SUPERIOR COURT OF NEW JERSEY

[COUNTY] LAW DIVISION – CIVIL PART

[PLAINTIFF NAME], as Administrator/Executor
of the ESTATE OF [DECEDENT NAME], and on behalf
of all statutory beneficiaries under the
New Jersey Wrongful Death Act, N.J.S.A. 2A:31-1 et seq.,

Plaintiff, Civil Action No.: [DOCKET NO.]

v. COMPLAINT AND JURY DEMAND
(Wrongful Death – N.J.S.A. 2A:31-1 et seq.
& Survival Act – N.J.S.A. 2A:15-3)

[DEFENDANT NAME(S)],

Defendant(s).
______/

[// GUIDANCE: Insert additional defendants, fictitious names (Rule 4:26-4), and amend caption as discovery progresses.]

TABLE OF CONTENTS

1. Parties, Jurisdiction, and Venue
2. Factual Allegations
3. Count I – Wrongful Death (Negligence)
4. Count II – Survival Action
5. Damages Allegations
6. Demand for Jury Trial
7. Prayer for Relief
8. Designation of Trial Counsel
9. Certification of Counsel Pursuant to R. 4:5-1(b)(2)

1. PARTIES, JURISDICTION, AND VENUE

1. Plaintiff [PLAINTIFF NAME] (the “Personal Representative”) is the duly appointed [administrator/executor] of the Estate of [DECEDENT NAME] (the “Decedent”), residing at [ADDRESS], and brings this action on behalf of:
   a. The Estate pursuant to the New Jersey Survival Act, N.J.S.A. 2A:15-3; and
   b. All statutory beneficiaries entitled to damages under the New Jersey Wrongful Death Act, N.J.S.A. 2A:31-1 to -6 (the “Wrongful Death Beneficiaries”), including but not limited to: spouse, children, parents, and other heirs-at-law as determined by N.J.S.A. 3B:5-3.

2. Defendant [DEFENDANT NAME] (“Defendant”) is a [corporation/individual/etc.] organized under the laws of [STATE] with its principal place of business at [ADDRESS] and conducted business and/or committed tortious acts in [COUNTY], New Jersey.

3. Jurisdiction is proper under N.J. Const. art. VI, § 3, ¶ 2 and N.J.S.A. 2B:2-3 because the cause of action arose in, and the damages were sustained in, the State of New Jersey.

4. Venue is proper in this Court pursuant to R. 4:3-2 because [COUNTY] is where the cause of action accrued and/or where Defendant resides or conducts business.

2. FACTUAL ALLEGATIONS

5. On or about [DATE], Defendant owed Decedent a duty of reasonable care to [describe duty: operate a motor vehicle safely/provide medical treatment/manufacture a safe product, etc.].

6. Defendant breached that duty by [SPECIFIC NEGLIGENT ACTS OR OMISSIONS].

7. As a direct and proximate result of Defendant’s negligence, Decedent sustained severe injuries on [DATE], causing Decedent’s death on [DATE OF DEATH].

8. All statutory prerequisites to the commencement of this action have been satisfied, including the timely appointment of the Personal Representative and compliance with any notice provisions applicable under New Jersey law.

[// GUIDANCE: Insert Affidavit of Merit placeholder if the case involves professional negligence under N.J.S.A. 2A:53A-27.]

3. COUNT I – WRONGFUL DEATH

(Negligence – N.J.S.A. 2A:31-1 et seq.)

9. Plaintiff repeats and realleges Paragraphs 1–8 as if fully set forth herein.

10. Under N.J.S.A. 2A:31-1, the wrongful act, neglect, or default of Defendant, which would have entitled Decedent to maintain an action and recover damages had death not ensued, gives rise to this cause of action for the exclusive benefit of the Wrongful Death Beneficiaries.

11. The Wrongful Death Beneficiaries have suffered pecuniary losses, including but not limited to:
    a. Loss of financial support, advice, and counsel;
    b. Loss of household services;
    c. Loss of Decedent’s expected future earnings and fringe benefits; and
    d. Reasonable funeral and burial expenses, as allowed by N.J.S.A. 2A:31-5.

12. Pursuant to N.J.S.A. 2A:31-4, any recovery shall be distributed among the Wrongful Death Beneficiaries in the proportions they would take under the intestacy laws of New Jersey.

4. COUNT II – SURVIVAL ACTION

(N.J.S.A. 2A:15-3)

13. Plaintiff repeats and realleges Paragraphs 1–12 as if fully set forth herein.

14. Under N.J.S.A. 2A:15-3, all causes of action Decedent could have maintained, had death not ensued, survive for the benefit of the Estate.

15. Between the date of injury and the date of death, Decedent endured conscious pain and suffering, incurred medical expenses, and sustained economic losses including lost wages.

16. Plaintiff, on behalf of the Estate, seeks all damages recoverable under the Survival Act, including pre-death pain and suffering, medical expenses, and lost earnings.

5. DAMAGES ALLEGATIONS

17. Plaintiff demands judgment against Defendant, jointly and severally where applicable, in amounts proven at trial, including:
    a. Pecuniary losses of Wrongful Death Beneficiaries (Count I);
    b. Conscious pain and suffering, medical bills, and lost wages of Decedent (Count II);
    c. Pre- and post-judgment interest as permitted by Court Rule and statute; and
    d. Costs of suit.

[// GUIDANCE: New Jersey does not cap compensatory wrongful death damages; punitive damages are generally unavailable under the Wrongful Death Act (N.J.S.A. 2A:31-5). Strike or include a punitive damages count only if a separate statutory basis exists.]

6. DEMAND FOR JURY TRIAL

18. Pursuant to N.J. Const. art. I, ¶ 9 and R. 4:32-1(b), Plaintiff hereby demands a trial by jury on all issues so triable.

7. PRAYER FOR RELIEF

WHEREFORE, Plaintiff respectfully requests that judgment be entered in favor of Plaintiff and against Defendant as follows:

A. Compensatory damages in an amount to be determined by the jury and consistent with the evidence;
B. All damages recoverable under the New Jersey Wrongful Death and Survival statutes;
C. Interest, costs of suit, and such other and further relief as the Court deems just and equitable.

8. DESIGNATION OF TRIAL COUNSEL

Pursuant to R. 4:25-4, [ATTORNEY NAME] of [LAW FIRM NAME] is hereby designated as trial counsel for Plaintiff in this matter.

9. CERTIFICATION OF COUNSEL PURSUANT TO R. 4:5-1(b)(2)

I certify that the matter in controversy is not the subject of any other action pending in any Court or arbitration proceeding, nor is any other action or arbitration proceeding contemplated. I know of no other parties who should be joined in this action at this time. If I subsequently become aware of any such action or parties, I will file and serve an amended certification as required by the Rule.

Date: ___ Respectfully submitted,

[ATTORNEY NAME], Esq.
[LAW FIRM NAME]
[ADDRESS]
[TEL] | [EMAIL]
Attorney for Plaintiff

[// GUIDANCE:
1. Attach a fully completed Civil Case Information Statement (CIS) when filing, per R. 4:5-1.
2. Remove or redact personal identifiers per R. 1:38-7.
3. For medical malpractice, file and serve an Affidavit of Merit within 60 days after Defendant’s Answer, see N.J.S.A. 2A:53A-27.
4. Statutory citations provided are foundational and well-established under New Jersey law.]