124 CMR 2.06
Compensable Expenses
The following expenses are compensable in accordance with the following requirements:
(1) Fund of Last Resort. A claimant must demonstrate that the compensable losses sought or
legal liability exceed reimbursements or eligibility for reimbursement or compensation from any
other source including all sources listed in 124 CMR 2.08(2)(e). Awards for compensation shall
be reduced by all amounts reimbursed, reimbursable or otherwise compensable by any other
source.
(2) Funeral and Burial Expenses. The maximum award for funeral and burial expenses shall
be $13,000. An award for funeral and burial expenses to be provided in the future may be based
on a bona fide contract for services. A legal guardian, dependent or other family member of the
victim or a person who actually incurs funeral and burial expenses directly related to the death
of a victim shall be eligible for compensation for such funeral and burial expenses.
(3) Ancillary Expenses. The maximum award or compensation for expenses other than funeral
and burial expenses associated with the interment of a victim whose death is the direct result of
a crime shall be $4,000. For purposes of 124 CMR 2.06(3) compensable expenses shall include,
but not be limited to:
(a) transportation of the victim to the location of interment;
(b) travel of a legal guardian or family member to accompany the victim to the location of
interment;
(c)
memorial markers at the location of interment or other associated expenses as
determined by the Agency in accordance with 124 CMR 2.00.
(d) in order to receive payment under 124 CMR 2.06(3) the claimant must submit receipts,
cancelled checks, bills for products and services provided, or other proof of payment or
liability for products or services. An award for expenses under this category may be based
on a bona fide contract for services to be provided.
(4) Medical Expenses. A victim shall be eligible for compensation for reasonable medical care
obtained as a result of the crime.
(a) Compensation for medical expenses is limited to services, supplies and equipment that
are medically necessary as a direct result of the crime. Compensation shall not be awarded
for unrelated conditions or services, or for preexisting conditions except to the extent they
were exacerbated by the crime.
(b) Compensation for transportation costs incurred while obtaining medical care is limited
to costs incurred for emergency and non-emergency ambulance service, chair car service,
dial-a-ride, taxi, or ridesharing service obtained. It does not include compensation for public
transportation, or mileage or parking when private transportation is used.
(c) The claimant must demonstrate an out-of-pocket loss or legal liability for payment of
compensable medical expenses which are not reimbursed or reimbursable by any other
source. In order to make this demonstration, the claimant must:
1. submit all bills to insurance providers;
exhaust all other sources of public reimbursement including medicaid, medicare,
workers compensation, social security, veterans benefits, and care funded by the Health
Safety Net Trust Fund under M.G.L. c. 118G;
comply with all reasonable requests by the Agency to secure information and
verifications necessary to investigate the claim.
2.06: continued
(d) Upon request by the Agency, medical providers are required to:
verify that the services rendered are medically necessary as a direct result of the
crime. Where medical services or therapy extend beyond six months or 30 sessions
(whichever is greater), the Agency may, as a condition of further payment, require current
verification that the services are medically necessary as a direct result of the crime.
2. provide current billing and balance information, including information about amounts
covered by insurance, public benefits or other sources, and current information about any
amounts paid and by whom;
3. certify whether the services rendered are reimbursable by medicaid;
4. in the case of hospitals, assist the claimant in applying for health insurance or care
funded by the Health Safety Net Fund under M.G.L. c. 118G.
(e) All health care providers must be licensed in accordance with 124 CMR 2.03.
(f) The Agency may authorize an award for outstanding medical expenses payable directly
to the health care provider, but only if said provider has fully cooperated with the Agency in
the administration of the claim. Otherwise, awards shall be made payable solely to the
claimant.
(g)
If an acute or non-acute hospital provides compensable medical services, any award
made payable jointly to the claimant and the hospital shall be based on current payment rates
established by the contract between the hospital and the Executive Office of Health and
Human Services in accordance with M.G.L. c. 118E, § 12 and M.G.L. c. 118G, § 11.
Amounts awarded for all other medical services shall be based on reasonable fees charged.
If the health care provider employs a sliding scale fee structure for any category of patient
or service, the award shall not exceed the amount the claimant would be charged if the
claimant qualified under the provider's sliding scale fee structure.
(h) Any health care provider that receives payment from the Commonwealth for medical
services, supplies or equipment pursuant to an award under M.G.L. c. 258C shall, as a
condition of the receipt of such payment, accept such payment as discharging in full any and
all obligations of the claimant to pay, reimburse or compensate the provider for medical
services, supplies or equipment, that have been reimbursed under M.G.L. c. 258C.
