Personal Injury Complaint - Auto Accident - Pennsylvania

Pennsylvania Personal Injury Updated October 30, 2026 Free Word and PDF

NOTICE TO DEFEND

You have been sued in court. If you wish to defend against the claims set forth in the following pages, you must take action within twenty (20) days after this complaint and notice are served, by entering a written appearance personally or by attorney and filing in writing with the court your defenses or objections to the claims set forth against you. You are warned that if you fail to do so the case may proceed without you and a judgment may be entered against you by the court without further notice for any money claimed in the complaint or for any other claim or relief requested by the plaintiff. You may lose money or property or other rights important to you.

YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW. THIS OFFICE CAN PROVIDE YOU WITH INFORMATION ABOUT HIRING A LAWYER.

IF YOU CANNOT AFFORD TO HIRE A LAWYER, THIS OFFICE MAY BE ABLE TO PROVIDE YOU WITH INFORMATION ABOUT AGENCIES THAT MAY OFFER LEGAL SERVICES TO ELIGIBLE PERSONS AT A REDUCED FEE OR NO FEE.

[COUNTY-DESIGNATED LAWYER-REFERRAL OFFICE NAME]

[OFFICE ADDRESS]

[OFFICE TELEPHONE NUMBER]


PERSONAL INJURY COMPLAINT – AUTO ACCIDENT

(Pennsylvania – Court of Common Pleas)


TABLE OF CONTENTS

I. Document Header
II. Definitions
III. Operative Provisions (Factual Allegations & Causes of Action)
IV. Representations & Warranties (Jurisdiction & Venue)
V. Covenants & Restrictions (Litigation Conduct)
VI. Default & Remedies (Prayer for Relief)
VII. Risk Allocation (Comparative Negligence & Statutory Limits)
VIII. Dispute Resolution
IX. General Provisions
X. Execution Block (Verification & Signature)


I. DOCUMENT HEADER

IN THE COURT OF COMMON PLEAS OF [COUNTY] COUNTY, PENNSYLVANIA – CIVIL DIVISION

[PLAINTIFF FULL NAME], an adult individual,
Plaintiff,
v. Docket No.: [___]
[DEFENDANT FULL NAME], an adult individual/ corporation,
Defendant.

COMPLAINT IN CIVIL ACTION – PERSONAL INJURY (MOTOR-VEHICLE COLLISION)
JURY TRIAL DEMANDED


II. DEFINITIONS

For purposes of this Complaint, the following terms have the meanings set forth below. Defined terms apply throughout this pleading, including the Prayer for Relief.

  1. “Collision” means the motor-vehicle accident that occurred on [DATE] at or near [PRECISE LOCATION], Commonwealth of Pennsylvania.
  2. “Plaintiff” means [PLAINTIFF FULL NAME], including any lawful successors, representatives, or assigns.
  3. “Defendant” means [DEFENDANT FULL NAME], including agents, servants, employees, and anyone acting in concert with Defendant at all relevant times.
  4. “Vehicle” means the [YEAR/MAKE/MODEL] operated by Defendant at the time of the Collision.
  5. “MVFRL” means the Pennsylvania Motor Vehicle Financial Responsibility Law, 75 Pa. Cons. Stat. § 1701 et seq.
  6. “Comparative Negligence Statute” means 42 Pa. Cons. Stat. § 7102.

III. OPERATIVE PROVISIONS

A. Parties

3.1 Plaintiff is an adult citizen and resident of [COUNTY], Pennsylvania, residing at [ADDRESS].

3.2 Defendant is [an adult individual residing at / a Pennsylvania business entity with its principal place of business at] [ADDRESS].

B. Jurisdiction & Venue

3.3 This Court has subject-matter jurisdiction under 42 Pa. Cons. Stat. § 931.

3.4 Venue is proper in [COUNTY] County because [SELECT APPLICABLE BASIS: the Collision giving rise to this action occurred here (Pa. R.C.P. 1006(a)(3) for an individual Defendant or Pa. R.C.P. 2179(a)(3)-(4) for a corporate Defendant); an individual Defendant may be served here (Rule 1006(a)(1)); or a corporate Defendant regularly conducts business here (Rule 2179(a)(2))]. Delete unused alternatives and state supporting facts.

