Personal Injury Complaint - Slip and Fall

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IN THE COURT OF COMMON PLEAS OF [___] COUNTY, PENNSYLVANIA


CIVIL ACTION – LAW

Docket No.: __________________

[PLAINTIFF NAME],
An adult individual,
residing at [PLAINTIFF ADDRESS],
Plaintiff,
v.
[DEFENDANT NAME],
A [corporation/limited liability company/individual/other] with a principal place of business at [DEFENDANT ADDRESS],
Defendant.

COMPLAINT IN CIVIL ACTION

(Slip-and-Fall / Premises Liability)


TABLE OF CONTENTS

  1. Parties, Capacity, and Preliminary Allegations
  2. Jurisdiction and Venue
  3. Factual Background
  4. Count I – Negligence / Premises Liability
  5. Damages
  6. Demand for Jury Trial
  7. Prayer for Relief
  8. Alternative Dispute Resolution Election (Optional)
  9. Notice of Comparative Negligence Allocation
  10. Verification
  11. Certificate of Service

1. PARTIES, CAPACITY, AND PRELIMINARY ALLEGATIONS

1.1 Plaintiff [PLAINTIFF NAME] (“Plaintiff”) is an adult individual residing at the address stated in the caption and is sui juris.
1.2 Defendant [DEFENDANT NAME] (“Defendant”) is a [type of entity] duly organized under the laws of [STATE] with its principal place of business as stated in the caption, and at all relevant times owned, leased, operated, possessed, controlled, and/or maintained the premises located at [PREMISES ADDRESS] (the “Premises”).
1.3 All conditions precedent to the institution of this action have been performed, have occurred, or have been excused.


2. JURISDICTION AND VENUE

2.1 This Court has subject-matter jurisdiction pursuant to 42 Pa. Cons. Stat. § 931 because the amount in controversy exceeds the arbitration limits of this County and the claims sound in tort.
2.2 Personal jurisdiction over Defendant is proper under 42 Pa. Cons. Stat. § 5322(a) because Defendant transacts business, derives substantial revenue, and/or maintains continuous and systematic contacts in Pennsylvania, including the operation of the Premises.
2.3 Venue lies in this County under Pa.R.C.P. 1006 because the cause of action arose in this County and the Premises are located here.


3. FACTUAL BACKGROUND

3.1 On or about [DATE OF INCIDENT] at approximately [TIME], Plaintiff lawfully entered the Premises as a [business invitee/licensee].
3.2 While walking [describe location—e.g., “along the main customer aisle adjacent to the refrigerated section”], Plaintiff slipped and fell due to [describe condition—e.g., “an accumulation of clear liquid”] (the “Dangerous Condition”).
3.3 The Dangerous Condition was:
a. Unreasonably hazardous;
b. Not open and obvious to Plaintiff exercising reasonable care; and
c. Within Defendant’s actual and/or constructive knowledge for a sufficient time prior to the incident to permit discovery and remediation.
3.4 Defendant failed to:
a. Inspect, maintain, and keep the Premises in a reasonably safe condition;
b. Warn Plaintiff of the Dangerous Condition; and
c. Correct or remove the Dangerous Condition in a timely manner.
3.5 As a direct and proximate result, Plaintiff sustained severe, painful, and permanent injuries as more fully set forth below.


4. COUNT I – NEGLIGENCE / PREMISES LIABILITY

4.1 Plaintiff realleges paragraphs 1 through 3 as though fully set forth herein.
4.2 Defendant owed Plaintiff the duty of reasonable care to maintain the Premises in a safe condition, including but not limited to the duties to inspect, repair, and warn.
4.3 Defendant breached its duties by acts and omissions including, without limitation:
a. Failing to discover and remedy the Dangerous Condition;
b. Failing to place warning signs, cones, or barriers;
c. Failing to institute and enforce adequate inspection policies; and
d. Allowing substances to accumulate on walking surfaces.
4.4 Defendant’s breach was the factual and legal cause of Plaintiff’s injuries.
4.5 Plaintiff’s right of recovery is subject to Pennsylvania’s comparative negligence statute, 42 Pa. Cons. Stat. § 7102; to the extent Defendant contends Plaintiff was comparatively negligent, such negligence, if any, was less than fifty percent (50%) and therefore does not bar, but may reduce, recovery.


5. DAMAGES

5.1 As a direct result of Defendant’s negligence, Plaintiff sustained:
a. Past and future medical expenses;
b. Past and future lost wages and loss of earning capacity;
c. Physical pain and suffering;
d. Mental anguish, embarrassment, and humiliation;
e. Loss of life’s pleasures; and
f. Other damages recoverable under Pennsylvania law.
5.2 The full extent of damages will be proven at trial; Plaintiff presently demands an amount in excess of the jurisdictional minimum of this Court.


6. DEMAND FOR JURY TRIAL

Pursuant to Pa.R.C.P. 1007.1, Plaintiff demands trial by jury on all issues so triable.


7. PRAYER FOR RELIEF

WHEREFORE, Plaintiff respectfully requests that this Honorable Court enter judgment in favor of Plaintiff and against Defendant, jointly and severally, for:

  1. Compensatory damages in an amount to be determined by the jury;
  2. Pre- and post-judgment interest as allowed by law;
  3. Costs of suit;
  4. Such other and further relief as the Court deems just and proper.

8. ALTERNATIVE DISPUTE RESOLUTION ELECTION (OPTIONAL)

Pursuant to Pa.R.C.P. 1021.1 and Local Rule ☐, Plaintiff hereby elects [binding/non-binding] arbitration for all claims not exceeding the jurisdictional threshold of compulsory arbitration.
Check county threshold (commonly $50,000) and formatting requirements.


9. NOTICE OF COMPARATIVE NEGLIGENCE ALLOCATION

Pursuant to 42 Pa. Cons. Stat. § 7102 and Pa.R.C.P. 1030, Plaintiff places Defendant on notice that allocation of comparative negligence, assumption of risk, and contributory negligence are affirmative defenses which must be timely pleaded or are waived.


10. 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 (unsworn falsification to authorities).

Date: ___ ___ 20__ ________________________________
[PLAINTIFF NAME]


11. CERTIFICATE OF SERVICE

I hereby certify that on the ___ day of __________ 20__, a true and correct copy of the foregoing Complaint was served upon all counsel and unrepresented parties of record via [first-class mail/e-service/hand delivery] addressed as follows:
• [DEFENSE COUNSEL OR DEFENDANT ADDRESS]

______________________________
[PLAINTIFF’S COUNSEL NAME]
Pa. I.D. No. __________
[LAW FIRM NAME]
[ADDRESS] | [PHONE] | [EMAIL]
Attorney for Plaintiff


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About This Template

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.

Important Notice

This template is provided for informational purposes. It is not legal advice. We recommend having an attorney review any legal document before signing, especially for high-value or complex matters.

Last updated: May 2026

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