FORM for SMALL COMPLAINTS (NON-Motor Vehicle)

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SMALL CLAIMS COMPLAINT FOR MOTOR VEHICLES

Form for Motor Vehicle Accident Complaint

: 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.

For more information, you can also visit www.richardconsole.com or call us at 1-866-778-5500

All questions must be answered unless the court otherwise orders or
unless a claim of privilege or protective order is made in accordance
with R. 4:17-1(b)(3). (Caption)
1. Full name, present address and date of birth.
2. Describe in detail your version of the accident or occurrence setting
forth the date, location, time and weather.
3. Detailed description of nature, extent and duration of any and all
injuries.
4. Detailed description of injury or condition claimed to be permanent
together with all present complaints.
5. If confined to a hospital, state its name and address, and dates of
admission and discharge.
6. If any diagnostic tests were performed, state the type of test
performed, name and address of place where
performed, date each test was performed and what each test disclosed.
Attach a copy of the test results.
7. If treated by any health care provider, state the name and present
address of each health care provider, the dates and places where
treatments were received and the date of last treatment. Attach true
copies of all written reports provided to you by any such health care
provider whom you propose to have testify in your behalf.
8. If still being treated, the name and address of each doctor or health
care provider rendering treatment, where and how often treatment is
received and the nature of the treatment.
9. If a previous injury, disease, illness or condition is claimed to
have been aggravated, accelerated or exacerbated, specify in detail the
nature of each and the name and present address of each health care
provider, if any, who ever provided treatment for the condition.
10. If employed at the time of the accident, state: (a) name and address
of employer; (b) position held and nature of work performed; (c) average
weekly wages for past year; (d) period of time lost from employment,
giving dates; and (e) amount of wages lost, if any.
11. If there has been a return to employment or occupation, state: (a)
name and address of present employer; (b) position held and nature of
work performed; and (c) present weekly wages, earning, income or profit.

12. If other loss of income, profit or earnings is claimed: (a) state
total amount of the loss; (b) give a complete detailed computation of
the loss; and (c) state the nature and source of the loss of income,
profit and earnings, and he dates of the deprivation.
13. Itemize in complete detail any and all moneys expended or expenses
incurred for hospitals, doctors, nurses, diagnostic tests or health care
providers, x-rays, medicines, care and appliances and state the name and
address of each payee and the amount paid and owed each payee.
14. Itemize any and all other losses or expenses incurred not otherwise
set forth.
15. Identify all documents that may relate to this action, and attach
copies of each such document.
16. State the names and addresses of all eyewitnesses to the accident or
occurrence, their relationship to you and their interest in this
lawsuit.
17. State the names and addresses of all persons who have knowledge of
any facts relating to the case.
18. If any photographs, videotapes, audio tapes or other forms of
electronic recording, sketches, reproductions, charts or maps were made
with respect to anything that is relevant to the subject matter of the
complaint, describe: (a) the number of each; (b) what each shows or
contains; (c) the date taken or made; (d) the names and addresses of the
persons who made them; (e) in whose possession they are at present; and
(f) if in your possession, attach a copy, or if not subject to
convenient copying, state the location where inspection and copying may
take place.
19. If you claim that the defendant made any admissions as to the
subject matter of this lawsuit, state: (a) the date made; (b) the name
of the person by whom made; (c) the name and address of the person to
whom made; (d) where made; (e) the name and address of each person
present at the time the admission was made; (f) the contents of the
admission; and (g) if in writing, attach a copy.
20. If you or your representative and the defendant have had any oral
communication concerning the subject matter of this lawsuit, state: (a)
the date of the communication; (b) the name and address of each
participant; (c) the name and address of each person present at the time
of such communication; (d) where such communication took place; and (e)
a summary of what was said by each party participating in the
communication.
21. If you have obtained a statement from any person not a party to this
action, state: (a) the name and present address of the person who gave
the statement; (b) whether the statement was oral or in writing and if
in writing, attach a copy; (c) the date the statement was obtained; (d)
if such statement was oral, whether a recording was made, and if so, the
nature of the recording and the name and present address of the person
who has custody of it;
(e) if the statement was written, whether it was signed by the person
making it; (f) the name and address of the person who obtained the
statement; and (g) if the statement was oral, a detailed summary of its
contents.
22. If you claim that the violation of any statute, rule, regulation or
ordinance is a factor in this litigation, state the exact title and
section.
23. State the names and addresses of any and all proposed expert
witnesses. Set forth in detail the qualifications of each expert named
and attach a copy of each expertís current resume. Also attach true
copies of all written re-ports provided to you by any such proposed
expert witnesses.
With respect to all expert witnesses, including treating physicians, who
are expected to testify at trial and with respect to any person who has
conducted an examination pursuant to Rule 4:19, who may testify, state
each such witness's name, address and area of expertise and attach a
true copy of all written reports provided to you. If a report is not
written, supply a summary of any oral report provided to you. State the
subject matter on which your experts are expected to testify. State the
substance of the facts and opinions to which your experts are expected
to testify and a summary of the grounds for each opinion.
24. State whether you have ever been convicted of a crime. YES ( ) or NO
( ). If the answer is "yes", state: (a) date; (b) place; and (c) nature.

