Va. Model Jury Instr. Civ. No. 9.100

[If you find your verdict for the plaintiff, then, in] [In] determining the damages to which he is

entitled, you shall include, but are not limited to, any of the following which you believe by the

greater weight of the evidence were suffered by the beneficiaries and caused by the defendant’s

negligence:

(1) any sorrow, mental anguish, and loss of solace suffered by the beneficiaries. Solace may

include society, companionship, comfort, guidance, kindly offices, and advice of the decedent;

(2) any reasonably expected loss in income of the decedent suffered by the beneficiaries;

(3) any reasonably expected loss of services, protection, care, and assistance which the decedent

provided to the beneficiaries;

(4) any expenses for the care, treatment, and hospitalization of the decedent incident to the injury

resulting in his death; and

(5) reasonable funeral expenses.

If you award damages under paragraphs (1), (2), and (3) above, you may distribute these

damages [among; between] (name of spouse, children, and children of any deceased child of decedent)

or (names of surviving statutory beneficiaries).

If you award damages under (4) and (5) above, you shall specifically state the amount of

damages for each.