Posted On: August 7, 2006 by Richard Console

"Motor Vehicle Accident Complaint" Form

In the extended entry of this blog post, you'll find an example of a NJ complaint form for a motor vehicle accident. Remember that no form can take the place of the advice of an experienced injury attorney. Please call us for more information 1-866-778-5500.

Form for Motor Vehicle Accident Complaint

RICHARD P. CONSOLE, JR., P.C.
1288 Route 73 South, Suite 300
Mt. Laurel, New Jersey 08054
(856) 778-5500
Attorney for Plaintiff(s),


: SUPERIOR COURT OF NEW JERSEY
: LAW DIVISION
: COUNTY
Plaintiff(s) :
:
v. : DOCKET NO.:
:
, JOHN DOE : Civil Action
#1-10 (fictitious) and ABC :
CORP. #1-10 (fictitious), i/j/s/a : COMPLAINT AND
Defendant(s) : DEMAND FOR JURY TRIAL


, an adult, residing at , in the Township of , County of , State of New Jersey, by and through his attorney, Richard P. Console, Jr., Esquire, states:

FIRST COUNT
Defendant,

1. On or about , the Plaintiff, , was operating a motor vehicle traveling westbound on I-195 in the Township of Jackson, Ocean County, State of New Jersey.

2. At the aforesaid time and place, the Defendant, , was operating a motor vehicle traveling westbound on I-195, in the Township of Jackson, Ocean County, State of New Jersey.

3. The Defendant, , failed to maintain control of his vehicle and struck Plaintiff, , vehicle in the rear.

4. Defendant, , did so carelessly, recklessly, and negligently operate a motor vehicle resulting in a collision with Plaintiff’s vehicle.

5. As a result of the negligence of the Defendant, , Plaintiff, , sustained diverse personal injuries of both a permanent and temporary nature, endured and will endure great pain, have been and will be compelled to expend large sums of money for physicians and other help in an attempt to cure Plaintiff’s said injuries, have been and will be prevented from attending to Plaintiff’s normal business and affairs, and have been otherwise damaged.

WHEREFORE, Plaintiff, , demands judgment against the Defendant, , for such sums as would reasonably and properly compensate Plaintiff in accordance with the laws of the State of New Jersey, together with interest and cost of suit.

SECOND COUNT
Defendant,

1. Plaintiff repeats each and every allegation contained in the First Count of this Complaint as though set forth at length herein.

2. Defendant, , was operating a vehicle with the full permission of and/or as an agent and/or employee of and, therefore, all negligence of Defendant, , is thereby imputed to by the doctrine of Respondeat Superior.

3. The Defendant, , did so carelessly, recklessly, and negligently operate a motor vehicle resulting in a collision with Plaintiff’s vehicle.

4. As a result of the negligence of the Defendant, , and, therefore, Defendant, , the Plaintiff, , suffered diverse personal injuries of both a permanent and temporary nature, endured and will endure great pain, has been and will be compelled to expend large sums of money for physicians and for other help in an attempt to cure Plaintiff’s injuries, has been and will be prevented from attending to Plaintiff’s normal business and affairs and has been otherwise damaged.

WHEREFORE, the Plaintiff, , demands judgment against the Defendant, , for such sums as would reasonably and properly compensate Plaintiff under the laws of the State of New Jersey, together with interests and costs of this suit.

THIRD COUNT
Defendant, John Doe #1-10 (fictitious)

1. Plaintiff repeats each and very allegation in the First and Second Counts of this Complaint as though set forth at length herein.

2. At the aforesaid time and place, Defendant, John Doe #1-10 (fictitious), was operating a vehicle traveling westbound on I-195.

3. Defendant, John Doe #1-10 (fictitious), failed to maintain control of his vehicle, and struck Plaintiff’s vehicle in the rear.

4. As a result of the negligence of the Defendant, John Doe #1-10 (fictitious), the Plaintiff, , sustained diverse personal injuries of both a permanent and temporary nature, endured and will endure great pain, has been and will be compelled to expend large sums of money for physicians and for other help in an attempt to cure Plaintiff’s injuries, has been and will be prevented from attending to Plaintiff’s normal business and affairs and has been otherwise damaged.

WHEREFORE, the Plaintiff, , demands judgment against the Defendant, John Doe #1-10 (fictitious), for such sums as would reasonably and properly compensate the Plaintiff under the laws of the State of New Jersey, together with interests and costs of this suit.

