PETITION FOR DAMAGES FOR WRONGFUL DEATH AND SURVIVAL ACTION
(Louisiana State Court – [___] Judicial District Court for the Parish of [PARISH])
[// GUIDANCE: This template follows Louisiana pleading practice (La. Code Civ. Proc. arts. 851–893). Replace bracketed placeholders before filing. Review local court rules for formatting, font size, and margin requirements.]
TABLE OF CONTENTS
- Caption & Parties Identification
- Definitions
- Jurisdiction, Venue & Governing Law
- Statement of Facts
- Cause of Action I – Wrongful Death (La. Civ. Code art. 2315.2)
- Cause of Action II – Survival Action (La. Civ. Code art. 2315.1)
- Damages Sought
- Reservation of Rights & Optional Arbitration Election
- Prayer for Relief
- Jury Demand
- Certification of Counsel (La. Code Civ. Proc. art. 863)
- Verification/Affidavit of Petitioners
- Service Information & Requests
1. CAPTION & PARTIES IDENTIFICATION
[COURT NAME]
STATE OF LOUISIANA
PARISH OF [PARISH]
[PETITIONER 1 FULL NAME], individually and on behalf of the wrongful-death beneficiaries of [DECEDENT FULL NAME];
[PETITIONER 2 FULL NAME], individually and on behalf of the survival action beneficiaries of [DECEDENT FULL NAME],
Petitioners,
v.
[DEFENDANT ENTITY/INDIVIDUAL FULL NAME],
Defendant.
Civil Action No.: __
Division:
Judge: _____
2. DEFINITIONS
For purposes of this Petition, the following capitalized terms have the meanings set forth below:
A. “Decedent” means [DECEDENT FULL NAME], who died on [DATE OF DEATH].
B. “Petitioners” means the individuals identified in Section 1 who are eligible beneficiaries under La. Civ. Code art. 2315.2 and/or art. 2315.1.
C. “Defendant” means [DEFENDANT FULL NAME], including all agents, employees, insurers, and successors.
D. “Incident” means the events occurring on [DATE OF INCIDENT] at [LOCATION] that caused Decedent’s injuries and subsequent death.
E. “Wrongful-Death Damages” means the damages recoverable under La. Civ. Code art. 2315.2(A)–(C).
F. “Survival Damages” means the damages recoverable under La. Civ. Code art. 2315.1(A)–(D).
[// GUIDANCE: Add or delete defined terms to match the facts.]
3. JURISDICTION, VENUE & GOVERNING LAW
3.1 This Court has subject-matter jurisdiction pursuant to La. Const. art. V, § 16 and La. Code Civ. Proc. art. 2.
3.2 Venue is proper in this Parish under La. Code Civ. Proc. arts. 42 and 74 because [state specific venue facts].
3.3 Louisiana substantive law, including La. Civ. Code arts. 2315.1 and 2315.2, governs the causes of action asserted herein.
4. STATEMENT OF FACTS
4.1 On [DATE OF INCIDENT], at approximately [TIME], Decedent was [brief factual narrative].
4.2 Defendant owed Decedent a duty of reasonable care under Louisiana law, specifically [describe duty—e.g., duty to safely operate a motor vehicle / maintain premises / provide medical care].
4.3 Defendant breached said duty by [list specific negligent acts or omissions].
4.4 As a direct and proximate result of Defendant’s breach, Decedent suffered severe injuries culminating in death on [DATE OF DEATH].
4.5 Petitioners, as statutory beneficiaries, sustained economic and non-economic losses detailed in Section 7.
5. CAUSE OF ACTION I – WRONGFUL DEATH
(La. Civ. Code art. 2315.2)
5.1 Petitioners reallege and incorporate Paragraphs 4.1–4.5.
5.2 At all relevant times, Petitioners are among the class of beneficiaries enumerated in La. Civ. Code art. 2315.2(B):
a. [ ] Surviving spouse and/or children;
b. [ ] Surviving parents (if no spouse/children);
c. [ ] Surviving siblings (if no spouse/children/parents);
d. [ ] Surviving grandparents (if none of the foregoing).
5.3 Defendant’s fault caused Decedent’s death, entitling Petitioners to Wrongful-Death Damages, including but not limited to:
i. Loss of love, affection, companionship, and consortium;
ii. Loss of support and services;
iii. Funeral and burial expenses;
iv. Mental anguish and emotional distress.
