Wrongful Death Complaint

IN THE CIRCUIT COURT OF THE ☐ JUDICIAL CIRCUIT

[COUNTY] COUNTY, ILLINOIS

Estate of [DECEDENT FULL LEGAL NAME], Deceased, by and through [PERSONAL REPRESENTATIVE FULL NAME] as [Administrator/Executor] of the Estate and on behalf of the next of kin,
Plaintiff,

v.

[DEFENDANT LEGAL NAME], a [State of Formation] [Corporation/Individual/Sole Proprietorship],
Defendant.

Case No.: [___]

COMPLAINT AT LAW FOR WRONGFUL DEATH (740 Ill. Comp. Stat. 180/0.01 et seq.)
AND SURVIVAL (755 Ill. Comp. Stat. 5/27-6)

JURY DEMAND ENDORSED HEREON

TABLE OF CONTENTS

1. Definitions
2. Jurisdiction and Venue
3. Parties
4. Factual Allegations
5. Count I – Wrongful Death (740 ILCS 180/1)
6. Count II – Survival Action (755 ILCS 5/27-6)
7. Damages
8. Prayer for Relief
9. Jury Demand
10. Verification
11. Attorney Signature Block

1. DEFINITIONS

For purposes of this Complaint, the following terms have the meanings set forth below:

a. “Decedent” means [DECEDENT FULL LEGAL NAME], who died on [DATE OF DEATH].
b. “Personal Representative” means [PERSONAL REPRESENTATIVE FULL NAME], duly appointed [administrator/executor] of the Estate of the Decedent by the [COUNTY] County Circuit Court, Probate Division, Case No. ☐.
c. “Beneficiaries” means the next of kin entitled to recovery under the Wrongful Death Act, including but not limited to [LIST OF ELIGIBLE BENEFICIARIES (e.g., spouse, minor children, parents)].
d. “Wrongful Death Act” means the Illinois Wrongful Death Act, 740 Ill. Comp. Stat. 180/0.01 et seq.
e. “Survival Act” means the Illinois Survival Act, 755 Ill. Comp. Stat. 5/27-6.
f. “Incident” means the events of [DATE] at [LOCATION] that caused the injuries and ultimate death of the Decedent as described herein.
g. “Defendant” means [DEFENDANT LEGAL NAME] and any of its agents, servants, employees, and/or contractors acting within the course and scope of employment or engagement.

2. JURISDICTION AND VENUE

2.1 This Court has subject-matter jurisdiction pursuant to Article VI, Section 9 of the Illinois Constitution and 735 ILCS 5/2-101 because the amount in controversy exceeds the jurisdictional minimum and this is a civil action not otherwise exclusively assignable to another division.

2.2 Venue is proper in [COUNTY] County under 735 ILCS 5/2-101 because:

a. The Defendant resides in, has its principal place of business in, or conducts business within this county; and/or
b. The acts or omissions giving rise to this cause of action occurred in whole or in part within this county.

2.3 Personal jurisdiction over Defendant exists because Defendant transacts business in Illinois and committed the tortious acts complained of herein within the State of Illinois.

3. PARTIES

3.1 Plaintiff, [PERSONAL REPRESENTATIVE FULL NAME], is the duly appointed [administrator/executor] of the Estate of [DECEDENT], probate case number [___], and brings this action on behalf of the Estate and Beneficiaries pursuant to the Wrongful Death Act and Survival Act.

3.2 Defendant, [DEFENDANT LEGAL NAME], is a [corporation/individual] organized and existing under the laws of [STATE] with its principal place of business located at [ADDRESS], and at all relevant times conducted business within the State of Illinois.

4. FACTUAL ALLEGATIONS

4.1 On [INCIDENT DATE], Decedent was lawfully present at [LOCATION].

4.2 At that time and place, Defendant, through its agents and employees, negligently and/or recklessly [DESCRIBE ACTS OR OMISSIONS] (“Incident”).

4.3 As a direct and proximate result of Defendant’s acts and omissions, Decedent sustained severe injuries, conscious pain and suffering, and subsequently died on [DATE OF DEATH].

4.4 Defendant owed Decedent a duty of reasonable care, including, but not limited to, [SPECIFY DUTIES: e.g., duty to maintain safe premises, comply with traffic laws, follow applicable safety regulations]. Defendant breached said duty.

4.5 Prior to death, Decedent incurred medical expenses, lost wages, and experienced conscious pain and suffering.

4.6 Subsequent to death, Beneficiaries have suffered pecuniary losses and non-economic damages including grief, sorrow, and mental suffering, all as contemplated by the Wrongful Death Act.

