COMPLAINT FOR WRONGFUL DEATH AND SURVIVAL ACTION
Vermont Superior Court – [COUNTY] Unit, Civil Division
Docket No.: _______
[PLAINTIFF’S FULL LEGAL NAME], in the capacity of Personal Representative of the Estate of [DECEDENT’S FULL LEGAL NAME],
Plaintiff,
v.
[DEFENDANT’S FULL LEGAL NAME(S)],
Defendant(s).
TABLE OF CONTENTS
- Parties .......................................................................................................................... 2
- Jurisdiction and Venue .............................................................................................. 2
- Factual Allegations ..................................................................................................... 3
- Causes of Action ........................................................................................................ 5
4.1 Count I – Wrongful Death (14 V.S.A. § 1491) .................................................. 5
4.2 Count II – Survival Action (14 V.S.A. § 1453) ................................................ 6 - Damages .................................................................................................................... 7
- Prayer for Relief ......................................................................................................... 8
- Jury Demand .............................................................................................................. 9
- Verification ................................................................................................................. 9
- Attorney Signature Block ..........................................................................................10
- Certificate of Service ...............................................................................................11
[// GUIDANCE: Page numbers update automatically in most word-processing programs. Adjust after final edits.]
1. PARTIES
1.1 Plaintiff [PLAINTIFF] (“Plaintiff”) is the duly appointed Personal Representative of the Estate of [DECEDENT] (“Decedent”) pursuant to the Letters Testamentary/Letters of Administration issued by the Vermont Probate Division, [COUNTY] Probate Unit, on [DATE OF APPOINTMENT].
1.2 Defendant [DEFENDANT] is a [corporation/individual/other entity] organized under the laws of [STATE] with its principal place of business/residence at [ADDRESS] and at all relevant times conducted business and/or committed tortious acts in the State of Vermont.
1.3 At all times relevant, Defendant acted by and through its officers, employees, agents, servants, and/or representatives, each of whom acted within the course and scope of their employment and/or agency and for whose acts Defendant is vicariously liable.
2. JURISDICTION AND VENUE
2.1 This Court has subject-matter jurisdiction under Vt. Const. ch. II, § 30 and 4 V.S.A. § 31, as this is a civil action asserting claims arising under Vermont’s Wrongful Death Statute, 14 V.S.A. §§ 1491–1492, and Vermont’s Survival Statute, 14 V.S.A. § 1453.
2.2 Personal jurisdiction is proper because Defendant:
(a) transacts business in Vermont;
(b) committed the tortious acts complained of within Vermont; and/or
(c) maintains sufficient minimum contacts with Vermont consistent with due process and 12 V.S.A. § 913(b).
2.3 Venue lies in this Court pursuant to 12 V.S.A. § 402 because the cause of action arose in [COUNTY] County and Defendant resides/does business in this county.
2.4 Pursuant to 14 V.S.A. § 1492, this action is timely filed within two (2) years of Decedent’s death (or of the date the cause of action reasonably should have been discovered, if applicable).
[// GUIDANCE: Confirm statute-of-limitations computations and allege any tolling facts if needed.]
3. FACTUAL ALLEGATIONS
3.1 On or about [DATE], Decedent was lawfully present at [LOCATION].
3.2 Defendant, through acts and omissions including but not limited to [SPECIFIC NEGLIGENT ACTS—e.g., failure to maintain safe premises / negligent operation of motor vehicle / medical malpractice], breached its duty of reasonable care owed to Decedent.
3.3 As a direct and proximate result of Defendant’s negligence, Decedent sustained severe injuries culminating in death on [DATE OF DEATH].
3.4 Plaintiff complied with all procedural prerequisites, including appointment as Personal Representative and issuance of any required probate orders authorizing this action.
3.5 Decedent is survived by the following statutory beneficiaries eligible to recover under 14 V.S.A. § 1492(a):
(a) [SPOUSE NAME] – spouse;
(b) [CHILD(REN) NAME(S)] – child(ren);
(c) [OTHER NEXT OF KIN, if applicable].
3.6 Plaintiff has incurred, and will continue to incur, funeral and burial expenses, medical expenses, and other pecuniary losses attributable to Defendant’s wrongful conduct.
3.7 Plaintiff, on behalf of Decedent’s Estate and statutory beneficiaries, seeks all damages available at law, including economic losses, loss of consortium, loss of guidance and nurture, and conscious pain and suffering sustained by Decedent prior to death.