6. CAUSE OF ACTION II – SURVIVAL ACTION
(La. Civ. Code art. 2315.1)
6.1 Petitioners reallege and incorporate Paragraphs 4.1–4.5 and 5.1–5.3.
6.2 Decedent survived for a period between the Incident and death, during which Decedent endured conscious pain and suffering.
6.3 Pursuant to La. Civ. Code art. 2315.1, Petitioners are entitled to recover Survival Damages, including:
i. Pre-death physical pain and suffering;
ii. Pre-death mental anguish and emotional distress;
iii. Medical expenses incurred prior to death;
iv. Loss of earnings and earning capacity during the survival period.
7. DAMAGES SOUGHT
7.1 Petitioners seek judgment against Defendant, jointly and severally with any insurers, in an amount reasonable in the premises, including all Wrongful-Death Damages and Survival Damages permitted by Louisiana law.
7.2 To the extent applicable, Petitioners acknowledge the statutory cap on damages under the Louisiana Medical Malpractice Act, La. Rev. Stat. § 40:1231.2, and reserve all rights therein.
7.3 Petitioners further claim legal interest from the date of judicial demand until paid, together with all taxable costs.
8. RESERVATION OF RIGHTS & OPTIONAL ARBITRATION ELECTION
8.1 Petitioners reserve the right to amend this Petition to assert additional claims, name additional parties, or adjust damages as discovery warrants.
8.2 [OPTIONAL] In the event Defendant demonstrates a binding and enforceable arbitration agreement covering the Incident, Petitioners elect [one: “to compel arbitration pursuant to said agreement” / “to object and demand judicial resolution”].
[// GUIDANCE: Delete Paragraph 8.2 if arbitration is not implicated.]
9. PRAYER FOR RELIEF
WHEREFORE, Petitioners pray that:
a. Defendant be duly cited and served;
b. After due proceedings, there be judgment in favor of Petitioners and against Defendant for all damages described herein, plus legal interest and costs;
c. All equitable and general relief be granted as justice requires.
10. JURY DEMAND
Pursuant to La. Code Civ. Proc. art. 1731 and the Louisiana Constitution, Petitioners hereby request a trial by jury on all issues so triable and tender the requisite filing fee.
11. CERTIFICATION OF COUNSEL
Undersigned counsel certifies, pursuant to La. Code Civ. Proc. art. 863(B), that he/she has read this Petition; that to the best of his/her knowledge, information, and belief it is well-grounded in fact, warranted by existing law, and not interposed for improper purpose.
12. VERIFICATION / AFFIDAVIT OF PETITIONERS
STATE OF LOUISIANA
PARISH OF [PARISH]
BEFORE ME, the undersigned Notary Public, personally came and appeared:
- [PETITIONER 1 NAME]
- [PETITIONER 2 NAME]
who, after being duly sworn, declared that they have read the foregoing Petition and that all facts alleged therein are true and correct to the best of their knowledge, information, and belief.
___ ___
[PETITIONER 1 SIGNATURE] [PETITIONER 2 SIGNATURE]
SWORN TO AND SUBSCRIBED before me on this _ day of _, 20__, at ____, Louisiana.
NOTARY PUBLIC
My Commission Expires: ____
[// GUIDANCE: Some courts accept unsworn declarations under 28 U.S.C. § 1746; verify local practice.]
13. SERVICE INFORMATION & REQUESTS
Please withhold service until requested. Upon issuance, kindly forward certified copies of citations and the Petition to undersigned counsel for service in accordance with La. Code Civ. Proc. arts. 1201–1235.
RESPECTFULLY SUBMITTED,
[LAW FIRM NAME]
[Address Line 1]
[Address Line 2]
Telephone: []
Facsimile: []
Email: [___]
By: _____
[ATTORNEY NAME] (Bar # ____)
Counsel for Petitioners
[// GUIDANCE:
1. Confirm whether the client is a statutory “survivor” under both Art. 2315.1 and 2315.2 before filing.
2. If multiple defendants include separate counts and specific allegations against each.
3. Review any applicable governmental-entity notice requirements (e.g., La. R.S. 13:5106).
4. Check insurance policy limits and preservation-of-evidence letters.
5. File Motion to Set for Jury Trial with initial pleading if local rules demand.]