IN THE CIRCUIT COURT OF THE [NUMBER]ᵀᴴ CIRCUIT
STATE OF HAWAI‘I

[PLAINTIFF NAME], in the capacity of Personal │
Representative of the ESTATE OF [DECEDENT NAME], │
│
Plaintiff, │
│
v. │ CIVIL NO. ____________
│ (Wrongful Death; Survival Action)
[DEFENDANT NAME(S)], │
│ COMPLAINT; SUMMONS TO ISSUE;
Defendant(s). │ DEMAND FOR JURY TRIAL;
------------------------------------------------------------- CERTIFICATE OF SERVICE

COMPLAINT

Plaintiff, by and through undersigned counsel, alleges upon knowledge, information, and belief as follows:

[// GUIDANCE: Insert law-firm header, attorney identifiers, and Rule 11 signature block per Haw. R. Civ. P. 10(a).]

TABLE OF CONTENTS

1. Jurisdiction and Venue
2. Parties
3. Factual Allegations
4. Causes of Action
   4.1 Count I – Wrongful Death (HRS § 663-3)
   4.2 Count II – Survival Action (HRS § 663-7)
5. Prayer for Relief
6. Demand for Jury Trial
7. Verification / Declaration
8. Exhibits (if any)

[// GUIDANCE: Delete TOC before filing if not required by court clerk.]

1. JURISDICTION AND VENUE

1.1 This Court has subject-matter jurisdiction under Haw. Const. art. VI § 1 and Haw. Rev. Stat. § 603-21.5.
1.2 Venue is proper in this Circuit pursuant to Haw. Rev. Stat. § 603-36 because the acts and omissions giving rise to these claims occurred within this Circuit and Defendant(s) reside(s)/does business here.
1.3 All statutory prerequisites to suit have been satisfied or are inapplicable.

2. PARTIES

2.1 Plaintiff [FULL NAME] (“Plaintiff”) is the duly appointed Personal Representative of the Estate of [DECEDENT NAME] (“Decedent”), having been issued Letters Testamentary/Letters of Administration by the [NAME] Probate Court on [DATE].
2.2 Decedent was, at all relevant times, a resident of the State of Hawai‘i.
2.3 Defendant [DEFENDANT NAME] is a [corporation/individual/other entity] organized under the laws of [STATE] with its principal place of business at [ADDRESS] and transacting business in Hawai‘i.
2.4 At all times material hereto, Defendant’s agents, servants, and employees were acting within the course and scope of their employment and/or agency, rendering Defendant vicariously liable.

[// GUIDANCE: Add or modify paragraphs for additional defendants, fictitious Doe parties (see Haw. R. Civ. P. 17(d)), or respondeat superior allegations.]

Eligible Beneficiaries

2.5 Pursuant to HRS § 663-3, the following persons are statutory beneficiaries entitled to recovery in this action:
a. [SPOUSE/RECIPROCAL BENEFICIARY NAME] – surviving spouse/reciprocal beneficiary;
b. [CHILD(REN) NAME(S)] – surviving child(ren);
c. [OTHER STATUTORY BENEFICIARY, if any]; and
d. The Estate of the Decedent.

3. FACTUAL ALLEGATIONS

3.1 On or about [DATE], at approximately [TIME], Decedent was located at [LOCATION], when Defendant, through negligence and/or wrongdoing, caused severe bodily injuries to Decedent.
3.2 As a direct and proximate result of Defendant’s acts and omissions, Decedent died on [DATE OF DEATH].
3.3 Defendant owed Decedent a duty of reasonable care, including but not limited to [SPECIFIC DUTIES – e.g., to operate a motor vehicle in accordance with Hawai‘i traffic laws].
3.4 Defendant breached said duty by, inter alia, [SPECIFY ACTS/OMISSIONS].
3.5 Defendant’s breach was the factual and legal (proximate) cause of Decedent’s injuries and death.
3.6 All conditions precedent to bringing this action have been performed, waived, or excused.

4. CAUSES OF ACTION

4.1 COUNT I – WRONGFUL DEATH (HRS § 663-3)

4.1.1 Plaintiff realleges and incorporates Paragraphs 1 through 3.6 as though fully set forth herein.
4.1.2 Under HRS § 663-3, when the death of a person is caused by the wrongful act, neglect, or default of another, the personal representative may maintain an action on behalf of the statutory beneficiaries.
4.1.3 Defendant’s negligence constitutes a “wrongful act” within the meaning of the statute.
4.1.4 Recoverable Damages. Eligible beneficiaries are entitled to:
a. Pecuniary losses (e.g., support, services, loss of prospective inheritance);
b. Reasonable expenses of funeral and burial;
c. Loss of love and affection, consortium, companionship, comfort, protection, care, and attention; and
d. Other damages permitted by law, subject to any statutory caps (see HRS § 663-8.7 for noneconomic damages in medical torts where applicable).
4.1.5 Plaintiff seeks all such damages, plus prejudgment interest as allowed by HRS § 636-16 and court costs.

