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In Massachusetts, Personal Injury Protection (PIP) benefits are often found in drivers’ car insurance policies. While this type of coverage is not required by law and can be waived, it is frequently purchased by Massachusetts drivers. These are often described as “no-fault” benefits and are available to the driver or a passenger of the insured vehicle. They are also available to injured pedestrians from the policy of the vehicle that hit them. PIP benefits were designed to cover reasonable and necessary medical expenses, funeral expenses, loss of wages, and ordinary and necessary household services that you can no longer provide for yourself as a result of the injury. However, the amount of PIP available to an injured party may vary, depending on several factors.

Someone injured in an auto accident while working cannot access PIP benefits, since he or she would be able to use workers’ compensation benefits, which also cover medical expenses, funeral expenses, and lost wages. They are also unavailable to those who are injured while committing a felony or driving while under the influence. The maximum amount of PIP benefits is $8,000.00, but only $2,000.00 of those benefits are assuredly available to the injured. If the claimant does not have health insurance or MedPay, he or she is covered up to $8,000.00. If the policy holder has a separate health insurance policy, any amount over $2,000.00 must be submitted to the health insurer for a determination of whether or not the claim is covered. The claim cannot be denied based solely upon the existence of PIP, but if the claim is not covered under the health insurance policy, it can be denied by the health insurer for reasons outlined in the policy. The claim may be re-submitted to the motor vehicle insurer for consideration. While an auto insurance carrier can deny claims using the same reasons as the medical insurer, such as the injured person going to an out-of-network provider, it must pay for items that may not be included in the health insurance plan, like chiropractor and dentist visits.
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Workers’ compensation injuries often involve individuals who work for companies that perform contract tasks for other entities. Workers’ compensation is designed to provide financial relief to an injured employee, while removing the possibility of extensive litigation for the employer. In other words, if an injured worker obtains Massachusetts workers’ compensation benefits, she or he is generally precluded from pursuing negligence damages in a civil suit with the employer that carries the insurance. However, if another party is either partially or fully responsible for the injuries, such as a contractor, the employee can pursue civil action against the third party in addition to the workers’ compensation benefits received.

Massachusetts General Laws, Ch. 152, Section 15, allows an injured employee to receive workers’ compensation from his or her employer, but it also provides the employer’s insurer the opportunity to place a lien over any third-party settlement for its payment to the employee. This statute allows the insurer to recover costs already paid to the employee and includes the ability to offset future compensation benefits. The injured employee receives the remaining amounts in addition to amounts he or she paid toward costs from the third-party settlement.

A recent Massachusetts Appeals Court case provides an example of how far insurance companies will go to recoup the costs paid to an injured employee. In DiCarlo vs. Suffolk Construction Company, an injured worker received workers’ compensation benefits and then sued the owner of the building and received a settlement from the third-party tortfeasor. Part of this settlement was allocated as non-economic damages to the injured employee for pain and suffering and lack of consortium for his spouse. The employer’s workers’ compensation insurer attempted to file a lien under G. L. c. 152, § 15, with the insurer insisting that the lien applied to the non-economic damages. The Appeals Court disagreed and ultimately allowed the injured worker and his spouse to keep the portion of the settlement allocated as non-economic damages.
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When accidents happen at the workplace, the injured person has no control over the severity of the injury and whether or not he or she suffered from other medical ailments independent of the workplace. Pre-existing conditions often present large hurdles to obtaining workers’ compensation benefits. While fault or negligence does not have to be shown, the injury must have occurred while furthering the business of the employer. Complex medical records and expert testimony from physicians or other medical professions may be necessary to show the origins of the injury and what type of medical treatment will be necessary to make the employee whole from the work-place accident.

In Lastih v. Erickson Retirement Community, a bus driver for a retirement community injured her lower back while lifting a resident’s walker. After a denial by the insurance company for benefits, she sought a hearing in front of a Workers’ Compensation Judge, where the insurance company claimed that she had pre-existing conditions as its defense. The judge ruled in favor of the injured bus driver, relying on testimony from the impartial medical examiner, who opined that she sustained lumbar and sacroiliac (lower back) strain that aggravated the pre-existing degenerative joint and disc disease in her spine. The judge found her to be totally incapacitated and ordered benefits. No party appealed this decision.