C. Factual Allegations

3.5 On [DATE] at approximately [TIME], Defendant was operating the Vehicle eastbound on [ROADWAY].

3.6 Defendant negligently, carelessly, and/or recklessly:
a. Failed to maintain a proper lookout;
b. Drove at an unreasonable speed;
c. Violated the Pennsylvania Vehicle Code;
d. Failed to yield the right-of-way; and
e. Failed to maintain proper control of the Vehicle.

3.7 As a direct and proximate result of Defendant’s conduct, Defendant’s Vehicle collided with Plaintiff’s vehicle/pedestrian person, causing Plaintiff severe and permanent injuries.

D. Damages

3.8 Plaintiff sustained, inter alia, the following injuries: [LIST PHYSICAL, EMOTIONAL, AND ECONOMIC DAMAGES].

3.9 Plaintiff has incurred and will continue to incur medical expenses recoverable after applying 75 Pa.C.S. § 1722, wage loss, loss of earning capacity, and other economic and noneconomic losses. Amounts paid or payable under benefit arrangements to which § 1722 applies are excluded from this tort demand. The amount claimed relative to the local compulsory-arbitration limit is stated below.

E. Causes of Action

COUNT I – NEGLIGENCE
3.10 Plaintiff incorporates Paragraphs 3.1 through 3.9 as though fully set forth herein.

3.11 Defendant owed Plaintiff a duty of reasonable care in the operation of a motor vehicle.

3.12 Defendant breached that duty by the acts and omissions described above.

3.13 Defendant’s breach was the factual and legal cause of Plaintiff’s injuries and damages.

COUNT II – RECKLESS CONDUCT / PUNITIVE DAMAGES (optional)
3.14 Plaintiff incorporates Paragraphs 3.1 through 3.13.

3.15 Defendant’s conduct exhibited a reckless indifference to the rights and safety of others, warranting punitive damages under Pennsylvania law.

COUNT III – LOSS OF CONSORTIUM (optional)
3.16 Plaintiff’s spouse, [SPOUSE NAME], realleges Paragraphs 3.1 through 3.13 and has suffered loss of consortium.


IV. REPRESENTATIONS & WARRANTIES (Jurisdiction & Venue)

4.1 Plaintiff represents that he/she has elected [FULL TORT / LIMITED TORT with statutory exception under 75 Pa. Cons. Stat. § 1705(d)] and is therefore entitled to assert claims for non-economic damages.

4.2 If this county has a compulsory-arbitration rule, Plaintiff states under Pa. R.C.P. 1021(c) that the amount claimed [does / does not] exceed the local arbitration referral amount. [IDENTIFY COUNTY LOCAL RULE AND AMOUNT.]


V. COVENANTS & RESTRICTIONS (Litigation Conduct)

5.1 Plaintiff will respond to discovery requests as required by the applicable Pennsylvania Rules of Civil Procedure.

5.2 Plaintiff covenants to preserve all relevant evidence and demands that Defendant do the same, triggering Defendant’s duty to preserve under applicable spoliation law.

5.3 Plaintiff reserves the right to amend this Complaint pursuant to Pa. R.C.P. 1033.


VI. DEFAULT & REMEDIES (Prayer for Relief)

WHEREFORE, Plaintiff respectfully requests that this Court enter judgment in Plaintiff’s favor and against Defendant, awarding:

a. Compensatory damages in an amount to be determined by the trier of fact;
b. Punitive damages (if Count II is asserted);
c. Delay damages pursuant to Pa. R.C.P. 238;
d. Post-judgment interest as allowed by law;
e. Reasonable costs of suit; and
f. Such other and further relief as the Court deems just and proper.