(5) Mental Health Counseling. A victim, the dependents and family members of a homicide
victim, or the parent or legal guardian of a victim who is a minor shall be eligible for
compensation for reasonable mental health counseling expenses incurred as a direct result of the
crime. Compensation shall not be awarded for treatment of unrelated conditions, or for
preexisting conditions except to the extent they were exacerbated by the crime.
(a) Upon request of the Agency, the treating health care provider must verify that the mental
health counseling services are necessary as a direct result of the crime. If mental health
treatment extends beyond six months or 30 sessions (whichever is greater), the Agency may
require, as a condition of further payment, updated verification by the treating mental health
provider.
(b) All health care providers must be licensed in accordance with 124 CMR 2.03.
(c)
Compensation for transportation costs incurred while obtaining mental health care is
limited to costs incurred for emergency and non-emergency ambulance service, dial-a-ride,
taxi, or ridesharing service obtained. It does not include compensation for public
transportation, or mileage or parking when private transportation is used
(d)
In making determinations regarding claims for mental health counseling, the Agency
may obtain an advisory opinion of a peer review panel consisting of volunteer members of
the mental health provider community.
(e) The Agency shall compensate mental health counseling expenses based on reasonable
rates charged by a health care provider. If the health care provider employs a sliding scale
fee structure for any category of client, patient or service, the award shall not exceed the
amount the claimant would be charged if the claimant qualified under the provider's sliding
scale fee structure.
(f) Compensation for mental health counseling may be denied for expenses incurred in the
following instances:
1. missed or cancelled appointments;
2. non-therapeutic testimonial court appearances by a health care provider;
3. non-therapeutic investigatory consultations;
4. photocopying and report writing;
(g)
The Agency may authorize payment directly to a health care provider, but only if the
health care provider has fully cooperated with the Agency in the administration of the claim.
Any health care provider that receives payment from the Commonwealth pursuant to an
award under M.G.L. c. 258C shall, as a condition of the receipt of such payment, accept such
payment as discharging in full any and all obligations of the claimant to pay, reimburse or
compensate the provider for services that have been reimbursed under M.G.L. c. 258C.
Otherwise, awards shall be made payable solely to the claimant.
(6) Lost Wages. If, at the time of the crime, the victim was employed or had received a bona
fide employment offer, or if the victim was a minor who will be disabled from working beyond
the age of 18, the victim may be eligible for compensation for lost wages.
(a) In order to be eligible for lost wages, the victim must demonstrate that, as a direct result
of injuries caused by the crime, the victim is medically or psychologically disabled from
working and, further, the period of time for which the victim will be disabled from working.
Upon request by the Agency, the victim must submit a disability letter from a treating health
care provider demonstrating that the victim is disabled from working full time, or limited to
working part time, as a direct result of the crime and specifying when the victim is able to
resume working.
(b) An award for lost wages shall be based on the victim's actual earnings at the time of the
crime. If the victim was performing salaried employment at the time of the crime, the award
shall be based on the victim's salary at the time of the crime. If the victim was performing
seasonal, nonsalaried or intermittent work at the time of the crime, the Agency may look to
the victim's earnings history and the value of the victim's contractual work obligations in
order to determine the victim's lost wages. If overtime pay is included in the victim's regular
earning history, that pay may be considered to determine the victim's lost wages. The
Agency may review three months prior earning history and consider an average of the
overtime pay in determining lost wages.
(c)
If the victim was not employed at the time of the crime but had received a bona fide
offer of salaried employment, the award shall be based on the victim's net starting salary. If
the victim was not working at the time of the crime but had received a bona fide offer of
seasonal, nonsalaried or intermittent employment, the Agency may look to the victim's
earnings history and the value of the victim's contractual work obligations and offers of
employment in order to determine the victim's lost wages.
(d) If the victim was a minor at the time of the crime and was not employed, the victim shall
be eligible for compensation for lost wages after the age of 18 if the victim provides a
disability letter from a treating physician or mental health provider demonstrating that the
victim is disabled from working full time, or limited to working part time after the age of 18,
as a direct result of the crime and specifying when, if ever, the victim will be able to
commence working. An award for lost wages issued under 124 CMR 2.06(6)(d) shall be
based on the prevailing minimum wage.
(e) If, at the time of the crime, the victim was not employed or had not received a bona fide
employment offer, or if the victim was not a minor who is disabled from working beyond the
age of 18, the Agency shall not make an award for lost wages.
