COMMONWEALTH OF KENTUCKY

[_____] CIRCUIT COURT

CIVIL ACTION NO. ______

DIVISION ____

_____

[PLAINTIFF NAME], as Personal Representative of the Estate of

[DECEDENT NAME], Deceased,

Plaintiff,

v.

_____

[DEFENDANT NAME(S)],

Defendant(s).

_____/

COMPLAINT FOR WRONGFUL DEATH, SURVIVAL, AND RELATED RELIEF

(KRS § 411.130; KRS § 411.140; KRS § 411.133)

[// GUIDANCE: Insert case caption exactly as required by local clerk’s office. Verify division lettering/numbering conventions for your county.]

TABLE OF CONTENTS

1. Parties .......................................................................................... ¶¶ 1-3
2. Jurisdiction and Venue .......................................................... ¶¶ 4-8
3. General Allegations / Facts .................................................... ¶¶ 9-26
4. Count I – Wrongful Death (KRS § 411.130) ................................ ¶¶ 27-35
5. Count II – Survival Action (KRS § 411.140) ............................... ¶¶ 36-41
6. Count III – Loss of Consortium (KRS § 411.133) if applicable .... ¶¶ 42-48
7. Damages ................................................................................. ¶¶ 49-55
8. Prayer for Relief .................................................................... ¶¶ 56-58
9. Jury Demand .............................................................................. ¶ 59
10. Verification, CR 11 Certification & Signature Block ............................ p. ___
11. Exhibits ....................................................................................... p. ___

PARTIES

1. Plaintiff [PLAINTIFF NAME] (“Plaintiff”) is a resident of [COUNTY], Kentucky, duly appointed Personal Representative of the Estate of [DECEDENT NAME] (the “Estate”) by Order of the [_] District Court, Probate Division, Case No. ____, dated [DATE] (attached hereto as Exhibit A).
2. Decedent [DECEDENT NAME] (“Decedent”) was a resident of [COUNTY], Kentucky, and died on [DATE OF DEATH] as a direct and proximate result of Defendant(s)’ wrongful conduct alleged herein.
3. Defendant [DEFENDANT NAME] is a [corporation/LLC/individual] organized under the laws of [STATE] with its principal place of business at [ADDRESS] and may be served through its registered agent, [AGENT NAME & ADDRESS].
   [// GUIDANCE: Duplicate ¶3 for each additional defendant and insert fictitious defendants if necessary (e.g., “UNKNOWN DEFENDANTS 1-5”).]

JURISDICTION AND VENUE

4. This Court has subject-matter jurisdiction under Ky. Const. § 112 and KRS § 23A.010 because the amount in controversy exceeds the jurisdictional minimum of the Circuit Court.
5. Personal jurisdiction is proper under Kentucky’s long-arm statute, KRS § 454.210, because Defendant(s) [transacted business / committed tortious acts] in Kentucky, and Plaintiff’s claims arise from said activities.
6. Venue is proper in this Court under KRS § 452.450 because the cause of action arose in [COUNTY], Kentucky.
7. All statutory prerequisites to filing this action have been satisfied or are inapplicable.
8. Plaintiff brings this action within the limitation period prescribed by KRS § 413.180(1) (wrongful-death actions to be commenced within one year after the Personal Representative’s qualification and within two years of death).

GENERAL ALLEGATIONS / FACTS

9. On [DATE], at approximately [TIME], Decedent was located at [SCENE/ADDRESS/LOCATION].
10. Defendant(s) owed Decedent a duty of reasonable care, including but not limited to the duties articulated in [IDENTIFY STATUTES/REGULATIONS/COMMON-LAW DUTIES—e.g., traffic statutes, premises liability standards, product safety regulations].
11. Defendant(s) breached said duties by [SPECIFIC NEGLIGENT ACTS OR OMISSIONS].
12. As a direct and proximate result of Defendant(s)’ negligence, Decedent sustained severe injuries leading to death on [DATE OF DEATH].
13. Decedent experienced conscious pain and suffering from [DATE/TIME] until death.
14. Plaintiff timely notified Defendant(s) of Decedent’s injuries and death.
15. [Insert additional factual paragraphs (¶ 16-26) describing investigation, reports, expert findings, etc.]

COUNT I – WRONGFUL DEATH (KRS § 411.130)

27. Plaintiff realleges and incorporates ¶¶ 1-26 herein.
28. Under KRS § 411.130(1), when a person’s death is caused by the wrongful act or neglect of another, the Personal Representative may maintain an action to recover damages.
29. Defendant(s)’ acts and omissions constituted such wrongful acts and/or neglect.
30. Pursuant to KRS § 411.130(2), recoverable damages include, inter alia:
    a. Funeral and burial expenses;
    b. Loss of earning power of Decedent from the time of injury until death;
    c. Destruction of Decedent’s power to labor and earn income; and
    d. Punitive damages, where the act was willful or the negligence gross.
31. Allocation of any award shall be made in accordance with KRS § 411.130(2)(a-d) among the following statutory beneficiaries:
    • [SPOUSE NAME] (spouse),
    • [CHILD(REN) NAME(S)],
    • [PARENT(S) NAME(S)] (if applicable),
    • The Estate (to the extent required by statute).
32. Defendant(s)’ conduct directly and proximately caused Decedent’s death and the resulting damages.
33. Defendant(s) are jointly and severally liable to Plaintiff and the statutory beneficiaries.
34. Plaintiff seeks all damages allowed by law, including punitive damages.
35. Plaintiff reserves the right to amend this Complaint to conform to proof.

