WRONGFUL DEATH / SURVIVAL PETITION

(Missouri Circuit Court – Template)

[// GUIDANCE: This template is drafted for use in Missouri state courts (Circuit Court level) and is designed to comply with Mo. Rev. Stat. §§ 537.080–.090 (Wrongful Death) and §§ 537.020–.021 (Survival). Customize bracketed fields, double-check venue facts, and attach all required exhibits before filing.]

TABLE OF CONTENTS

1. Caption & Style of Case
2. Preliminary Allegations
   2.1 Parties
   2.2 Jurisdiction and Venue
   2.3 Definitions
3. Factual Background
4. Causes of Action
   4.1 Count I – Wrongful Death (Negligence)
   4.2 Count II – Survival Action
   4.3 Count III – Punitive Damages (Optional)
5. Damages Allegations
6. Prayer for Relief
7. Jury Demand
8. Verification
9. Certificate of Service

1. CAPTION & STYLE OF CASE

IN THE CIRCUIT COURT OF [COUNTY_NAME] COUNTY, STATE OF MISSOURI

[PLAINTIFF_NAME(S)], )
Plaintiff[s], )
) Case No. ________
v. ) Division No. ______
)
[DEFENDANT_NAME(S)], )
Defendant[s]. )
)
PETITION FOR WRONGFUL DEATH AND SURVIVAL DAMAGES

[// GUIDANCE: Missouri practice uses “Petition,” not “Complaint.”]

2. PRELIMINARY ALLEGATIONS

2.1 Parties

1. Plaintiff. Plaintiff [PLAINTIFF_NAME] is an individual residing at [PLAINTIFF_ADDRESS] and is:
   a. the [relationship—e.g., spouse, child, parent, or court-appointed plaintiff ad litem] of [DECEDENT_NAME] (“Decedent”), who died on [DATE_OF_DEATH]; and
   b. an eligible beneficiary under Mo. Rev. Stat. § 537.080.

2. Defendant. Defendant [DEFENDANT_NAME] is a [corporation / individual / partnership] organized under the laws of [STATE] with its principal place of business at [DEFENDANT_ADDRESS] and may be served at [SERVICE_ADDRESS] pursuant to Mo. Sup. Ct. R. 54.

2.2 Jurisdiction and Venue

3. This Court has subject-matter jurisdiction under Mo. Const. art. V, § 14 and Mo. Rev. Stat. §§ 537.080–.090.

4. Venue is proper in [COUNTY_NAME] County under Mo. Rev. Stat. § 508.010 because [select all that apply]:
   a. the cause of action accrued in this county;
   b. Defendant resides or may be found in this county;
   c. Decedent received treatment and died in this county.

2.3 Definitions

For pleading clarity, the following terms are used:
a. “Decedent” means [DECEDENT_NAME], deceased.
b. “Beneficiaries” means the persons entitled to recover under Mo. Rev. Stat. § 537.080.

3. FACTUAL BACKGROUND

5. On or about [DATE_OF_INCIDENT], at or near [LOCATION], Defendant owed Decedent a duty of ordinary care to [describe duty, e.g., operate a motor vehicle safely / provide medical care in accordance with the standard of care].

6. Defendant breached that duty by [specific acts or omissions].

7. As a direct and proximate result of Defendant’s negligence, Decedent suffered severe injuries culminating in death on [DATE_OF_DEATH].

8. Decedent left surviving the following statutory beneficiaries:
   • [NAME], [relationship];
   • [NAME], [relationship].

9. All statutory conditions precedent to filing this action have been satisfied or waived.

4. CAUSES OF ACTION

4.1 Count I – Wrongful Death (Negligence)

10. Plaintiff realleges Paragraphs 1–9.

11. Under Mo. Rev. Stat. § 537.080, Plaintiff, on behalf of all Beneficiaries, has a statutory cause of action for Decedent’s wrongful death.

