Usually in a wrongful death case, there is a survivorship claim and a wrongful death claim under N.J.S.A. 2A:31-1. In such a case, the following damage questions are appropriate: 
    1.    Set forth the sum of money that will fairly and reasonably compensate the Estate of [name] for the losses sustained by the decedent while alive due to the defendant's negligence: 
        a.    Lost wages
$ 
        b.    Pain, suffering, disability, impairment
            and loss of enjoyment of life
$ 
    2.    Set forth the sum of money that will fairly and reasonably compensate the survivors of the decedent for the losses sustained by them due to the wrongful death of [name]. 
        a.    Medical bills (this sum may not
            exceed $ )
$ 
        b.    Funeral Expenses (this sum may
            not exceed $ )
$ 
        c.    Financial losses sustained by the
            survivors of the decedent due to the
            wrongful death of [name].
$ 
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Model Civil Jury Charges