4.2 COUNT II – SURVIVAL ACTION (HRS § 663-7)

4.2.1 Plaintiff realleges and incorporates Paragraphs 1 through 3.6 as though fully set forth herein.
4.2.2 HRS § 663-7 provides that causes of action for personal injury to a decedent survive and may be prosecuted by the personal representative.
4.2.3 Prior to death, Decedent sustained conscious pain, suffering, and mental anguish directly attributable to Defendant’s negligence.
4.2.4 The Estate is entitled to recover:
a. Decedent’s pre-death medical expenses;
b. Conscious pain and suffering;
c. Lost earnings between injury and death.
4.2.5 These damages are distinct from and in addition to the wrongful-death damages recovered on behalf of statutory beneficiaries.

[// GUIDANCE: If asserting punitive damages, add a separate count and plead with specificity under Haw. R. Civ. P. 9(g).]

5. PRAYER FOR RELIEF

WHEREFORE, Plaintiff respectfully prays for judgment against Defendant(s) as follows:
a. General and special damages in an amount to be proven at trial;
b. Pre-death damages recoverable by the Estate under HRS § 663-7;
c. Costs of suit and prejudgment/post-judgment interest as allowed by law;
d. Any applicable statutory noneconomic damage caps be applied only where mandated and not otherwise;
e. Such other and further relief as the Court deems just and proper.

6. DEMAND FOR JURY TRIAL

Pursuant to Haw. Const. art. I § 13 and Haw. R. Civ. P. 38, Plaintiff hereby demands trial by jury on all issues so triable.

7. VERIFICATION / DECLARATION

I, [PLAINTIFF NAME], declare under penalty of perjury that I have read the foregoing Complaint and that the factual allegations are true and correct to the best of my knowledge, information, and belief.

Date: _____________ _______________________________
[PLAINTIFF NAME]
Personal Representative of the Estate of [DECEDENT NAME]

[// GUIDANCE: Some practitioners use unsworn declaration under 28 U.S.C. § 1746 for federal court; adapt to Haw. R. Civ. P. Form 2 or local rules for state court.]

8. EXHIBITS

Exhibit A – Letters Testamentary/Administration
Exhibit B – Death Certificate
Exhibit C – Any other pertinent documents

ATTORNEY SIGNATURE BLOCK

Respectfully submitted,

_______________________________
[ATTORNEY NAME] (Bar No. [####])
[LAW FIRM NAME]
[ADDRESS]
Telephone: [PHONE]
Email: [EMAIL]

Attorney for Plaintiff
[PLAINTIFF NAME], Personal Representative

[// GUIDANCE: Insert Certificate of Service referencing Haw. R. Civ. P. 5(b), and prepare a Summons on Form 1.]

KEY DRAFTING NOTES

[// GUIDANCE:
1. Statutory Citations (HRS):
• Wrongful Death – HRS § 663-3
• Survival of Actions – HRS § 663-7
• Noneconomic Damage Cap (medical tort only) – HRS § 663-8.7
• Prejudgment Interest – HRS § 636-16

2. Filing & Procedural Compliance:
   • Use Hawai‘i Electronic Filing and Service System (JEFS) formatting standards.
   • Confirm venue (Circuit) based on county where incident occurred or where Defendant resides.
   • Ensure Letters Testamentary/Administration are issued before filing; otherwise, file concurrently with probate petition and move to substitute once appointed.

3. Damages Strategy:
   • Plead broad categories; avoid specifying dollar amounts unless required by insurer-notification statutes.
   • If medical malpractice is alleged, address Haw. Rev. Stat. Ch. 671 (Medical Claims Conciliation Panel) prerequisites.

4. Service of Process:
   • Issue Summons for each Defendant; follow Haw. R. Civ. P. 4 for personal or corporate service.

5. Multiple Defendants & Comparative Negligence:
   • Hawai‘i follows modified comparative negligence (≤ 50% bar). Anticipate affirmative defenses and plead joint and several liability under HRS § 663-10.9 where applicable.
   ]