SUPERIOR COURT OF WASHINGTON

FOR THE COUNTY OF [COUNTY]

[PLAINTIFF], as Personal Representative of the ESTATE OF [DECEDENT], and on behalf of the Statutory Beneficiaries,

Plaintiff,

v.

[DEFENDANT LEGAL NAME], a [State] [corporation/LLC/partnership/individual],
  Defendant.

[// GUIDANCE: File in the county where the cause of action arose or where any Defendant resides. See Wash. Super. Ct. Civ. R. (“CR”) 82.]

TABLE OF CONTENTS

1. Introduction & Preliminary Allegations
2. Parties
3. Jurisdiction & Venue
4. Definitions
5. Factual Allegations
6. Cause of Action I – Wrongful Death (RCW 4.20.010, .020)
7. Cause of Action II – Survival (RCW 4.20.046)
8. Cause of Action III – Negligence
9. Cause of Action IV – Limited Injunctive Relief (Preservation of Evidence)
10. Damages & Recoverable Elements
11. Prayer for Relief
12. Demand for Jury Trial
13. Reservation of Rights
14. Attorney Certification (CR 11)
15. Verification (Optional)

1. INTRODUCTION & PRELIMINARY ALLEGATIONS

1.1 This is a civil action for wrongful death and survival arising from the death of [DECEDENT] on [Date of Death], proximately caused by Defendant’s negligent and otherwise wrongful acts and omissions.
1.2 Plaintiff seeks all damages recoverable under Washington law, including—but not limited to—pecuniary losses, loss of consortium, loss of services, medical and funeral expenses, pre-death pain and suffering, and any other damages allowed under statute or common law.
1.3 Plaintiff also seeks reasonable attorney fees and costs, pre- and post-judgment interest, and such further relief as the Court deems just and equitable.

2. PARTIES

2.1 Plaintiff [PLAINTIFF NAME] (“Personal Representative”) is the duly appointed personal representative of the Estate of [DECEDENT] pursuant to Letters Testamentary/Letters of Administration issued by the Superior Court of [County], Washington, Cause No. [Probate No.].
2.2 Decedent [DECEDENT] was, at all relevant times, a resident of [County], Washington.
2.3 Statutory Beneficiaries include:
 a. [NAME], spouse/domestic partner;
 b. [NAME(S)], child(ren) (minor or adult);
 c. [NAME], stepchild or other dependent per Wash. Rev. Code § 4.20.020 (2023);
 d. [NAME], parent(s)/sibling(s) dependent on Decedent for support, if applicable.
[// GUIDANCE: Modify to match factual eligibility; RCW 4.20.020 creates a two-tier beneficiary system.]
2.4 Defendant [DEFENDANT] is a [corporation/LLC/partnership/individual] organized under the laws of [State] with its principal place of business at [Address]. Defendant transacts substantial business in Washington, including in [County], and committed the tortious acts complained of herein within this State.

3. JURISDICTION & VENUE

3.1 This Court has subject-matter jurisdiction under RCW 2.08.010 and Washington Constitution art. IV, § 6.
3.2 Personal jurisdiction is proper because Defendant purposefully availed itself of the privileges of conducting activities within Washington, and the causes of action arise out of those activities.
3.3 Venue lies in [County] under RCW 4.12.020(2) because the tort occurred in, and/or Defendant resides or does business in, this County.

4. DEFINITIONS

As used in this Complaint:
“Decedent” means [DECEDENT FULL NAME].
“Estate” means the probate estate of Decedent pending under Cause No. [Probate No.].
“Beneficiaries” means those persons entitled to recover under Wash. Rev. Code § 4.20.020 (2023).
“Wrongful Conduct” means any negligent, reckless, or otherwise wrongful act or omission of Defendant that proximately caused Decedent’s injury and death.

5. FACTUAL ALLEGATIONS

5.1–5.__ [Set forth detailed chronology of events, including date, time, location, duty, breach, causation, and damages. Reference statutes, regulations, industry standards, and internal policies violated, if known.]
[// GUIDANCE: Attach accident reports, expert analyses, photographs, and other exhibits as needed and incorporate by reference under CR 10(e).]

6. CAUSE OF ACTION I – WRONGFUL DEATH

( Wash. Rev. Code §§ 4.20.010, 4.20.020 (2023) )
6.1 Plaintiff realleges §§ 1–5 as though fully set forth herein.
6.2 Under RCW 4.20.010, the personal representative may maintain an action against the person whose wrongful act, neglect, or default caused the death of the Decedent.
6.3 Defendant owed Decedent a duty of reasonable care.
6.4 Defendant breached that duty by [Specify negligent acts/omissions].
6.5 As a direct and proximate result, Decedent suffered fatal injuries on [Date], causing damages recoverable by the Beneficiaries pursuant to RCW 4.20.020.
6.6 Plaintiff seeks all pecuniary and non-pecuniary damages allowed by law, subject to any statutory limitations applicable to the specific Defendant (e.g., governmental entity caps under RCW 4.92.090).

