Everything You Need To Know About The “Serious Injury” Threshold

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Massachusetts is a “no-fault” state, which means that if you are involved in a car crash, you notify your insurance company first for reimbursement for medical bills and lost income.

Only in certain severe cases will you include the at-fault party’s insurance company. In these situations, the injuries are serious and often cause long-term damage. Claim holders must meet a “serious injury” threshold or “lawsuit threshold” before they can involve another insurance company or the court system.

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PIP Coverage in Massachusetts

In Massachusetts, medical expenses are limited to two years after the accident, and you can receive 75% of your average weekly wage for lost wages. PIP coverage will also only pay the first $2,000 in medical bills. Additional fees should be billed to your health insurance. However, any deductibles, co-pays, or other out-of-pocket expenses can be charged to the PIP coverage for reimbursement. PIP will pay up to $8,000 in medical bills, but only if you do not have a private health insurance plan.

The insurance company providing PIP coverage can request that you submit to an independent medical examination (often known as an IME). This exam will determine whether you will need additional medical treatment and whether the treatment you have received thus far has been helpful or necessary. If that particular doctor determines that you do not need treatment any longer, PIP will stop paying your medical bills, even if another doctor says that you still need medical services.

PIP coverage will also help pay for services that the individual would have performed if not for the accident, such as childcare cleaning services. However, in reality, these benefits are few and far between.

Regardless of what kind of benefit you receive, the PIP benefit will only reach $8000 in total.

What is the Serious Injury Threshold?

When you have been involved in a serious accident, you can use remedies available outside of the no-fault system. The no-fault system in Massachusetts does not allow for claims like pain and suffering or loss of enjoyment of life. Instead, you are limited to claims that are tied to specific, quantifiable damages, such as lost wages and medical expenses.

Every state defines “serious injury” slightly differently. In Massachusetts, your injuries considered “serious” if you have more than $2,000 in reasonable medical expenses or you have suffered from severe and permanent disfigurement, broken bones, loss of hearing, or loss of sight.

Once your claim reaches the serious injury threshold, your damages can increase significantly under the law. This is because your PIP coverage provider is no longer involved, and your costs are paid through a different insurance company or the person at fault.

Getting a Claim Started

Regardless of whether you think your PIP coverage applies, you should notify your insurance company immediately after an accident. You may have notice requirements that must be met to assert a claim against your own insurance carrier. However, avoid signing anything before having it reviewed by an experienced car accident lawyer in Massachusetts. Contact Jim Glaser Law today at 781-689-2277 or fill out our online form to request a free case evaluation.