Two years later, the insurer filed to have the benefits discontinued, which was denied. The insurer then had another impartial medical examiner assess the injured bus driver. The insurer withdrew the appeal following the report, and the employee filed for total, permanent incapacity benefits. After an additional examination, reports, and appeals, the judge awarded total and permanent benefits. The judge found that the employee’s disability was casually related to the injuries she sustained when lifting the resident’s wheelchair onto the bus.
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In Massachusetts, when a medical malpractice action is filed in court, the case must be submitted to the Massachusetts Medical Malpractice Tribunal (MMT) for review. The MMT was established in the mid-1970s, and it does not apply to those who present claims in a letter addressed to the healthcare provider. The tribunal has one superior court judge, an attorney, and a Massachusetts-licensed healthcare provider. The provider is often a physician but can be a nurse, pharmacist, or physical therapist; and he or she must be a provider that works in the same medical specialty in which the alleged injury occurred.

Tribunals ask the question of whether or not the injured person or the deceased person’s estate has enough properly substantiated evidence to bring a case before a jury. A statement from an expert stating the standard of care was breached and caused injury to the patient must be included. The MMT reviews medical, hospital, and office records to make a determination. If two of the three panelists agree with the injured patient, the case can proceed. If the MMT agrees with the defendant hospital or physician, a bond has to be posted to proceed.

In a Massachusetts case, Thou v. Russo, the Appeals Court reviewed an appeal from a dismissed malpractice action. The deceased patient suffered a heart attack after liposuction and abdominoplasty procedures. The injured patient’s estate filed suit against the anesthesiologist, who used a solution containing lidocaine and epinephrine delivered through “several small stab incisions” in the areas to be suctioned. During the surgery, the patient’s blood pressure dropped, and emergency procedures were performed for an hour and a half. The patient became stable for an hour and a half but eventually went into cardiac arrest.
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Massachusetts residents often travel to nearby states, and several out-of-state drivers make their way to Massachusetts. If an accident occurs in Massachusetts, and the at-fault party has an out-of-state policy, the question of which law applies may arise in a personal injury action, especially if there’s a difference in the required minimum coverage. Individual states each have their own car insurance policy requirements that dictate minimum amounts of coverage. Individual insurance companies have uniquely written policies that comply with the state in which they are licensed. As medical bills add up, maximizing the amount paid by an insurance company can mean saving thousands of dollars, and a judicial determination of which law applies can affect how much is paid out of pocket.

A Massachusetts state appellate case, Clarendon Nat’l Ins. Co. vs. Arbella Mutual Ins. Co., provides an example of how state courts handle this situation. In this case, a woman was driving a loaner car from her dealership when she had a car accident with four other vehicles. The loaner car was covered by an insurance policy in Rhode Island. When there are two competing laws that could apply to a car accident, the forum state’s conflict-of-laws rules choose which state’s law is applicable. The accident in Clarendon occurred in Massachusetts, so the court looked to Massachusetts case law and the Restatement of Conflict of Laws to determine whether Massachusetts or Rhode Island insurance law applied.
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When workers are injured in Massachusetts, they have access to different types of workers’ compensation benefits: temporary disability, permanent partial disability, and permanent total disability. When filing a claim for benefits under the Workers’ Compensation Act, there is no need to prove that a co-worker or employer was negligent. An injured worker must only show that there was an injury that occurred during the course of employment. This can require extensive medical testimony, and it usually involves a prediction about the effects of the injury upon the worker in the future.

The questions, “Is there anything I can do if my condition worsens?” and “What happens if my benefits run out?” may arise following an award of permanent partial disability. The Reviewing Board Decision of Tsitsilianos v. Worcester Housing Authority sheds some light on the process. In this case, the Board looks at two cases determining the award and claim of partial incapacity and total incapacity benefits under § 35 and § 34 benefits, respectively.

