Catastrophic Injury FAQs: Brain and Spinal Cord Injuries

Often, yes, though Massachusetts law has no single definition of "catastrophic." Lawyers use the term for injuries that permanently change how a person lives or works, such as a moderate or severe traumatic brain injury, a spinal cord injury with paralysis, an amputation, or severe burns.

The label matters less than what follows from it. These claims depend heavily on proof of future care and lost earning capacity, and a single policy is often not enough, so every responsible party and every layer of insurance, including umbrella and underinsured motorist coverage, has to be identified. Our catastrophic injury [page describes the cases we take.

Because the early signs can be subtle and the first scan can be normal. The CDC says some concussion and mild TBI symptoms appear right away, while others may not appear for hours or days. An emergency room CT scan looks mainly for bleeding, swelling, and fractures, and a normal CT does not rule out a brain injury.

In a busy ER, a patient with a broken leg or visible cuts may be treated for those, with a headache or confusion noted only in passing. Problems such as memory gaps, slower thinking, irritability, and trouble returning to work often surface weeks later at home. Read more about traumatic brain injuries.

Yes. A brain injury can be proven through how a person functions, not only through imaging. Useful proof includes:

• The ambulance and ER records, including any confusion, memory loss, or loss of consciousness.
• Neuropsychological testing, which measures memory, attention, and processing speed.
• Follow-up with a neurologist and treatment such as speech or cognitive therapy.
• Statements from family, coworkers, and friends who can compare the person before and after.

The defense may argue that symptoms come from stress or an earlier condition. Consistent treatment and credible witnesses who knew the person before the injury are how that argument is tested. Our brain injury lawyers help families gather this record.

Usually with a life care plan and an economist. A life care planner, often a rehabilitation nurse or physician, works from the treating doctors' records to list each future need: therapies, medications, equipment and its replacement, home and vehicle changes, attendant care, and likely complications. An economist then calculates the cost over the person's expected lifetime and states it in today's dollars. Doctors in fields such as physical medicine, neurology, or neuropsychology often support the plan, and life expectancy itself can be disputed.

National averages show the scale. The National Spinal Cord Injury Statistical Center's 2025 figures, in 2024 dollars, estimate first-year costs of about $1.41 million for high tetraplegia (C1 to C4) and about $687,000 for paraplegia, with costs every year after, not counting lost wages. Averages are not proof in a specific case. A plan built on one person's medical needs is. See our spinal cord injury page.

It is based on what the person could have earned over a working life, not only the wages missed so far. A vocational expert looks at education, skills, work history, and the injury's limits, and an economist projects the earnings, benefits, and raises lost over time.

This matters most for younger people with short work histories. For example, an apprentice electrician in their early 20s who can no longer do physical work may have lost the higher pay a licensed electrician earns later in a career, and that loss has to be shown with evidence. When a person can still work in a different job, the claim is the difference between the two paths. Read how damages are measured.

Yes, within limits. Massachusetts recognizes loss of consortium claims for close family members of a person who is seriously hurt:

• A spouse can claim the loss of companionship and support (Diaz v. Eli Lilly & Co., 364 Mass. 153 (1973)).
• A minor child who depends on the parent, both financially and for closeness, guidance, and nurture, can claim the loss of the parent's society (Ferriter v. Daniel O'Connell's Sons, Inc., 381 Mass. 507 (1980)).
• Parents of a seriously injured minor child, or of an adult child dependent on them for support, can claim under M.G.L. c. 231, § 85X.

When the injury happened at work, M.G.L. c. 152, § 24 generally bars these family claims against an employer covered by workers' compensation, unless the worker reserved common law rights in advance. Claims against other responsible parties are not barred by that rule. If a catastrophic injury later leads to death, our wrongful death FAQs explain the family's rights.