FOURTH COUNT
Defendant, ABC Corporation #1-10 (fictitious)

1. Plaintiff repeats each and every allegation of the First, Second and Third Counts of this Complaint as though set forth at length herein.

2. Defendant, , was operating a vehicle with the full permission of and/or as an agent and/or employee of ABC Corporation #1-10 (fictitious) and, therefore, all negligence of Defendant, , is thereby imputed to ABC Corporation #1-10 (fictitious) by the doctrine of Respondeat Superior.

3. The Defendant, , did so carelessly, recklessly, and negligently operate a motor vehicle resulting in a collision with Plaintiff’s vehicle.

4. As a result of the negligence of the Defendant, , and, therefore, Defendant ABC Corporation #1-10 (fictitious), the Plaintiff, , suffered diverse personal injuries of both a permanent and temporary nature, endured and will endure great pain, has been and will be compelled to expend large sums of money for physicians and for other help in an attempt to cure Plaintiff’s injuries, has been and will be prevented from attending to Plaintiff’s normal business and affairs and has been otherwise damaged.

WHEREFORE, the Plaintiff, , demands judgment against the Defendant, ABC Corporation #1-10 (fictitious), for such sums as would reasonably and properly compensate the Plaintiff under the laws of the State of New Jersey, together with interests and costs of this suit.

FIFTH COUNT

1. Plaintiff repeats each and every allegation in the First, Second, Third and Fourth Counts of this Complaint as though set forth at length herein.

WHEREFORE, the Plaintiff, , demands judgment against the Defendant(s), , , John Doe #1-10 (fictitious) and ABC Corporation #1-10 (fictitious), individually, jointly, severally and in the alternative, for such sums as would reasonably and properly compensate Plaintiff under the laws of the State of New Jersey, together with interest and the costs of suit.


DATED RICHARD P. CONSOLE, JR., ESQUIRE,
Attorney for Plaintiff,

DEMAND FOR JURY

PLEASE TAKE NOTICE that the Plaintiff hereby demands a jury trial as to all of the within issues.


DATED RICHARD P. CONSOLE, JR., ESQUIRE,
Attorney for Plaintiff,

DEMAND FOR DISCOVERY OF INSURANCE COVERAGE

Pursuant to R. 4:10-2(b), demand is hereby made that you disclose to the undersigned whether there are any insurance agreements or policies under which any person or entity carrying on an insurance business may be liable to satisfy part or all of a judgment which may be entered in this action or to indemnify or reimburse for payments made to satisfy the judgment.

If so, provide to the undersigned a copy of each policy or agreement, or in the alternative state, under oath or certification; (a) policy number; (b) name and address of insurer; (c) inception and expiration dates; (d) names and addresses of all persons/entities covered; (e) personal injury limits; (f) property damage limits; (g) medical payment limits.



DATED RICHARD P. CONSOLE, JR., ESQUIRE,
Attorney for Plaintiff,

NOTICE OF NO OTHER ACTION

Pursuant to Rule 4:5-1 the Plaintiff's Attorney hereby certifies to the best of his knowledge that there is no other action or arbitration pending in which the matter in controversy is the subject.


DATED RICHARD P. CONSOLE, JR., ESQUIRE,
Attorney for Plaintiff,

DESIGNATION OF TRIAL COUNSEL
PLEASE TAKE NOTICE that James F. Zaccaria, Esquire, is hereby designated trial counsel on behalf of the law firm of Richard P. Console, Jr., P.C., Attorney for Plaintiffs, .



DATED RICHARD P. CONSOLE, JR., ESQUIRE,
Attorney for Plaintiff,

CONSORTIUM CLAIM
Defendant,

1. Plaintiff repeats each and every allegation contained in the First Count of this Complaint as though set forth at length herein.

2. At all times relevant hereto, Plaintiff, _____________ was and is married to Plaintiff, ______________ .

3. As a direct and proximate result of Defendant’s______________ negligence and the injuries sustained therefrom by Plaintiff, ____________ Plaintiff ___________
incurred expenses for the care, treatment and cure of his/her spouse.

4. As a direct and proximate result of Defendant’s __________ negligence and the injuries sustained therefrom by Plaintiff, ____________, Plaintiff,__________ has suffered a loss or impairment of his/her spouse’s services, society, or sex due to the injuries.


WHEREFORE, the Plaintiff, , demands judgment against the Defendant, , for such sums as would reasonably and properly compensate Plaintiff under the laws of the State of New Jersey, together with interests and costs of this suit.