A Massachusetts industrial worker had previously been awarded payment of § 35 benefits, including medical bills and psychiatric treatment for an accident that resulted in bilateral trauma to his calf muscles and depression. However, the judge denied full disability, since the orthopedic physician opined that he could still perform full-time sedentary light work. After the employee exhausted his § 35 benefits, he refiled for total incapacity benefits, which were denied at conference. During an appeal, additional medical evidence regarding the worker’s physical injuries was submitted, but the judge determined there was insufficient proof of the worker’s mental health decline and denied benefits.
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Civil litigation revolves around questions of whether the named party or parties were negligent and whether the defendant or defendants caused the injury. There is less of a general discussion around another element that must be proven: damages. It is easy to assume that if someone was injured, he or she is probably paying for doctors’ bills and prescriptions that were previously absent from his or her daily life. However, if the injured party had pre-existing medical conditions with overlapping symptoms, the proof becomes much more intricate than providing a stack of receipts to the court. Medical experts may be necessary to testify as to what physical and psychological conditions, and therefore treatment of those conditions, can be attributed to the accident. Testimony may also be necessary to not only show what happened in the past but advise what lifelong impairments will result from the injury.

In a recently published decision, Fyffe v. Massachusetts Bay Transportation Authority, the Massachusetts Court of Appeals addressed several issues stemming from a damages-only trial. The woman was injured when she rode a public transit trolley that crashed into another trolley. Both sides agreed that the operator was negligent, but they disagreed as to what the defendants’ obligation was for reasonable and fair compensation for the injuries she suffered. The woman was employed as a gate agent for an airline and suffered injuries to her spine from the accident. The injuries prevented her from performing one of her main duties of lifting heavy suitcases. She was able to earn up to $40,000 per year plus benefits and was eligible for a 4% raise every three years, but she found herself working as a waitress for around $15,000 a year due to her injuries.
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You may be eligible for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) if you have become incapacitated in a way that would prevent you from maintaining employment. To obtain these benefits, you must be unable to work as a result of a medical condition that will last more than a year or result in death. The condition does not have to be work-related. In order to qualify for SSDI, you must have worked, but employment history is not necessary for SSI.

The United District Court of Massachusetts issued an opinion in Burgos v. Mastroianni regarding the final decision by the Commissioner of the Social Security Administration in denying a woman’s application for SSI benefits. In any review of a decision to deny benefits, the District Court is obligated to uphold the decision if the ruling is supported by substantial evidence that a reasonable mind would find adequate.
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Assumption of the risk is a term you may have heard while participating in an activity that is either strenuous or involves an amount of danger. A company may ask you to sign a waiver of liability before you or a friend bungee jumps or rides across a zip line. Waivers of liability can also be found at gyms or participant sporting events. When death or injury happens to a participant in an athletic activity, the tragedy is amplified by the fact the injured person was attempting to enhance, not hinder, health. If injury or death occurs, questions may arise as to whether or not a signed waiver of liability can act as a complete shield to accountability in the civil justice system.

Recently, the United States District Court of Massachusetts rendered a Memorandum and Order in Angelo v. USA Triathlon, which supported a portion and denied a portion of the organization’s Motion for Summary Judgment. The deceased person was a member of a Triathlon association and signed an agreement to waive and release the liability of the organization. During the triathlon, the man died during or shortly after the swimming event. The wife filed suit on behalf of his estate and alleged that the organization wrongfully caused his death, pain and suffering prior to his death, and infliction of emotional distress as a result of the company’s gross negligence. The triathlon company moved for partial summary judgment, based on the signed waiver of indemnity agreements.
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As school and extra-curricular activities pick up around the state of Massachusetts, concern over serious and permanent injuries may arise among parents. Even with the best of care and protective gear, accidents can happen on sports fields or while in a bus on the way to an activity. No parent wants to see any type of harm befall his or her child, but knowledge of what options are available in the event of an injury is essential when there is a catastrophic injury to the head, neck, or spine. Accountability is also important if a person or facility failed to maintain safe premises as required by law. A civil action may provide the remedies you need by holding an at-fault party responsible for negligence and receiving payments for the money spent on medical expenses.

One of the first steps of a personal injury suit is determining who is responsible for the injury. In most auto accident cases, it is a straightforward determination that the driver of the car that caused the harm is the responsible party. In other personal injury suits, several parties can share blame for the injury. In the 2013 Massachusetts case, Moore v. Town of Billerica, the Court looked at whether or not the city should be held accountable for a serious head injury sustained by a child at a public baseball field. The trial court denied the city’s motion for summary judgment, which claimed that it could not be sued due to the protection of sovereign immunity.
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