VII. RISK ALLOCATION (Comparative Negligence & Statutory Limits)

7.1 Pursuant to 42 Pa. Cons. Stat. § 7102, Plaintiff’s recovery, if any, shall be diminished only by Plaintiff’s proportionate share of negligence, provided that share does not exceed fifty percent (50%).

7.2 To the extent any statutory damage cap applies (e.g., claims against a local governmental unit under 42 Pa. Cons. Stat. § 8553), Plaintiff pleads in the alternative and seeks the maximum recoverable amount.


VIII. DISPUTE RESOLUTION

8.1 Governing Law: This action is governed by Pennsylvania substantive law and the Pennsylvania Rules of Civil Procedure.

8.2 Forum Selection: Plaintiff consents to and selects the Court of Common Pleas of [COUNTY] County, Pennsylvania.

8.3 Arbitration: The court may refer a claim within the county's compulsory-arbitration limit under Pa. R.C.P. 1301 et seq. and applicable local rules. Any appeal from an arbitration award is governed by the applicable court rules. Plaintiff demands a jury trial on triable issues.

8.4 Jury Demand: Plaintiff hereby demands a trial by twelve (12) jurors on all issues so triable.

8.5 Injunctive Relief: Plaintiff reserves the right to seek equitable relief to preserve the status quo or prevent spoliation, as circumstances require.


IX. GENERAL PROVISIONS

9.1 Amendment & Waiver: No amendment of pleadings shall occur without leave of court where required; no waiver of rights shall be inferred from silence.

9.2 Assignment: Claims asserted herein are personal to Plaintiff and may not be assigned without compliance with Pennsylvania law.

9.3 Severability: Should any portion of this Complaint be deemed legally deficient, the remaining allegations shall survive to the fullest extent permitted.

9.4 Integration: This Complaint constitutes the entire pleading of Plaintiff as of the date of filing.

9.5 Electronic Filing & Signatures: File and sign this Complaint in the manner required by the applicable Pennsylvania Rules of Civil Procedure and the filing court's local rules. Use the court's electronic filing system and signature procedure when applicable.

9.6 Civil Cover Sheet: Complete and file the civil cover sheet required by Pa. R.C.P. 205.5 when commencing this action, unless the filing court's electronic filing procedures collect the required information without a separate cover sheet. Check the filing court's current form and local rules.


X. EXECUTION BLOCK

A. Verification

I, [PLAINTIFF NAME], verify that the statements made in the foregoing Complaint are true and correct to the best of my knowledge, information, and belief. I understand that false statements herein are made subject to the penalties of 18 Pa. Cons. Stat. § 4904 relating to unsworn falsification to authorities.

Date: ______________________ _______________________________
[PLAINTIFF NAME]

B. Signature Block

Respectfully submitted,

[LAW FIRM NAME]
By: _______________________________
[ATTORNEY NAME] (Atty. ID No. ☐)
[ADDRESS]
[PHONE] | [EMAIL]
Counsel for Plaintiff

C. Certificate of Compliance with Case Records Public Access Policy

I certify that this filing complies with the Case Records Public Access Policy of the Unified Judicial System of Pennsylvania, including its requirements for filing confidential information and confidential documents separately from publicly accessible filings.

Date: ______________________ _______________________________
[ATTORNEY OR FILING PARTY]


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About this template

Last updated
October 30, 2026
Jurisdiction
Pennsylvania
Category
Personal Injury

Personal injury cases are brought by people who were hurt because of someone else's carelessness: car crashes, slip and falls, defective products, and more. Demand letters, settlement agreements, and court filings in these cases have to document the injuries, the medical treatment, the lost income, and the exact legal basis for holding the other side responsible. Well-prepared paperwork is what drives higher settlements and forces insurers to take the claim seriously.

Not legal advice

This template is provided for informational purposes. We recommend having an attorney review any legal document before signing, especially for high-value or complex matters.

Checked against the law it cites

The statutes this template relies on are listed under Legal authority.

75 Pa.C.S. § 1722 (checked October 30, 2026): "shall be precluded from recovering the amount of benefits paid or payable under this subchapter"

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