Wrongful Death Complaint — NC CV

← FORMVANA NC FORMS VIEW ALL FORMS →

01 ATTORNEY INFORMATION

Attorney Name *

State Bar No. *

Firm / Office Name

Address *

Phone *

Fax

Email *

02 COURT & CASE INFORMATION

County *

Case Number

Division

03 PLAINTIFF — PERSONAL REPRESENTATIVE

Personal Representative Full Name * Personal Representative of the Estate of:

Relationship to Decedent

Letters Testamentary / Letters of Administration No.

Estate Name

04 DECEDENT INFORMATION

Decedent Full Name *

Date of Birth

Date of Death *

Age at Death

Place of Death (City, County, State)

Cause of Death per Death Certificate

05 DEFENDANT(S)

06 NATURE OF WRONGDOING

Select Primary Theory of Liability *

07 FACTUAL BASIS

Date of Incident *

Location of Incident

Description of Incident *

08 PRE-DEATH INJURIES

Medical Treatment Received

Medical Providers

09 DAMAGES

Medical expenses

Funeral and burial expenses

Pain and suffering before death

Lost income / earning capacity

Basis for lost income calculation

Loss of companionship to survivors

Punitive damages

TOTAL DAMAGES $0.00

10 SURVIVORS

11 ATTORNEY CERTIFICATION

I certify that to the best of my knowledge, the allegations in this complaint are supported by facts and applicable law

Signature Date *

SELECTED COUNTY

— Select above —

⚡ AUTO-FILL FROM CLIO

Connect cLAWde and load any matter in one click — decedent name, estate, county, and parties auto-populate instantly from your Clio matter.

OPEN CLAWDE VERSION →

FILING REQUIREMENTS

Only the Estate's personal representative can file this action
If no estate is open, file probate first (AOC-E-201 or E-202)
Statute of limitations: 2 years from date of death
Medical malpractice: must have expert review and Rule 9(j) certification before filing
Wrongful death damages go to the estate, then distributed per will or intestacy
Two claim types: estate's claim (medical/funeral) vs. survivors' claim (companionship)
Punitive damages available only for egregious conduct (G.S. 1D)
Contact attorney immediately — malpractice cases require expert affidavit before deadline

STATUTORY REFERENCE

G.S. 28A-18-1Wrongful death — survival

G.S. 28A-18-2Wrongful death — damages

G.S. 1-53(4)2-year statute of limitations

Rule 9(j)Med-mal expert certification