7. CAUSE OF ACTION II – SURVIVAL

( Wash. Rev. Code §§ 4.20.046, 4.20.060 (2023) )
7.1 Plaintiff realleges §§ 1–6.
7.2 Under RCW 4.20.046, all causes of action the Decedent could have maintained had they lived survive to the Estate.
7.3 Prior to death, Decedent suffered conscious pain, suffering, fear of impending death, medical expenses, and other special damages.
7.4 Plaintiff, as Personal Representative, is entitled to recover these survival damages for the benefit of the Estate and its lawful heirs.

8. CAUSE OF ACTION III – NEGLIGENCE

8.1 Plaintiff realleges §§ 1–7.
8.2 Defendant had a duty to [describe].
8.3 Defendant breached that duty by [describe conduct].
8.4 The breach was the proximate cause of Decedent’s injuries and death.
8.5 Plaintiff and Beneficiaries sustained damages as outlined below.

9. CAUSE OF ACTION IV – LIMITED INJUNCTIVE RELIEF

( Preservation of Evidence )
9.1 Plaintiff realleges §§ 1–8.
9.2 There is a substantial risk that critical physical and electronic evidence in Defendant’s possession may be altered, destroyed, or lost.
9.3 Plaintiff requests a limited injunction requiring Defendant to preserve and not spoliate such evidence for the pendency of this litigation.
[// GUIDANCE: Tailor to facts; request narrowly-tailored preservation order consistent with CR 65.]

10. DAMAGES & RECOVERABLE ELEMENTS

Subject to proof at trial, Plaintiff seeks:
a. Economic damages: funeral and burial expenses, medical expenses, past and future financial support, loss of services, and other pecuniary losses;
b. Non-economic damages: loss of love, care, companionship, consortium, and guidance;
c. Survival damages: pre-death pain and suffering, medical expenses, loss of earnings between injury and death;
d. Pre- and post-judgment interest at the maximum lawful rate;
e. Reasonable attorney fees, expert fees, and litigation costs as allowed by contract, statute, or equitable principles;
f. Any statutory exemplary or special damages, subject to any applicable caps or immunities;
g. Such other and further relief as the Court deems just and proper.

11. PRAYER FOR RELIEF

WHEREFORE, Plaintiff respectfully prays for judgment against Defendant as follows:
1. For all compensatory and special damages proved at trial;
2. For survival damages under RCW 4.20.046;
3. For prejudgment and post-judgment interest;
4. For an order compelling preservation of evidence;
5. For costs and reasonable attorney fees;
6. For trial by jury on all issues so triable; and
7. For any further relief the Court deems just and equitable.

12. DEMAND FOR JURY TRIAL

Pursuant to Washington Constitution art. I, § 21 and CR 38, Plaintiff demands a trial by jury on all issues so triable.

13. RESERVATION OF RIGHTS

Plaintiff reserves the right to amend this Complaint to add additional parties, claims, and prayers for relief as discovery and investigation proceed.

14. ATTORNEY CERTIFICATION

Pursuant to CR 11, the undersigned certifies that the claims and contentions herein are warranted by existing law or a good-faith argument for its extension, modification, or reversal, and that this pleading is not presented for any improper purpose.

15. VERIFICATION (Optional)

STATE OF WASHINGTON )
         ) ss.
COUNTY OF [COUNTY] )

I, [PLAINTIFF NAME], being first duly sworn on oath, depose and state that I am the Plaintiff/Personal Representative in the above-entitled action; that I have read the foregoing Complaint and believe the contents to be true and correct to the best of my knowledge, information, and belief.

____    Date: ____
[PLAINTIFF NAME]

Subscribed and sworn to before me this _ day of _ 20__.

Notary Public in and for the State of Washington
My commission expires: _____

SIGNATURE BLOCK

DATED this _ day of _ 20__.

Respectfully submitted,

[LAW FIRM NAME]

By: _____
[ATTORNEY NAME], WSBA No. [____]
Attorneys for Plaintiff
[Address]
[Telephone]
[Email]

[// GUIDANCE:
1. Ensure a “Claim for Damages” has been served if the Defendant is a governmental entity (RCW 4.92.110; RCW 4.96.020).
2. Consider consolidation of survival and child-death claims where applicable (RCW 4.24.010).
3. Preserve subrogation interests (e.g., Medicare, Medicaid, private insurers).
4. Calendar statutes of limitation: three years for negligence/wrongful death in Washington (RCW 4.16.080(2)).
5. If statutory damage caps apply (e.g., claims against state agencies), plead “subject to applicable statutory limitations.”
6. Serve Defendant consistent with CR 4; file proof of service.
]