IN THE DISTRICT COURT OF [COUNTY] COUNTY, NEBRASKA
[PLAINTIFF NAME], in his/her capacity as the duly‐appointed Personal
Representative of the Estate of [DECEDENT NAME], Deceased,
Plaintiff,
v.
[DEFENDANT NAME(S)],
[DEFENDANT BUSINESS FORM, e.g., A Nebraska Corporation],
Defendant(s).
Case No.: [COURT CLERK TO ASSIGN]
COMPLAINT FOR WRONGFUL DEATH AND SURVIVAL DAMAGES
JURY TRIAL DEMANDED
[// GUIDANCE: The above caption follows Neb. Ct. R. Pldg. § 6-111 and Neb. Rev. Stat. § 25-801 et seq. Insert the county where the action is filed and confirm the defendant’s exact legal name.]
TABLE OF CONTENTS
I. Document Header
II. Definitions
III. Jurisdiction, Venue & Parties
IV. General Allegations
V. Count I – Wrongful Death (Neb. Rev. Stat. § 30-809 et seq.)
VI. Count II – Survival Action (Neb. Rev. Stat. § 25-1401 et seq.)
VII. Damages & Statutory Caps
VIII. Prayer for Relief
IX. Jury Demand
X. Verification
XI. Certificate of Service
I. DOCUMENT HEADER
- Effective Date: This pleading is deemed filed on the date reflected in the Clerk’s file-stamp.
- Governing Law: All substantive issues shall be governed by the wrongful-death and survival statutes of the State of Nebraska.
- Forum Selection: Exclusive venue lies in the District Court of [County] County, Nebraska.
- Parties Identification: See Section III, infra.
II. DEFINITIONS
The following terms, when used with initial capital letters, have the meanings set forth below:
“Act” means the Nebraska Wrongful Death Act, Neb. Rev. Stat. §§ 30-809–30-810.
“Decedent” means the late [DECEDENT NAME], who died on [DATE OF DEATH].
“Estate” means the probate estate of the Decedent, opened in the County Court of [COUNTY] County, Nebraska, Case No. [INSERT].
“Eligible Beneficiaries” means those persons entitled to share in any recovery under the Act, typically the Decedent’s next of kin as determined under Neb. Rev. Stat. § 30-810.
“Personal Representative” means [PLAINTIFF NAME], duly appointed by the County Court on [DATE], Letters Testamentary/Letters of Administration filed.
“Plaintiff” means the Personal Representative acting on behalf of the Estate and Eligible Beneficiaries.
“Statutory Damage Caps” means any monetary limitations on damages imposed by applicable Nebraska statutes, including, without limitation, Neb. Rev. Stat. § 44-2825 (medical malpractice) or any other cap applicable to the facts pleaded.
[// GUIDANCE: Delete or tailor any definition that is not relevant once facts are finalized.]
III. JURISDICTION, VENUE & PARTIES
3.1 Plaintiff. The Plaintiff is a resident of [COUNTY, STATE] and is authorized to prosecute this action on behalf of the Estate and all Eligible Beneficiaries pursuant to Neb. Rev. Stat. § 30-809.
3.2 Defendant(s).
a. [DEFENDANT NAME], a [STATE] [ENTITY TYPE], maintains its principal place of business at [ADDRESS] and transacts substantial business in Nebraska.
b. [ADDITIONAL DEFENDANTS—IF ANY].
3.3 Subject-Matter Jurisdiction. This Court possesses subject-matter jurisdiction over this civil action under Neb. Const. art. V, § 9 and Neb. Rev. Stat. § 24-302.
3.4 Personal Jurisdiction. Defendant(s) are subject to general and/or specific jurisdiction in Nebraska under Neb. Rev. Stat. § 25-536.
3.5 Venue. Venue is proper in this Court under Neb. Rev. Stat. § 25-403.01 because the wrongful acts and resulting death occurred in [COUNTY] County.
IV. GENERAL ALLEGATIONS
4.1 On [DATE], Decedent was lawfully present at/on [LOCATION] when Defendant(s) negligently, recklessly, and/or willfully committed the acts and omissions described herein.
4.2 Defendant(s) had a duty to exercise reasonable care in [DESCRIBE DUTY—e.g., operating a motor vehicle, manufacturing a product, maintaining premises].
4.3 Defendant(s) breached said duty by [SPECIFY BREACHES].
4.4 As a direct and proximate result of Defendant(s)’ breaches, Decedent sustained injuries that ultimately resulted in death on [DATE OF DEATH].
4.5 All conditions precedent to the maintenance of this action have been performed or have occurred.
[// GUIDANCE: Include pre-suit notice requirements if medical malpractice or governmental tort claims are implicated.]