12. Defendant’s negligent acts/omissions, detailed above, directly caused Decedent’s death.

13. Pursuant to Mo. Rev. Stat. § 537.090, Plaintiff seeks recovery of:
    a. Pecuniary losses, including the value of Decedent’s services, companionship, comfort, instruction, guidance, counsel, training, and support;
    b. Funeral and burial expenses;
    c. Reasonable value of medical expenses;
    d. Pre- and post-judgment interest as allowed by law; and
    e. If applicable non-economic damages subject to any statutory cap under Mo. Rev. Stat. § 538.210 (medical negligence cases).

4.2 Count II – Survival Action

14. Plaintiff realleges Paragraphs 1–13.

15. Under Mo. Rev. Stat. §§ 537.020–.021, all causes of action that accrued to Decedent prior to death survive and may be prosecuted by Plaintiff as personal representative.

16. Decedent endured conscious pain, suffering, and medical expenses between the time of injury and death for which Plaintiff is entitled to recover.

4.3 Count III – Punitive Damages (Optional – plead only when supported by facts)

17. Plaintiff realleges Paragraphs 1–16.

18. Defendant acted with flagrant disregard for the safety of others, showing conscious indifference and reckless disregard warranting punitive damages to punish and deter such conduct.

[// GUIDANCE: In Missouri, punitive damages require leave of court under § 510.261. Plead generally here; move for leave after discovery.]

5. DAMAGES ALLEGATIONS

19. Plaintiff seeks the full measure of damages allowed by Mo. Rev. Stat. § 537.090, including:
    • Economic and non-economic wrongful-death damages;
    • Survival damages (pain, suffering, medical bills);
    • Funeral and burial costs;
    • Pre-/post-judgment interest;
    • Costs of suit;
    • Punitive damages where proven; and
    • Any further relief the Court deems just and proper.

[// GUIDANCE: If the claim arises from medical negligence, incorporate statutory non-economic damage cap amounts and annual adjustments per § 538.210.]

6. PRAYER FOR RELIEF

WHEREFORE, Plaintiff prays for judgment against Defendant, jointly and severally where applicable, for:

A. Compensatory damages in a fair and reasonable sum exceeding $25,000;
B. Survival damages for Decedent’s conscious pain and suffering;
C. Funeral and burial expenses;
D. Punitive damages (if pled and subsequently permitted);
E. Pre-judgment and post-judgment interest as allowed by law;
F. Costs of court; and
G. Such other and further relief as the Court deems just and proper.

7. JURY DEMAND

Plaintiff hereby demands trial by jury on all triable issues pursuant to Mo. Const. art. I, § 22(a) and Mo. Sup. Ct. R. 69.01.
[// GUIDANCE: Metadata indicated “constitutional_right” for jury; do not waive.]

8. VERIFICATION

STATE OF MISSOURI )
) ss.
COUNTY OF ________ )

I, [PLAINTIFF_NAME], being duly sworn, depose and state that I have read the foregoing Petition; that the facts stated therein are true and correct to the best of my knowledge, information, and belief; and that this verification is made pursuant to and in compliance with Mo. Sup. Ct. R. 55.03.

_________________________________
[PLAINTIFF_NAME], Plaintiff

Subscribed and sworn to before me this ___ day of __________, 20__.

_________________________________
Notary Public
My Commission Expires: __________

9. CERTIFICATE OF SERVICE

I certify that on the ___ day of __________, 20__, a true and correct copy of the foregoing Petition was served upon all counsel/parties of record by [method of service] pursuant to Mo. Sup. Ct. R. 43.

_________________________________
[ATTORNEY_NAME], #________
Attorney for Plaintiff
[LAW FIRM NAME]
[ADDRESS]
[PHONE] | [EMAIL]

ATTORNEY SIGNATURE BLOCK

Respectfully submitted,

_________________________________
[ATTORNEY_NAME], Mo. Bar #________
[LAW FIRM NAME]
[ADDRESS]
[PHONE] | [EMAIL]
Counsel for Plaintiff

[// GUIDANCE: Consider attaching the following exhibits where applicable:
• Death Certificate (Exhibit A)
• Letters of Administration or Order Appointing Plaintiff Ad Litem (Exhibit B)
• Affidavit of Class 1 Beneficiaries (Exhibit C)
• Itemized Funeral Expenses (Exhibit D)
Ensure HIPAA compliance for any medical records.]