IN THE COURT OF COMMON PLEAS OF [COUNTY] COUNTY, PENNSYLVANIA
[CIVIL] DIVISION
[PLAINTIFF FULL LEGAL NAME], in the Representative Capacity of
[Executor/Administrator] of the Estate of [DECEDENT FULL NAME],
and on behalf of all Statutory Beneficiaries,
Plaintiff,
v. Civil Action No. ___
[DEFENDANT FULL LEGAL NAME],
Defendant(s).
COMPLAINT — WRONGFUL DEATH AND SURVIVAL ACTION
JURY TRIAL DEMANDED
[// GUIDANCE: Pennsylvania practice requires separate caption sheets (“Cover Sheets”) in some counties; insert if local rule mandates.]
TABLE OF CONTENTS
I. Document Header
II. Definitions
III. Operative Allegations
IV. Counts & Specific Causes of Action
V. Damages Allegations
VI. Risk Allocation & Statutory Caps Disclosure
VII. Demand for Jury Trial
VIII. Prayer for Relief
IX. General Provisions
X. Verification
XI. Certification of Service
I. DOCUMENT HEADER
-
Parties
1.1 Plaintiff — [PLAINTIFF NAME], duly appointed [Executor/Administrator] of the Estate of [DECEDENT NAME] pursuant to Letters [Testamentary/of Administration] issued by the Register of Wills of [COUNTY] County, Pennsylvania, on [DATE].
1.2 Defendant — [DEFENDANT NAME], a [legal description, e.g., “Pennsylvania corporation”] with a principal place of business at [ADDRESS]. -
Preliminary Statement
2.1 This action is brought under Pennsylvania’s Wrongful Death Act, 42 Pa. Cons. Stat. § 8301, and Survival Act, 42 Pa. Cons. Stat. § 8302, to recover damages arising from the death of [DECEDENT NAME] on [DATE OF DEATH] as a result of Defendant’s tortious conduct. -
Jurisdiction & Venue
3.1 This Court possesses subject-matter jurisdiction under 42 Pa. Cons. Stat. § 931.
3.2 Venue is proper in this County pursuant to Pa. R. Civ. P. 2179(a) because [specific venue facts].
II. DEFINITIONS
For purposes of this Complaint, the following capitalized terms have the meanings set forth below:
“Act” means, collectively, Pennsylvania’s Wrongful Death Act, 42 Pa. Cons. Stat. § 8301, and Survival Act, 42 Pa. Cons. Stat. § 8302.
“Beneficiaries” means the persons entitled to recover under the Wrongful Death Act—specifically the Decedent’s surviving spouse, children, and/or parents, or, if none, the personal representative for the benefit of the Estate.
“Decedent” means [DECEDENT FULL NAME], who died on [DATE].
“Estate” means the probate estate of the Decedent, administered by Plaintiff.
“Statutory Caps” means any limitations on damages applicable under 42 Pa. Cons. Stat. §§ 8528, 8553, or other Pennsylvania law, to the extent Defendant is a Commonwealth or local agency.
[// GUIDANCE: Add or delete definitions to match case facts.]
III. OPERATIVE ALLEGATIONS
3.1 Factual Background
a. On [DATE], at approximately [TIME], Defendant [describe wrongful act or omission] at/near [LOCATION].
b. As a direct and proximate result, Decedent sustained severe injuries leading to death on [DATE OF DEATH].
3.2 Conditions Precedent
a. Plaintiff has satisfied all notice requirements, including any applicable Tort Claims Act notices, or such requirements are inapplicable.
b. Letters [Testamentary/Administration] confer legal standing upon Plaintiff.
3.3 Statute of Limitations Compliance
a. This Complaint is filed within two (2) years of the cause of action’s accrual as required by 42 Pa. Cons. Stat. § 5524(2).
IV. COUNTS & SPECIFIC CAUSES OF ACTION
COUNT I — WRONGFUL DEATH
(42 Pa. Cons. Stat. § 8301)
4.1 Plaintiff reincorporates Paragraphs 1-3 as though fully set forth herein.
4.2 Defendant owed Decedent a duty of reasonable care to [describe duty].
4.3 Defendant breached that duty by [specific acts/omissions].
4.4 The breach was the factual and proximate cause of Decedent’s death.
4.5 Under the Wrongful Death Act, Beneficiaries are entitled to recover:
a. Medical, hospital, nursing, and funeral expenses;
b. Loss of contributions, services, society, comfort, guidance, and consortium;
c. Pre-judgment and post-judgment interest as allowed by law.