TO BE ANSWERED ONLY IN AUTOMOBILE ACCIDENT CASES
25. Do you have insurance coverage and/or PIP benefits under an
applicable policy or policies of automobile insurance? As to each such
policy provide the name and address of the insurance carrier, policy
number, the named insured and attach a copy of the declaration sheet.
If you are making a claim for property damage to a motor vehicle,
provide answers to the uniform interrogatories contained in Form B,
questions 1 through 18.

RULE 4:17. INTERROGATORIES TO PARTIES
4:17-1. Service, Scope of Interrogatories
(a) Generally. Any party may serve upon any other party written
interrogatories relating to any matters which may be inquired into under
R. 4:10-2. The interrogatories may include a request, at the
propounder's expense, for a copy of any paper. (b) Uniform
Interrogatories in Certain Actions.
(1) Limitations on Interrogatories. In all actions seeking
recovery for property damage to automobiles and in all personal injury
cases other than wrongful death, toxic torts, cases involving issues of
professional malpractice other than medical malpractice, and those
products liability cases either involving pharmaceuticals or giving rise
to a toxic tort claim, the parties shall be limited to the
interrogatories prescribed by Forms A, B and C of Appendix II, as
appropriate, provided, however, that each party may propound ten
supplemental questions, without subparts, without leave of court. Any
additional interrogatories shall be permitted only by the court in its
discretion on motion.

(2) Automatic Service of Uniform Interrogatories. A party
defendant served with a complaint in an action subject to uniform
interrogatories as prescribed by subparagraph b(1) of this rule shall be
deemed to have been simultaneously served with such interrogatories. The
defendant shall serve answers to the appropriate uniform interrogatories
within 60 days after service by that defendant of the answer to the
complaint. The plaintiff in such an action shall be deemed to have been
served with uniform interrogatories simultaneously with service of
defendant's answer to the complaint and shall serve answers to the
interrogatories within 30 days after service of the answer to the
complaint. In all actions commenced prior to September 5, 2000, however,
answers to uniform interrogatories shall be demanded by letter of demand
served upon all adverse parties within the time prescribed by R. 4:17-2,
and answers shall be served within the time prescribed by R. 4:17-4(b).

