[COURT HEADER – Minnesota State District Court]

DISTRICT COURT OF [JUDICIAL DISTRICT]
COUNTY OF [COUNTY]

Court File No.: ___
Assigned Judge: _____

ESTATE OF [DECEDENT FULL LEGAL NAME], by and through its duly appointed Personal Representative, [PR FULL NAME], and on behalf of the Next-of-Kin enumerated herein,
Plaintiff,

v.

[DEFENDANT 1 LEGAL NAME], a [state of formation] [corporation/LLC/partnership/individual], and [DEFENDANT 2 LEGAL NAME],
Defendants.

COMPLAINT FOR WRONGFUL DEATH AND SURVIVAL ACTION

(Jury Trial Demanded)

[// GUIDANCE: Draft conforms to Minn. R. Civ. P. 8–11 & 52 and Minn. Stat. §§ 573.01-.02 (Wrongful-Death & Survival), with placeholders for counsel customization.]

TABLE OF CONTENTS

1. Parties ............................................................................................. 2
2. Jurisdiction, Venue & Pre-Suit Compliance ....................................... 3
3. Factual Allegations .............................................................................. 4
4. Count I – Wrongful Death (Minn. Stat. § 573.02) ................................. 7
5. Count II – Survival Action (Minn. Stat. § 573.01) ................................. 8
6. Damages ............................................................................................. 9
7. Demand for Jury Trial .......................................................................... 11
8. Prayer for Relief ................................................................................ 11
9. Reservation of Rights & Other Matters ............................................ 12
10. Verification ....................................................................................... 13
11. Signature Block ................................................................................. 14

(Page numbers will auto-generate upon final formatting.)

1. PARTIES (¶ 1-10)

1. Plaintiff Estate of [Decedent] (“Estate”) is a probate estate opened in [County], Minnesota, Probate Court File No. __.
2. [PR Name] (“Personal Representative”) was duly appointed on [date], is a resident of [County/State], and is authorized to prosecute this action on behalf of the Estate and the Decedent’s statutory next-of-kin.
3. Pursuant to Minn. Stat. § 573.02 subd. 1, the Estate brings this action for the exclusive benefit of the following Eligible Beneficiaries (“Next-of-Kin”):
   a. [Spouse Name] – spouse;
   b. [Child 1 Name] – minor child;
   c. [Child 2 Name] – adult child;
   d. [Parent 1 Name] – parent;
   e. [Any other statutorily recognized kin].
4. Defendant [Defendant 1] is a [business entity] with its principal place of business at [address]. It engaged in, directed, or ratified the wrongful acts complained of herein.
5. Defendant [Defendant 2] is a [business entity/individual] residing or headquartered at [address].
6. At all times relevant, each Defendant acted individually and/or through its officers, employees, agents, or apparent agents, who were acting within the scope of their authority and in furtherance of Defendants’ interests.

[// GUIDANCE: Insert additional Defendants, fictitious entities (“Does 1-10”), or respondeat superior allegations as necessary.]

2. JURISDICTION, VENUE & PRE-SUIT COMPLIANCE (¶ 11-18)

11. This Court has subject-matter jurisdiction under Minn. Const. art. VI § 3 and Minn. Stat. § 484.01 because the amount in controversy exceeds $15,000, exclusive of interest and costs.
12. Venue lies in [County] pursuant to Minn. Stat. § 542.09 because the cause of action arose here and/or Defendants reside, conduct business, or may be found in this county.
13. Plaintiff has complied with all conditions precedent required by statute, including timely appointment of a Personal Representative and service of Notices of Claim where applicable.
14. Any applicable statutory damage caps (e.g., Minn. Stat. § [cap statute #]) are acknowledged; Plaintiff pleads damages subject to those limitations while preserving constitutional objections.
15. No contractual arbitration clause governs the claims herein; forum selection for this statutory cause is constitutionally vested in the state courts.
16. Plaintiff requests trial by jury as of right under Minn. Const. art. I § 4 and Minn. R. Civ. P. 38.

3. FACTUAL ALLEGATIONS (¶ 19-45)

17. On [Date of Incident], Decedent was lawfully present at/on [location] when Defendants, through negligent acts and/or omissions, caused a [describe incident – e.g., motor-vehicle collision, defective product failure, medical negligence, etc.].
18. Specifically:
    a. Defendant [1] breached its duty of reasonable care by [acts/omissions];
    b. Defendant [2] violated [statutory/regulatory standard] constituting negligence per se;
    c. Defendants jointly failed to warn, supervise, inspect, or otherwise act to prevent foreseeable harm.
19. As a direct and proximate result, Decedent sustained catastrophic injuries resulting in death on [Date of Death].
20. Decedent experienced conscious pain, suffering, and emotional distress from the time of injury until death.
21. Plaintiff incurred medical, funeral, and burial expenses in excess of $[amount] and expects additional pecuniary losses.
22. The Next-of-Kin have suffered, and will continue to suffer, loss of support, services, companionship, guidance, and emotional suffering.

