The Medical Expense Threshold in Massachusetts Car Accident Claims

If you’re in a car accident in Massachusetts, your own Personal Injury Protection policy should pay up to $8,000 in combined medical and wage loss benefits. After the first $2,000 in medical bills, your health insurer (if you have one) typically becomes the primary payer, with PIP covering certain remaining eligible expenses depending on coordination of benefits. Your PIP policy does not pay for your pain and suffering. PIP coverage also does not pay for any damage to your car.

To file a claim for pain and suffering against an at-fault driver, you must meet the criteria for filing a tort claim in Massachusetts. However, even if you do not meet the tort threshold, you may still pursue recovery from an at-fault driver for economic losses not covered by PIP, subject to liability rules.

In those cases, accident victims can:

• Seek compensation for the amount of medical bills and lost wages that their PIP insurance does not cover.
• Seek payment for the damage to their car – generally, the cost to repair the car, unless the car is totaled (in which event the damage is the value of the car).

What are the criteria for filing a tort claim against an at-fault driver?

Under Massachusetts law, accident victims must meet one of the following thresholds to recover pain and suffering damages in a motor vehicle case:

The victim’s reasonable and necessary medical expenses must exceed $2,000

The medical bills must be reasonable and necessary and relate to the treatment of your injuries. Medical bills may include the following:

• Emergency care. This category includes the cost of emergency medical transportation and the initial care and treatment by an emergency room doctor.
• Hospital expenses. This category includes surgeries and all other types of hospital care.
• Physician visits. These costs include visits with a family doctor, a specialist, a physical therapist, and other doctors.
• Rehabilitative therapy. These medical bills include visits with physical therapists, occupational therapists, vocational therapists, and other types of therapists.
• Diagnostic tests. These include X-rays, CT scans, MRIs, ultrasound, and blood tests.
• Prosthetic devices and other assistive devices.
• Prescription medications.
• Ambulatory surgical procedures outside of a hospital.
• Dental services.
• Professional nursing expenses.

Serious injury qualifications

A car accident victim can also qualify for the tort threshold if the car accident causes:

• A wrongful death. We can file a wrongful death action on behalf of the family of the fatal car accident victim.
• The loss of a body member (in whole or in part). An example is a traumatic amputation of a limb, hand, finger, foot, or toe.
• Permanent and serious disfigurement (in whole or in part). An example includes a third-degree burn injury.
• Loss of hearing or vision.
• A bone fracture.

The advantage of the Massachusetts no-fault system and PIP benefits

Massachusetts General Laws Chapter 90, Section 34M provides for PIP coverage to ensure that accident victims can receive prompt medical care and prompt wage loss payments without having to wait for their car accident case to resolve (either through a settlement or a determination of fault). Massachusetts also provides for PIP coverage in the hope that many accident victims will accept their PIP benefits without filing an at-fault claim (regardless of whether the victim meets the tort threshold).

PIP coverage is generally available for drivers and car owners, up to $8,000. PIP coverage includes:

• Medical bills. These costs include emergency medical transport, ER care, hospital care, doctor visits, rehabilitative therapy, assistive devices, and prescription medications.
• Lost wages. PIP pays your lost wages up to 75% of your lost income – up to the remaining balance of your overall PIP benefits (including your medical bills).
• Replacement (Substitute) Services. PIP also compensates accident victims (again, up to the policy limit) if an accident victim needs to hire someone to perform tasks, such as household cleaning, that the victim can no longer do.

What is pain and suffering, and why is it an important part of your car accident claim?

The term pain and suffering refers to the daily physical pain and emotional suffering of an accident victim due to their injuries from the accident. Pain and suffering include the physical pain and emotional distress caused by your injuries, such as discomfort, anxiety, sleep disruption, and other effects.

Pain and suffering also include the inability to enjoy the things you could enjoy before the car accident.

Often, in car accident cases, where victims meet the tort threshold, the pain and suffering amount is much more than the medical bills and the lost income combined.

Steps you should take to show you meet the $2,000 threshold or the serious injury threshold.

We can request medical bills and medical reports from your healthcare providers to verify that you meet the criteria for a serious injury. Steps to meet the tort threshold requirements include the following:

• Keep a list of every medical provider you see and the date you saw the provider.
• Keep a list of every prescription medication you take.
• Keep all the correspondence, including bills, that your healthcare providers give you.
• Keep your medical appointments and follow your healthcare provider’s advice.
• Keep a personal journal of your pain and suffering, including focusing on the things you couldn’t do or enjoy because of your injuries.
• Take photos of your injuries as soon as possible after the accident and during the recovery process.

The insurance company for the at-fault driver does not determine whether you meet the $2,000 threshold or the serious injury threshold. We can review your medical records with you and your doctors to help support your claim. If there is no agreement between you and the insurance company, a court will ultimately decide whether the threshold requirements are met.

In Massachusetts, you must file for your car accident claim against an at-fault driver (whether you are seeking pain and suffering or just financial damages) within three years from the date of the accident.

Any passengers in your car who wish to seek pain and suffering damages against an at-fault party must also show that they meet the tort threshold requirements.

Passengers are subject to the same $2,000 (or death or serious injury exception) to seek pain and suffering damages from an at-fault driver.

Contact our Brockton lawyers now

Call The Law Offices of Gerald J. Noonan today to discuss your full right to compensation after a car accident in Massachusetts. We can review if you meet the tort threshold requirements. Please contact us to schedule a free consultation.