(3) Claims of Privilege, Protection. Privileged information need
not be disclosed provided the claim of privilege is made pursuant to R.
4:10-2(e). Nor need information be disclosed if it is the subject of an
identified protective order issued pursuant to R. 4:10-3.
(4) Obligation to Answer Every Question. Except as otherwise
provided in subparagraph (b)(3) of this rule, every question propounded
by a uniform interrogatory must be answered unless the court has
otherwise ordered.
4:17-2. Time to Serve Interrogatories
Interrogatories may, without leave of court, be served upon the
plaintiff or answers demanded pursuant to R. 4:17-1(b) after
commencement of the action and served upon or demanded from any other
party with or after service of the summons and complaint upon that
party. Except as provided in R. 4:17-1(b)(2), initial interrogatories
shall be served by plaintiff as to each defendant within 40 days after
service of that defendant's answer and each defendant shall serve
initial interrogatories within said 40-day period.
4:17-3. Number of Copies Served; Form of Interrogatories
The party serving the interrogatories shall furnish the answering party
with the original thereof. The interrogatories shall be so arranged that
after each separate question shall appear a blank space reasonably
calculated to enable the answering party to have the answer typed in.
4:17-4. Form, Service and Time of Answers
(a) Form of Answers; By Whom Answered. Except as otherwise provided in
this rule, interrogatories shall be answered in writing under oath by
the party upon whom served, if an individual, or, if a public or private
corporation, a partnership or association, or governmental agency, by an
officer or agent who shall furnish all information available to the
party. If a party is unavailable, the interrogatories may be answered by
an agent or authorized representative, including a liability carrier who
is conducting the defense, whose answers shall bind the party. The party
shall furnish all information available to the party and the party's
agents, employees, and attorneys. The person answering the
interrogatories shall designate which of such information is not within
the answerer's personal knowledge and as to that information shall state
the name and address of every person from whom it was received, or, if
the source of the information is documentary, a full description
including the location thereof. Each question shall be answered
separately, fully and responsively either in the space following the
question or on separate pages. Except as otherwise provided by paragraph
(d) of this rule, if in any interrogatory a copy of a paper is
requested, the copy shall be annexed to the answer. If the interrogatory
requests the name of an expert or treating physician of the answering
party or a copy of the expert's or treating physician's report, the
party shall comply with the requirements of paragraph (e) of this rule.
(b) Service of Answers; Time; Enlargement of Time. Except as
otherwise provided by R. 4:17-1(b)(2), the party served with
interrogatories shall serve answers thereto upon the party propounding
them within 60 days after being served with the interrogatories. For
good cause shown the court may enlarge or shorten such time upon motion
on notice made within the 60-day period. Consent orders enlarging the
time are prohibited.
(c) Copies; Service by Propounding Party. The original of the
answers shall be served upon the propounding party, who shall then serve
a copy of the interrogatories and answers upon each of the other
parties. Parties against whom default has been entered need not,
however, be served, and parties represented by the same attorney need be
served with one copy.
(d) Option to Produce Business Records. Where the answer to an
interrogatory may be derived or ascertained from or requires annexation
of copies of the business records of the party upon whom the
interrogatory has been served or from an examination, audit or
inspection of such business records, or from a compilation abstract or
summary based thereon, and the burden of deriving or ascertaining the
answer is substantially the same for the party serving the interrogatory
as for the party served, it is a sufficient answer to such interrogatory
to specify the records from which the answer may be derived or
ascertained and to afford to the party serving the interrogatory
reasonable opportunity to examine, audit or inspect such records and to
make copies, compilations, abstracts or summaries.
(e) Expert's or Treating Physician's Names and Reports. If an
interrogatory requires a copy of the report of an expert witness or a
treating physician, the answering party shall annex to the interrogatory
an exact copy of the entire report or reports rendered by the expert or
treating physician or a complete summary of any oral report. The
answering party shall further certify to not knowing of the existence of
other reports of that expert or treating physician, either written or
oral, and if such become later known or available, they shall be served
promptly on the propounding party, but in no case later than the time
provided by R. 4:17-7. If the answer to an interrogatory requesting the
name and report of the party's expert or treating physician indicates
that the same will be supplied thereafter, the propounder may, on
notice, move for an order of the court fixing a day certain for the
furnishing of that information by the answering party. Such order may
further provide that an expert or treating physician whose name or
report is not so furnished shall not be permitted to testify at trial.

Pizzolato sued Leighton in Monmouth County over herniated and bulging disks and a shoulder injury. She had surgery to remove bone from her hip for grafting near a metal plate in her neck. Pizzalato now has limited movement of her neck and tingling and numbness in her left arm.

(This information was obtained from the New Jersey Law Journal)

Defense noted that Guadara was outside the crosswalk. The evidence showed some of her pain could have been caused by shingles and a post accident fracture.

When DNI's driver delivered the lift to the site, he instructed Luso employees to drive the lift up a ramp. Rodriguez, though not a Luso employee, was one of the few workers on site who spoke English and he agreed. As he drove, the lift slid, crushing his right foot.

The jury found DNI 75 percent liable and Rodriguez 25 percent liable on the theory that he should not have been driving. The jury no-caused Luso.