4. CAUSES OF ACTION
4.1 Count I – Wrongful Death (14 V.S.A. § 1491)
4.1.1 Plaintiff realleges and incorporates by reference Paragraphs 1 through 3.7.
4.1.2 Under Vermont law, when the death of a person is caused by the wrongful act, neglect, or default of another, damages may be recovered by the decedent’s personal representative for the benefit of the statutory beneficiaries. 14 V.S.A. § 1491.
4.1.3 Defendant owed Decedent a duty of reasonable care and breached that duty by [SPECIFIC BREACHES].
4.1.4 Defendant’s breach was the direct and proximate cause of Decedent’s death and of the damages described herein.
4.1.5 Plaintiff therefore seeks all wrongful-death damages permitted under 14 V.S.A. § 1492, including but not limited to:
(a) medical and funeral expenses;
(b) loss of Decedent’s earning capacity;
(c) loss of consortium, care, and companionship;
(d) mental anguish suffered by the beneficiaries; and
(e) any statutory interest.
[// GUIDANCE: Vermont has no general cap on wrongful-death compensatory damages; insert a cap only if a specific statutory limit applies to the underlying tort (e.g., healthcare liability).]
4.2 Count II – Survival Action (14 V.S.A. § 1453)
4.2.1 Plaintiff realleges and incorporates by reference Paragraphs 1 through 3.7.
4.2.2 All causes of action that Decedent could have maintained had death not ensued survive in favor of the Estate. 14 V.S.A. § 1453.
4.2.3 Prior to death, Decedent experienced conscious pain, suffering, and emotional distress directly attributable to Defendant’s wrongful conduct.
4.2.4 Plaintiff seeks all compensatory and exemplary damages recoverable under the Survival Statute, including pre-death pain and suffering, medical expenses, and lost earnings.
5. DAMAGES
5.1 Economic Damages
(a) Past medical expenses: $[AMOUNT]
(b) Funeral and burial costs: $[AMOUNT]
(c) Loss of expected earnings and benefits: $[AMOUNT]
5.2 Non-Economic Damages
(a) Loss of consortium, care, guidance, and companionship.
(b) Mental anguish and emotional distress of statutory beneficiaries.
(c) Decedent’s conscious pain and suffering prior to death.
5.3 Pre- and post-judgment interest as allowed by law.
5.4 Costs of suit and such other relief as the Court deems just.
[// GUIDANCE: If any statutory cap applies (e.g., under Vt. medical-malpractice reforms), insert sub-paragraph 5.5 noting “Damages are sought subject to the statutory maximum of $[CAP] as provided in [CITATION].”]
6. PRAYER FOR RELIEF
WHEREFORE, Plaintiff respectfully requests that this Court:
A. Enter judgment in favor of Plaintiff and against Defendant on all Counts;
B. Award compensatory damages in an amount to be proven at trial;
C. Award pre- and post-judgment interest as permitted by 12 V.S.A. § 2903;
D. Award costs of suit pursuant to V.R.C.P. 54(d);
E. Grant such other and further relief as the Court deems equitable and just.
7. JURY DEMAND
Pursuant to V.R.C.P. 38(a), Plaintiff demands a trial by jury on all issues so triable as of right.
8. VERIFICATION
I, [PLAINTIFF], Personal Representative of the Estate of [DECEDENT], verify under oath that the factual allegations in this Complaint are true and correct to the best of my knowledge, information, and belief.
[PLAINTIFF NAME]
Date: _______
State of Vermont
County of [COUNTY]
Subscribed and sworn to before me on this ___ day of ____, 20__, by [PLAINTIFF].
Notary Public
Commission Expires: _____
[// GUIDANCE: Verification is recommended but not universally required; omit if strategy dictates.]
9. ATTORNEY SIGNATURE BLOCK
Respectfully submitted,
[ATTORNEY NAME], Esq.
Bar No. [VT BAR #]
[LAW FIRM NAME]
[ADDRESS]
[PHONE] | [EMAIL]
Counsel for Plaintiff
Date: _______
10. CERTIFICATE OF SERVICE
I hereby certify that on this ___ day of ____, 20__, I caused a true and correct copy of the foregoing Complaint to be served on all counsel/parties of record via [METHOD OF SERVICE CONSISTENT WITH V.R.C.P. 5].
[ATTORNEY NAME], Esq.
[// GUIDANCE:
1. Attach a completed Vermont Civil Cover Sheet (Form CIV-CivCoversheet) when filing.
2. Confirm filing fee, summons issuance, and service requirements per V.R.C.P. 3, 4, and 4.1.
3. Review local standing orders for the chosen Superior Court unit.
4. Customize factual allegations and damages with admissible detail supported by discovery.
5. Preserve all viable theories (e.g., negligence per se, strict liability) in additional counts if warranted. ]