5. COUNT I – WRONGFUL DEATH

(740 Ill. Comp. Stat. 180/1)

5.1 Plaintiff incorporates by reference paragraphs 1 through 4.6 above as if fully set forth herein.

5.2 Pursuant to 740 ILCS 180/1, whenever the death of a person is caused by wrongful act, neglect, or default, an action may be brought by the personal representative for the exclusive benefit of the deceased person’s next of kin.

5.3 Defendant’s wrongful acts, neglect, and/or default as set forth herein directly and proximately caused the death of the Decedent.

5.4 As a result, Beneficiaries are entitled to recover the following damages, subject to any applicable statutory limitations:

a. Pecuniary losses including lost support, services, and future earnings;
b. Loss of consortium, society, companionship, guidance, and instruction;
c. Grief, sorrow, and mental suffering (740 ILCS 180/2);
d. Reasonable funeral and burial expenses;
e. Pre-judgment interest as allowed by law; and
f. Costs of suit.

5.5 [OPTIONAL—Statutory Damage Cap] Plaintiff acknowledges that damages are subject to the limitations of [CITE SPECIFIC STATUTE OR “N/A”].

WHEREFORE, Plaintiff demands judgment against Defendant on Count I in an amount in excess of the jurisdictional minimum of this Court and sufficient to fully compensate the Beneficiaries, together with costs, pre-judgment interest, and such other relief as this Court deems just and proper.

6. COUNT II – SURVIVAL ACTION

(755 Ill. Comp. Stat. 5/27-6)

6.1 Plaintiff incorporates by reference paragraphs 1 through 5.5 above as if fully set forth herein.

6.2 Under the Survival Act, causes of action for personal injuries survive the death of the injured party and may be pursued by the personal representative of the decedent’s estate.

6.3 Prior to death, Decedent incurred the following damages as a result of Defendant’s conduct:

a. Conscious pain and suffering;
b. Medical, hospital, and related expenses;
c. Loss of earnings and impairment of earning capacity;
d. Other special damages as may be proven at trial.

6.4 Plaintiff, on behalf of the Estate, is entitled to recover said damages, which shall be distributed in accordance with applicable probate law.

WHEREFORE, Plaintiff demands judgment against Defendant on Count II in an amount adequate to fully compensate Decedent’s Estate, together with costs, pre-judgment interest, and such other relief as the Court deems just and proper.

7. DAMAGES SUMMARY

The aggregate damages sought by Plaintiff across all Counts include, without limitation:

1. Economic Damages:
   • Past and future loss of financial support;
   • Medical and funeral expenses;
   • Loss of services and benefits.

2. Non-Economic Damages:
   • Grief, sorrow, and mental suffering of the Beneficiaries;
   • Loss of society, consortium, and companionship;
   • Decedent’s conscious pain and suffering.

3. Punitive/Exemplary Damages (if facts support and permitted by law):
   • [INSERT BASIS FOR PUNITIVE DAMAGES, e.g., willful and wanton misconduct].

4. Costs, statutory interest, and any other relief deemed just.

8. PRAYER FOR RELIEF

WHEREFORE, Plaintiff respectfully requests that this Court:

A. Enter judgment in favor of Plaintiff and against Defendant on all Counts;
B. Award compensatory damages in an amount to be determined at trial;
C. Award punitive damages where legally permissible and factually warranted;
D. Award costs of suit and pre-judgment interest;
E. Grant such further relief as the Court deems equitable and just.

9. JURY DEMAND

Plaintiff hereby demands trial by jury on all issues so triable as a matter of right pursuant to Article I, Section 13 of the Illinois Constitution and 735 ILCS 5/2-1105.

10. VERIFICATION

I, [PERSONAL REPRESENTATIVE NAME], on oath state that I have read the foregoing Complaint and that the allegations contained herein are true and correct to the best of my knowledge, information, and belief.

Date: __[DATE]__

______________________________
[PERSONAL REPRESENTATIVE NAME]
[Title: Administrator/Executor]

Subscribed and sworn to before me on __[DATE]__.

______________________________
Notary Public

My commission expires: _________________

11. ATTORNEY SIGNATURE BLOCK

Respectfully submitted,

[ATTORNEY NAME] (ARDC No. ☐)
[LAW FIRM NAME]
[Street Address]
[City, State ZIP]
Telephone: [___-___-____]
Facsimile: [___-___-____]
Email: [___]

Attorney for Plaintiff

OPTIONAL CERTIFICATE OF MERIT – MEDICAL MALPRACTICE ONLY

[If the wrongful act involves healing-art malpractice, attach the 735 ILCS 5/2-622 affidavit and physician’s report here.]

END OF TEMPLATE
```