V. COUNT I – WRONGFUL DEATH
(Neb. Rev. Stat. §§ 30-809–30-810)
5.1 Plaintiff re-alleges and incorporates by reference ¶¶ 4.1–4.5 as though fully set forth herein.
5.2 Under the Act, Plaintiff is entitled to recover, for the exclusive benefit of the Eligible Beneficiaries, damages including but not limited to:
a. Loss of the Decedent’s society, comfort, and companionship;
b. Loss of services and support reasonably expected from the Decedent;
c. Funeral and burial expenses reasonably incurred; and
d. Any other pecuniary losses contemplated by Neb. Rev. Stat. § 30-810.
5.3 Defendant(s)’ conduct was a proximate cause of the Decedent’s death, entitling Plaintiff to judgment for all compensable damages allowable under the Act.
VI. COUNT II – SURVIVAL ACTION
(Neb. Rev. Stat. § 25-1401 et seq.)
[Pled in the Alternative]
6.1 Plaintiff re-alleges ¶¶ 4.1–4.5.
6.2 Nebraska’s survival statutes preserve causes of action accruing to the Decedent prior to death, allowing the Estate to recover damages that the Decedent could have pursued had he/she lived.
6.3 Prior to death, Decedent experienced conscious pain, suffering, mental anguish, medical expenses, and other personal injuries directly caused by Defendant(s). These damages survive and are recoverable by the Estate.
VII. DAMAGES & STATUTORY CAPS
7.1 Plaintiff seeks the following categories of damages, subject to any applicable statutory limitations:
a. Economic Damages: Funeral costs, burial expenses, medical bills, loss of financial contributions, and loss of household services.
b. Non-Economic Damages: Loss of society, comfort, and companionship; Decedent’s pre-death pain and suffering (survival claim).
7.2 Statutory Damage Caps. To the extent the wrongful act qualifies under a statutory damages-limitation scheme (e.g., the Nebraska Hospital-Medical Liability Act), Plaintiff pleads damages in an amount not to exceed the maximum statutory limit and reserves the right to contest the applicability of any cap.
7.3 Punitive Damages. Nebraska law does not permit exemplary or punitive damages; therefore, none are sought.
VIII. PRAYER FOR RELIEF
WHEREFORE, Plaintiff respectfully requests that the Court enter judgment:
A. On Count I, for wrongful-death damages in an amount to be proven at trial and apportioned among Eligible Beneficiaries as the Court may direct;
B. On Count II, for survival damages recoverable by the Estate;
C. Awarding allowable costs, pre- and post-judgment interest, and statutory attorney fees where authorized;
D. Granting such other and further relief, at law or in equity, to which Plaintiff may be justly entitled.
IX. JURY DEMAND
Pursuant to Neb. Rev. Stat. § 25-1104 and Article I, § 6 of the Nebraska Constitution, Plaintiff demands trial by jury on all issues so triable.
X. VERIFICATION
I, [PLAINTIFF NAME], being first duly sworn, depose and state that I have read the foregoing Complaint, know the contents thereof, and that the same is true and correct to the best of my knowledge, information, and belief.
Date: ___ , 20_
[PLAINTIFF NAME], Personal Representative
State of _ )
) ss.
County of _____ )
Subscribed and sworn before me this ___ day of _, 20.
Notary Public
My Commission Expires: _______
[// GUIDANCE: Verification is required under Neb. Ct. R. Pldg. § 6-111 when allegations are based on personal knowledge. Include if strategic.]
XI. CERTIFICATE OF SERVICE
I hereby certify that on the ___ day of _, 20, I caused a true and correct copy of the foregoing Complaint to be served upon the following counsel of record via [METHOD OF SERVICE]:
• [DEFENSE COUNSEL NAME & ADDRESS]
[ATTORNEY NAME], # [NE BAR NO.]
Counsel for Plaintiff
SIGNATURE BLOCK
Respectfully submitted,
[LAW FIRM NAME]
[ADDRESS]
[PHONE] | [FAX] | [EMAIL]
By: __________
[ATTORNEY NAME], # [NE BAR NO.]
Counsel for Plaintiff
[// GUIDANCE:
1. Verify all statutory citations before filing; omit or modify any citation if uncertain.
2. Adjust Count II if no survival claim is appropriate under case facts.
3. If the claim involves a governmental entity or medical provider, comply with the Nebraska Political Subdivisions Tort Claims Act or pre-litigation medical review panel procedures, respectively.
4. Consider including a “Savings Clause” if the statute of limitations is near expiration.
5. Attach additional exhibits (e.g., Letters of Personal Representative) as needed.]