehicle or other property to the INCIDENT? If so, for each item of property:

(a)describe the property;

(b)describe the nature and location of the damage to the property;

DISC-001

(c)state the amount of damage you are claiming for each item of property and how the amount was calculated; and

(d)if the property was sold, state the name, ADDRESS, and telephone number of the seller, the date of sale, and the sale price.

7.2Has a written estimate or evaluation been made for any item of property referred to in your answer to the preceding interrogatory? If so, for each estimate or evaluation state:

(a)the name, ADDRESS, and telephone number of the PERSON who prepared it and the date prepared;

(b)the name, ADDRESS, and telephone number of each PERSON who has a copy of it; and

(c)the amount of damage stated.

7.3 Has any item of property referred to in your answer to interrogatory 7.1 been repaired? If so, for each item state:

(a)the date repaired;

(b)a description of the repair;

(c)the repair cost;

(d)the name, ADDRESS, and telephone number of the PERSON who repaired it;

(e)the name, ADDRESS, and telephone number of the PERSON who paid for the repair.

8.0Loss of Income or Earning Capacity

8.1 Do you attribute any loss of income or earning capacity to the INCIDENT? (If your answer is “no,” do not answer interrogatories 8.2 through 8.8).

8.2 State:

(a)the nature of your work;

(b)your job title at the time of the INCIDENT; and

(c)the date your employment began.

8.3 State the last date before the INCIDENT that you worked for compensation.

8.4 State your monthly income at the time of the INCIDENT and how the amount was calculated.

8.5 State the date you returned to work at each place of employment following the INCIDENT.

8.6 State the dates you did not work and for which you lost income as a result of the INCIDENT.

8.7 State the total income you have lost to date as a result of the INCIDENT and how the amount was calculated.

8.8 Will you lose income in the future as a result of the INCIDENT? If so, state:

(a)the facts upon which you base this contention;

(b)an estimate of the amount;

(c)an estimate of how long you will be unable to work; and

(d)how the claim for future income is calculated.

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9.0 Other Damages

9.1 Are there any other damages that you attribute to the INCIDENT? If so, for each item of damage state:

(a)the nature;

(b)the date it occurred;

(c)the amount; and

(d)the name, ADDRESS, and telephone number of each PERSON to whom an obligation was incurred.

9.2 Do any DOCUMENTS support the existence or amount of any item of damages claimed in interrogatory 9.1? If so, describe each document and state the name, ADDRESS, and telephone number of the PERSON who has each

DOCUMENT. 10.0 Medical History

10.1 At any time before the INCIDENT did you have com- plaints or injuries that involved the same part of your body claimed to have been injured in the INCIDENT? If so, for each state:

(a)a description of the complaint or injury;

(b)the dates it began and ended; and

(c)the name, ADDRESS, and telephone number of each HEALTH CARE PROVIDER whom you consulted or who examined or treated you.

10.2 List all physical, mental, and emotional disabilities you had immediately before the INCIDENT. (You may omit mental or emotional disabilities unless you attribute any mental or emotional injury to the INCIDENT. )

10.3 At any time after the INCIDENT, did you sustain injuries of the kind for which you are now claiming damages? If so, for each incident giving rise to an injury state:

(a)the date and the place it occurred;

(b)the name, ADDRESS, and telephone number of any other PERSON involved;

(c)the nature of any injuries you sustained;

(d)the name, ADDRESS, and telephone number of each HEALTH CARE PROVIDER who you consulted or who examined or treated you; and

(e)the nature of the treatment and its duration.

11.0Other Claims and Previous Claims

11.1 Except for this action, in the past 10 years have you filed an action or made a written claim or demand for compensation for your personal injuries? If so, for each action, claim, or demand state:

(a)the date, time, and place and location (closest street ADDRESS or intersection) of the INCIDENT giving rise to the action, claim, or demand;

(b)the name, ADDRESS, and telephone number of each PERSON against whom the claim or demand was made or the action filed;

DISC-001

(c)the court, names of the parties, and case number of any action filed;

(d)the name, ADDRESS, and telephone number of any attorney representing you;

(e)whether the claim or action has been resolved or is pending; and

(f)a description of the injury.

11.2 In the past 10 years have you made a written claim or demand for workers' compensation benefits? If so, for each claim or demand state:

(a)the date, time, and place of the INCIDENT giving rise to the claim;

(b)the name, ADDRESS, and telephone number of your employer at the time of the injury;

(c)the name, ADDRESS, and telephone number of the workers’ compensation insurer and the claim number;

(d)the period of time during which you received workers’ compensation benefits;

(e)a description of the injury;

(f)the name, ADDRESS, and telephone number of any HEALTH CARE PROVIDER who provided services; and

(g)the case number at the Workers’ Compensation Appeals Board.

12.0 Investigation—General

12.1 State the name, ADDRESS, and telephone number of each individual:

(a)who witnessed the INCIDENT or the events occurring immediately before or after the INCIDENT;

(b)who made any statement at the scene of the

INCIDENT;

(c)who heard any statements made about the INCIDENT by any individual at the scene; and

(d)who YOU OR ANYONE ACTING ON YOUR BEHALF claim has knowledge of the INCIDENT (except for expert witnesses covered by Code of Civil Procedure section 2034).

12.2 Have YOU OR ANYONE ACTING ON YOUR BEHALF interviewed any individual concerning the INCIDENT? If so, for each individual state:

(a)the name, ADDRESS, and telephone number of the individual interviewed;

(b)the date of the interview; and

(c)the name, ADDRESS, and telephone number of the PERSON who conducted the interview.

12.3 Have YOU OR ANYONE ACTING ON YOUR BEHALF obtained a written or recorded statement from any individual concerning the INCIDENT? If so, for each statement state:

(a)the name, ADDRESS, and telephone number of the individual from whom the statement was obtained;

(b)the name, ADDRESS, and telephone number of the individual who obtained the statement;

(c)the date the statement was obtained; and

(d)the name, ADDRESS, and telephone number of each PERSON who has the original statement or a copy.

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