Several sources, in an order set by law and by each policy. After a car crash, PIP benefits come first and coordinate with health insurance, as our motor vehicle accident FAQs explain. Health insurance, MassHealth, or Medicare then usually pays. If the injury happened at work, workers' compensation pays medical bills and part of lost wages, even while a claim against an outside party goes forward.

For someone who cannot work for a year or more, Social Security disability benefits may help. See our Social Security disability page. The at-fault party's insurer generally does not pay bills as they come in. It pays at settlement or judgment.

Usually, yes, and each follows its own rules:

• Medicare. Under the Medicare Secondary Payer Act, 42 U.S.C. § 1395y(b)(2), Medicare's payments for injury-related care are conditional, and Medicare has a recovery claim against a liability settlement or judgment. Medicare has its own procedures for disputing charges and requesting reductions or waivers, and future Medicare-covered care should be considered when the case settles.
• MassHealth. M.G.L. c. 118E, § 22 gives MassHealth repayment and subrogation rights for benefits it paid. Under § 22(j), the claimant or the claimant's attorney must notify MassHealth in writing within 10 calendar days of making an insurance claim, sending a demand letter, or filing suit.
• Private health plans. Many plans, especially self-funded employer plans, have reimbursement terms that can be strong.
• Workers' compensation. The insurer is generally repaid from a third-party recovery under M.G.L. c. 152, § 15, with a share of attorney's fees and costs taken into account.

These claims have to be resolved before settlement money is paid out. Read about third-party claims after a work injury.

Compensatory damages for physical injuries generally are not. Under 26 U.S.C. § 104(a)(2), damages other than punitive damages received on account of personal physical injuries or physical sickness are excluded from income, whether paid as a lump sum or in periodic payments. That includes emotional distress damages that flow from the physical injury.

Some amounts are taxable. Punitive damages are taxable, and so is interest. Amounts that reimburse medical expenses you already deducted on an earlier tax return can be taxable. Emotional distress damages that are not tied to a physical injury generally are taxable, except to the extent they pay for medical care. A tax adviser should review a large settlement before it is signed. Our injury lawyers coordinate with the family's advisers.

A structured settlement pays some or all of the recovery over time, usually through an annuity bought as part of the settlement. When it is set up correctly at settlement, typically through a qualified assignment under 26 U.S.C. § 130, the periodic payments, including the growth built into them, are generally tax-free under § 104(a)(2). Buying an annuity yourself with a lump sum after the case ends does not get the same treatment, and investment earnings on a lump sum are taxable.

A structure can guarantee income for life and protect against spending too fast. It cannot easily be changed later. In Massachusetts, a sale of future structured payments to a buyer requires court approval under M.G.L. c. 231C. The right split between cash for immediate needs, such as a home modification, and scheduled payments for ongoing care depends on the person's age, health, and needs. Talk with us about the options before a settlement is final.

It is a trust that holds settlement money for a person with a disability without cutting off needs-based benefits such as SSI and MassHealth. Under 42 U.S.C. § 1396p(d)(4)(A), a trust for a disabled person under 65 can be set up by the person, a parent, a grandparent, a legal guardian, or a court, as long as MassHealth is repaid from what remains at the person's death. The person has been able to set up their own trust since a December 2016 change to the law. A pooled trust run by a nonprofit, under § 1396p(d)(4)(C), is another option.

Not everyone needs one. Medicare and private insurance are not needs-based, so a person relying only on them may not. A person who relies on SSI or MassHealth, especially for long-term care, may lose eligibility if a lump sum is paid directly to them, depending on the amount and the program's rules.

A family member may need court authority to act. Under the Massachusetts Uniform Probate Code, M.G.L. c. 190B, the Probate and Family Court can appoint a guardian to make personal and medical decisions and a conservator to manage money and property for an adult who is incapacitated.

This can matter for the injury case itself, since someone with legal authority has to sign a fee agreement, approve a settlement, and receive the funds. A power of attorney or health care proxy signed before the injury may cover some of this. Our catastrophic injury lawyers work with probate counsel when an appointment is needed.