Two model cars representing car accident on paper reading plaintiff vs defendant

Making an Insurance Claim vs. Filing a Lawsuit 

Law Office of James A. Maniatis Sept. 30, 2022

Massachusetts is one of 12 states that have instituted no-fault accident insurance standards. In other words, when you’re injured in an auto accident in the Commonwealth of Massachusetts, you are covered by the Personal Injury Protection (PIP) feature of your mandated auto insurance policy. Currently, the minimum PIP coverage you can purchase is $8,000. 

This means that you must turn to your own PIP coverage to pay for your medical expenses when you suffer an injury in a vehicular accident, even if the accident is the other driver’s fault. Fortunately, Massachusetts law also provides an option to sue the other driver under certain circumstances. You can file a personal injury lawsuit if your “reasonable” medical expenses exceed $2,000 or your injuries are permanent and severe and will affect your quality of life.  

A point to remember here is that PIP will reimburse only for medical expenses and lost time at work, but not for noneconomic damages such as pain and suffering. To cover noneconomic losses, you must file and win a personal injury lawsuit. 

If you or a loved one has been injured in an automobile accident in the Commonwealth of Massachusetts and the injuries are the fault of the other driver’s negligence, contact me immediately at the Law Office of James A. Maniatis. I have 30 years of experience in pursuing personal injury claims through both the insurance system and the legal system, and I will be able to guide you through the process to obtain the just compensation you deserve. 

I maintain offices in Shrewsbury, Southborough, and Webster, Massachusetts, but proudly serve clients in all neighboring areas, including Westborough, Northborough, Grafton, Boylston, Millbury, Upton, Dudley, and Oxford. 

Difference Between an
Insurance Claim & a Lawsuit 

The primary difference between seeking a settlement for your injuries through your insurance carrier and through a personal injury lawsuit is the type and amount of compensation available. Your PIP rider is capped at whatever sum you purchased – the minimum is $8,000 – and is limited to economic losses for medical expenses and time lost from work. 

A personal injury jury award has no real monetary cap and will also compensate you for noneconomic losses such as the pain and suffering you’re undergoing, and even for the loss of consortium or companionship you endure as a result of your injuries. 

Of course, in one type of claim, you have to convince a claims adjuster, and in the other a jury of your fellow citizens or a judge. 

Pros and Cons of an Insurance Claim 

In addition to the limits on an insurance claim discussed above, keep in mind that your PIP coverage Is reduced by the amount of your deductible. Say you have a $1,000 auto insurance deductible to make your monthly premium more affordable. That leaves $7,000 for PIP expenses and losses. 

Also, if you have health insurance, your PIP coverage may require you to use your medical coverage to pay for your injuries, and auto insurance will cover only your deductible and copays.  

The biggest challenge with a PIP claim, however, is having to deal with the insurance company’s claims adjuster assigned to your case. A claims adjuster is a trained professional who employs an arsenal of tricks and strategies to get you to say or do something that can justify lowering or denying your claim.  

Many people, unfamiliar with these tactics, may end up saying something – or even signing a document without attorney review – that leads to a lowball settlement offer. Don’t ever deal with an insurance adjuster on your own. Let an experienced attorney handle all negotiations and review all documents. 

Pros and Cons of a Personal Injury Lawsuit 

Going to court presents challenges of its own. First, you have to wait to have your case heard, so time can become a significant element. Whereas you may be able to settle an insurance claim in a few weeks, court battles can continue on and on. Meanwhile, your expenses – which you hope to cover with your jury award – can accumulate. 

Though a jury award can far exceed an insurance company settlement in terms of compensation and losses covered (noneconomic in addition to economic), you have to decide whether the cost in time and attorney’s fees can justify the effort. Certainly, if you’re facing a life-altering injury, the extra time and cost will be well worth it, but if it’s just a few thousand dollars more, you may have a more difficult decision to make. 

In Both Situations: Modified Comparative Negligence Sets Limits on Claims 

Massachusetts relies on the modified comparative negligence rule when deciding on who’s at fault in an automobile accident. In short, this principle recognizes that both drivers may have played a role in what happened. For instance, if Driver A is rear-ended by Driver B and sustains $20,000 in losses, Driver A will expect full compensation for that amount. 

But wait a minute: Driver A’s brake lights were malfunctioning at the time of the collision, which contributed to Driver B’s response time. Therefore, Driver A is partially responsible. Say the claims adjuster or the jury decides that Driver A is 30 percent responsible, then the $20,000 settlement or award is reduced by 30 percent – from $20,000 to $14,000. 

If Driver A’s responsibility is set at above 50 percent, then no compensation can be obtained. To win a settlement or judgment, your percentage of fault must be 50 percent or less. This is why modified comparative negligence is also known as “the 51 percent rule.” If your part is found to be 51 percent or above, you have no claim. 

Obtain Legal Counsel
& Choose the Best Option 

Whenever you suffer injuries in an accident, contact a personal injury attorney immediately. Let that person evaluate the situation and advise you of the best option going forward. At the very least, let the attorney handle all negotiations with the insurance company. An experienced attorney knows all the tricks of the trade used by claims adjusters and can fight for the best settlement possible. 

Your attorney can also advise you if a personal injury lawsuit offers a more favorable avenue to obtaining the just compensation you deserve. Remember, your PIP policy has caps on it, both in terms of what’s covered and in the total amount available for compensation. A lawsuit is more wide open. 

If you or a loved one is injured in an accident in the Commonwealth of Massachusetts, reach out immediately and contact me at the Law Office of James A. Maniatis.  

I will review the circumstances of your accident and injuries and advise you on the next steps. I will then stand by your side as we work toward obtaining the just compensation you deserve, whether through an insurance claim or a personal injury lawsuit. Let me do the heavy lifting, so to speak, while you recover from your injuries.