COUNT II – SURVIVAL ACTION (KRS § 411.140)

36. Plaintiff realleges and incorporates ¶¶ 1-35 herein.
37. KRS § 411.140 authorizes the Estate to recover for personal injuries sustained by Decedent between the time of injury and death.
38. Decedent suffered conscious pain and suffering, medical expenses, and related special damages during this period.
39. Defendant(s)’ negligence was a direct and proximate cause of these injuries.
40. Plaintiff seeks all damages recoverable under KRS § 411.140, including but not limited to pain and suffering, medical bills, and lost wages prior to death.
41. Plaintiff further seeks punitive damages to deter similar conduct.

COUNT III – LOSS OF CONSORTIUM (KRS § 411.133) (if applicable)

42. Plaintiff realleges and incorporates ¶¶ 1-41 herein.
43. [CONSORTIUM PLAINTIFF], as lawful [SPOUSE/CHILD] of Decedent, enjoyed the companionship, services, and consortium of Decedent.
44. As a result of Defendant(s)’ wrongful conduct, [CONSORTIUM PLAINTIFF] has been permanently deprived of said consortium.
45. KRS § 411.133 provides a separate cause of action for loss of consortium damages.
46. Defendant(s) are liable for all damages arising from this statutory claim, including but not limited to loss of affection, care, assistance, and household services.
47. [CONSORTIUM PLAINTIFF] has complied with the procedural requirements for asserting this claim.
48. Plaintiff demands judgment accordingly.

DAMAGES

49. Plaintiff repeats and realleges ¶¶ 1-48.
50. Plaintiff seeks damages in an amount to be proven at trial, including:
    a. Funeral and burial expenses;
    b. Medical expenses related to Decedent’s last illness/injury;
    c. Loss of Decedent’s earning capacity and future income;
    d. Pain and suffering endured by Decedent prior to death;
    e. Loss of consortium damages (if applicable);
    f. Statutory interest;
    g. Punitive damages due to willful, wanton, or grossly negligent conduct;
    h. Costs of this action and reasonable attorney fees as allowed by law.
51. Plaintiff expressly pleads any recoverable prejudgment and post-judgment interest.
52. No statutory cap on compensatory damages exists under current Kentucky law; however, punitive damages, if awarded, shall comport with constitutional and statutory standards.
53. Plaintiff reserves the right to supplement the damages claim after discovery.
54. All damages shall be allocated pursuant to KRS § 411.130(2).
55. Plaintiff requests a trial by jury on all issues so triable.

PRAYER FOR RELIEF

WHEREFORE, Plaintiff respectfully prays that the Court:

56. Enter judgment in favor of Plaintiff and against Defendant(s), jointly and severally, for all compensatory, punitive, and statutory damages proved at trial;
57. Award costs, reasonable attorney fees, and statutory interest; and
58. Grant such other and further relief as the Court deems just and proper.

JURY DEMAND

59. Pursuant to Section 7 of the Kentucky Constitution and CR 38, Plaintiff hereby demands a trial by jury on all issues so triable.

VERIFICATION AND CIVIL RULE 11 CERTIFICATION

I, [PLAINTIFF NAME], being the duly appointed Personal Representative of the Estate of [DECEDENT NAME], verify under penalty of perjury that I have read the foregoing Complaint, know the contents thereof, and that the facts stated therein are true and correct to the best of my knowledge, information, and belief.

[PLAINTIFF NAME], Personal Representative

Date: ________

Counsel for Plaintiff certifies pursuant to Kentucky Civil Rule 11 that the foregoing Complaint is filed in good faith, is well grounded in fact and warranted by existing law or a good-faith argument for the extension, modification, or reversal of existing law, and is not interposed for any improper purpose.

SIGNATURE BLOCK

Respectfully submitted,

[ATTORNEY NAME] (KBA No. ______)
[LAW FIRM NAME]
[STREET ADDRESS]
[CITY], KY [ZIP]
Telephone: [PHONE]
Facsimile: [FAX]
Email: [EMAIL]

Counsel for Plaintiff

EXHIBITS

Exhibit A – Letters Testamentary / Order Appointing Personal Representative
Exhibit B – Death Certificate
Exhibit C – [Accident/Incident Report]
Exhibit D – [Medical Records Summary]

[// GUIDANCE: Attach only those exhibits required for filing. Redact personal identifiers per Ky. R. Admin. 9 (Privacy Protections).]