COUNT II — SURVIVAL ACTION
(42 Pa. Cons. Stat. § 8302)
4.6 Plaintiff reincorporates Paragraphs 1-4.5.
4.7 All causes of action possessed by Decedent survive his/her death and inure to the Estate.
4.8 The Estate is entitled to recover:
a. Decedent’s conscious pain and suffering;
b. Loss of earnings from injury to death and impairment of future earning capacity;
c. Medical and related expenses incurred prior to death;
d. Any punitive damages permitted by law.
[// GUIDANCE: Plead separate punitive-damage averments with specific facts if claiming punitive damages; Pa. law requires “outrageous” or “reckless indifference.”]
V. DAMAGES ALLEGATIONS
5.1 Total damages exceed the compulsory arbitration limits of this Court.
5.2 Plaintiff seeks all damages recoverable under the Act, subject to any Statutory Caps applicable to governmental entities.
5.3 Plaintiff reserves the right to amend this Complaint to conform to the evidence.
VI. RISK ALLOCATION & STATUTORY CAPS DISCLOSURE
6.1 If Defendant is determined to be a Commonwealth or local agency, recovery shall not exceed the monetary limitations set forth in 42 Pa. Cons. Stat. §§ 8528(b) or 8553(b), absent legislative waiver.
VII. DEMAND FOR JURY TRIAL
Pursuant to Pa. R. Civ. P. 1007.1 and the Seventh Amendment to the United States Constitution, Plaintiff demands trial by jury of all issues so triable.
VIII. PRAYER FOR RELIEF
WHEREFORE, Plaintiff respectfully requests that this Court enter judgment in favor of Plaintiff and against Defendant for:
1. Wrongful-death damages in an amount to be proven at trial;
2. Survival-action damages in an amount to be proven at trial;
3. Punitive damages as allowed by law;
4. Pre- and post-judgment interest;
5. Costs of suit and such other relief as the Court deems just.
IX. GENERAL PROVISIONS
9.1 Governing Law — This Complaint is governed by the substantive law of the Commonwealth of Pennsylvania.
9.2 Forum Selection — The parties shall litigate exclusively in the Court of Common Pleas of [COUNTY] County, Pennsylvania.
9.3 Alternative Dispute Resolution — The parties may mutually agree in writing to submit any or all issues to binding or non-binding arbitration or mediation.
9.4 Reservation of Rights — Plaintiff reserves all rights not expressly waived herein.
X. VERIFICATION
I, [PLAINTIFF NAME], affirm that I am the Plaintiff in the foregoing action; that I have read the foregoing Complaint and the factual allegations therein are true and correct to the best of my knowledge, information, and belief; and that this Verification is made subject to the penalties of 18 Pa. Cons. Stat. § 4904 (unsworn falsification to authorities).
[PLAINTIFF NAME]
Date: ______
[// GUIDANCE: Pennsylvania requires verification by a party, not counsel, unless counsel’s personal knowledge is alleged.]
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 all counsel and unrepresented parties of record via [method of service, e.g., certified mail, hand delivery, or Pa. E-Filing System] as follows:
• [NAME & ADDRESS OF DEFENSE COUNSEL OR DEFENDANT]
[ATTORNEY NAME], Esquire
[PA Attorney I.D. No.]
Counsel for Plaintiff
SIGNATURE BLOCK
Respectfully submitted,
[ATTORNEY NAME], Esquire
[LAW FIRM NAME]
[ADDRESS]
[PHONE] | [EMAIL]
PA Atty. I.D. No. _
Attorney for Plaintiff
[// GUIDANCE:
1. Insert county-specific cover sheets, case management orders, or local rule certificates as required.
2. If the defendant is a healthcare provider, evaluate Certificate of Merit requirements under Pa. R.C.P. 1042.3.
3. Consider separately pleading negligent infliction of emotional distress or other derivative claims if supported by facts.
4. For government defendants, add notice of intention to sue and reference to 42 Pa. Cons. Stat. § 5522.
5. Review all placeholder text for accuracy before filing.]