[// GUIDANCE: Attach police reports, OSHA findings, medical examiner’s report, or other exhibits as separate numbered exhibits; reference them in the paragraph text.]

4. COUNT I – WRONGFUL DEATH (Minn. Stat. § 573.02) (¶ 46-56)

23. Plaintiff realleges and incorporates ¶¶ 1-45.
24. Under Minn. Stat. § 573.02 subd. 1, whenever death is caused by the wrongful act or omission of another, an action may be maintained if the Decedent might have maintained an action had death not ensued.
25. Decedent could have maintained a personal-injury action against Defendants for the conduct alleged.
26. Defendants’ acts and omissions constituted negligence, gross negligence, and/or willful disregard for the safety of others.
27. Defendants’ wrongful conduct was the direct and proximate cause of Decedent’s death.
28. Plaintiff is therefore entitled to recover “pecuniary damages,” including but not limited to:
    a. Loss of earnings and future earning capacity of Decedent;
    b. Loss of services, protection, care, assistance, society, and companionship to the Next-of-Kin;
    c. Medical, funeral, and burial expenses;
    d. Reasonable counsel fees under Minn. Stat. § 573.02 subd. 1;
    e. [If applicable] Punitive damages upon subsequent motion and court approval under Minn. Stat. § 549.20.
29. All beneficiaries’ interests will be allocated pursuant to Minn. Stat. § 573.02 subd. 1a or as otherwise ordered by the Court.

5. COUNT II – SURVIVAL ACTION (Minn. Stat. § 573.01) (¶ 57-64)

30. Plaintiff realleges and incorporates ¶¶ 1-56.
31. Minn. Stat. § 573.01 preserves causes of action accruing to a decedent prior to death except as otherwise limited by law.
32. Decedent sustained pre-death special damages including medical expenses, lost wages, and property damage, which survive to the Estate.
33. Decedent also endured conscious pain and suffering between the time of injury and death.
34. Plaintiff seeks all damages recoverable under Minn. Stat. § 573.01, subject to any statutory limitations then in force.
35. These survival damages are distinct from, and cumulative to, the wrongful-death damages sought in Count I.

[// GUIDANCE: Counsel should review current Minnesota amendments regarding recovery of the decedent’s non-economic damages to ensure compliance.]

6. DAMAGES (¶ 65-76)

36. Plaintiff seeks judgment jointly and severally against Defendants for:
    a. Past and future pecuniary loss to the Next-of-Kin;
    b. Pre-death medical expenses;
    c. Funeral and burial costs pursuant to Minn. Stat. § 573.02 subd. 1;
    d. Decedent’s conscious pain and suffering (if and to the extent permitted);
    e. Reasonable attorney fees recoverable under Minn. Stat. § 573.02;
    f. Pre- and post-judgment interest under Minn. Stat. § 549.09;
    g. Taxable costs and disbursements;
    h. Punitive damages to deter and punish willful indifference, subject to court approval;
    i. Any other relief the Court deems just and equitable.
37. Plaintiff expressly pleads damages in excess of $50,000 to satisfy Minn. R. Civ. P. 8.01 and will provide computation via Rule 26 disclosures.

7. DEMAND FOR JURY TRIAL

38. Pursuant to Minn. R. Civ. P. 38, Plaintiff demands a trial by jury on all triable issues.

8. PRAYER FOR RELIEF

WHEREFORE, Plaintiff respectfully requests that the Court enter judgment:

A. In favor of Plaintiff and against Defendants, jointly and severally;
B. Awarding damages as set forth in ¶¶ 36(a)-(i), subject to any statutory caps;
C. Awarding lawful interest, costs, and disbursements; and
D. Granting such other and further relief as the Court deems just and proper.

9. RESERVATION OF RIGHTS & OTHER MATTERS

39. Plaintiff reserves the right to:
    a. Amend this Complaint to conform to evidence;
    b. Assert punitive damages upon motion under Minn. Stat. § 549.191;
    c. Add additional parties or theories of liability as discovery warrants.

10. VERIFICATION

[To be executed by Personal Representative per Minn. R. Civ. P. 11 & local rule.]

I, [PR Name], certify 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: _ , 20
Signature: ________
[PR Name], Personal Representative

11. SIGNATURE BLOCK

Respectfully submitted,

[LAW FIRM NAME]
[Firm Address]
[City, State ZIP]
Telephone: () -____
Email: [attorney email]

By: ______
[ATTORNEY NAME] (MN Bar No. ______)
Attorneys for Plaintiff

[// GUIDANCE:
1. Attach Civil Cover Sheet (Form CIV102) and Confidential Information Form (Form 11.1) when filing.
2. Serve Summons & Complaint per Minn. R. Civ. P. 4; file proof of service.
3. Calendar the 60-day deadline for appointment of a trustee ad litem if necessary.
4. Consider early probate coordination to expedite approval of settlement or distribution orders.
]