* This information appeared in the New Jersey Law Journal

The plaintiff claimed the machine, made by Sterling Manufacturing of Wilkes-Barre, PA, was defectively designed because it lacked a safety latch to prevent the hammer and block from coming loose.

* This information appeared in the New Jersey Law Journal

According to the suit, Teresa Perez asked her landlord, Maurice Wolfe, to remove the peeling paint when Jonathan was 2 years old. After six months went by with no response, a test showed such high levels of lead that Jonathan was hospitalized for removal of the lead.

Perez sued in Hudson County in 2003 over Jonathan's neurodevelopmental disabilities, cognitive defects and learning disabilities.

(This information appeared in the New Jersey Law Journal)

Rodriguez's estate sued their primary care physician Jodi Abramowitz and a consulting cardiologist Mahesh Ghayal. The jury found that for the 14 months Rodriguez was her patient, Abramowitz failed to diagnose his coronary artery disease. At one point, she diagnosed him as suffering from malignant hypertension yet sent him home.

But the jury also found Rodriguez 20 percent liable for having delayed a visit to the cardiologist for six weeks after Abramowitz told him to go.

Rodriguez was hospitalized and died three days after his visit with Ghayal, but the jury found Ghayal did not deviate from the proper standard of care in his reading of the EKG or int he post diagnosis procedure he ordered. The jury assessed damages against him in the amount of 2 million for Rodriguez's pain and suffering and 2 million for the loss suffered by his surviving adult children.

(This information appeared in the New Jersey Law Journal)

Osborne has been unable to return to her job as a regional sales manager for a pet supply company. The other driver said a tie rod that broke loose from her car and was found at the scene caused a steering malfunction.

(This information appeared in the New Jersey Law Journal)

The lawsuit was brought by a former welder who suffers arm tremors and other movement problems that he says could be Parkinson's. Ernest G. Solis, 57, of Corpus Christi, is seeking unspecified damages from four welding rod makers.

It is the first trial among about 3,800 lawsuits from around the country that have been consolidated in federal court in Cleveland. Solis' case could set the ground rules for the other lawsuits.

At issue is whether manganese — a chemical element found in vitamin supplements, tea, nuts and grain, as well as the fumes from burning welding rods — can at high exposures lead to tremors or shaking, poor balance and difficulty walking and swallowing.

Companies that make welding equipment argue that a link between fumes and Parkinson's has not been established, and that in any case, warning labels and welding safety equipment minimize any risk.

~Associated Press

The boy, Thomas Yoon, was returning home from Buckland Park with his sister and a baby sitter when he was hit by a vehicle on Oct. 6, 2005. The driver and the baby sitter are also defendants in the suit, which was filed in State Supreme Court last week.

On May 30, a traffic light was installed at the location and a sidewalk was added. State, county and town officials were present for the unveiling.

But at the time of the accident, people had to weave through traffic to get across the street or walk along with traffic to get to the next crosswalk.

The boy's injuries include a traumatic brain injury, bilateral pulmonary contusion and paralysis and severe atrophy of the left calf muscle.

The suit, which asks for an unspecified amount of damages, claims that the "intersection, roadway, path, and area was also improperly designed, improperly constructed, improperly maintained, and the municipal defendants failed to correct a known dangerous condition."

During the planning process, the town did request that a traffic signal be added near the park, said Brighton Supervisor Sandra Frankel. However, Westfall Road is a county road, which means the county has the final say, she said.

(This information appeared in the New Jersey Law Journal)

A jury in Stamford Superior Court said Friday that the town and Officer Andrew Kelly were liable for a 2002 crash in which James Peterson, 21, suffered pelvic fractures and other injuries.

The jury found that Kelly failed to show due regard for other drivers while responding to a report of a traffic accident. An attorney representing the town said he did not yet know whether an appeal would be filed.

Kelly's police cruiser, with lights and sirens activated, struck the driver's side door of Peterson's car as Peterson attempted to make a left turn at an intersection.

After the accident, police cited Peterson for failure to yield the right of way to an emergency vehicle and failure to grant the right of way at a stop sign.

Peterson's suit contended that Kelly's speed was so excessive that there was no reasonable expectation that the police car's approach could have been seen.

(This information was obtained from the New Jersey Law Journal)