(f) Upon request by the Agency, the claimant must provide:
1. verification from the victim's employer (or, if self-employed, from the victim's own
records) that the victim was employed at the time of the crime; and of the dates the
victim was absent from work, the their net weekly earnings at the time of the crime, and
any sick, vacation, and personal time off or other compensable leave benefits used in the
their absence;
2. verification from the victim's prospective employer of when the offer of employment
was made, when the employment was to begin, net weekly starting salary, and sick and
vacation benefits to which the victim would have been entitled;
3. proof of employment and earnings history for up to one year preceding the crime.
(g) An award for lost wages shall be based on loss of reported income. Unreported income
may not form the basis of an award for lost wages.
(h) An award for lost wages shall be based on net (after tax) earnings. Any compensation
awarded shall be reduced by any money received or receivable from any other public or
private source including workers compensation benefits, social security benefits, disability
benefits, sick, vacation, and personal time off benefits.
(i) Failure to provide proof of lost wages, or failure to provide proof of medical disability,
may result in denial of a claim for lost wages.
(7) Homemaker Services. If the sole occupation of the victim at the time of the crime, and for
one year preceding the crime, was limited to performing the duties and responsibilities of a
homemaker, and if, as a direct result of injuries from the crime, the victim is disabled from
continuing to provide some or all of the duties and responsibilities of a homemaker, the Agency
may award reimbursement for the reasonable costs of maintaining such services.
(a)
Homemaker services include housekeeping, shopping, errands, meal preparation,
laundry and supervision of children.
(b) In order to demonstrate the victim's occupation at the time of the crime, and for the year
preceding the crime, the claimant must submit copies of the victim's tax returns, and such
other information and verifications as the Agency requires.
(c)
Except in the case of homicide, the claimant must submit a disability letter from a
treating physician or mental health provider demonstrating that, as a direct result of injuries
from the crime, the victim is disabled from performing some or all of the duties and
responsibilities of a homemaker, and specifying the duties and responsibilities the victim is
unable to perform. The letter must also specify when the victim is able to resume the duties
and responsibilities of a homemaker.
(d)
Upon request by the Agency, the claimant must submit verification that replacement
homemaker services were obtained as a direct result of the victim's inability to perform such
homemaker services as a direct result of injuries due to the crime.
(e)
Except as provided in 124 CMR 2.06(7)(f), reimbursement for replacement home-
maker services is limited to reasonable out-of-pocket losses or liability for payment of such
services. In order to receive reimbursement for homemaker services, the claimant must
submit either:
1. receipts, cancelled checks, bills for services provided, or other proof of payment or
liability for such services; or
where the claimant demonstrates that they are unable to purchase homemaker
services prior to receipt of an award for compensation, a bona fide contract for services
must be provided. In this circumstance, the initial award shall be made payable to the
claimant but shall not exceed $1,000. In order to be eligible for a supplemental award
under 124 CMR 2.06(7)(e), the claimant must demonstrate that compensation already
received was expended for the purchase of homemaker services.
(f) When a victim's family member or a person on whom the victim is dependent ceases or
reduces paid employment in order to assume the homemaker responsibilities the victim is
disabled from performing as a direct result of the crime, the Agency may reimburse the
claimant for actual losses resulting from the assumption of homemaker responsibilities. In
order to qualify for compensation under 124 CMR 2.06(7)(f), the claimant must demonstrate
that:
1. the victim qualifies as an eligible homemaker under 124 CMR 2.06(7)(a) through (c);
the claimant was employed at the time of the crime, and ceased or reduced paid
employment as a direct result of the victim's inability to continue to perform the duties
and responsibilities of a homemaker; and
the claimant has assumed homemaker duties and responsibilities that were pre-
viously performed by the victim.
Reimbursement under 124 CMR 2.06(7)(f) is limited to lost earnings directly attributable
to the assumption of replacement homemaker services. Reimbursement shall be based on
the claimant's reported net lost earnings or the prevailing minimum wage, whichever is
greater.
Upon request by the Agency, the claimant must provide:
1. verification from their employer (or, if self-employed, from the their own records)
that the they were employed immediately prior to assuming caretaker; the their net
weekly earnings at the time they assumed caretaker duties, and any sick, vacation, and
personal time off or other compensable leave benefits used in the their absence;
verification from the caretaker's prospective employer of when the offer of
employment was made, when the employment was to begin, net weekly starting salary,
and sick and vacation benefits to which the victim would have been entitled;
3. proof of employment and earnings history for up to one year preceding taking over
caretaker duties.
(8)
Eligibility for Compensation for Loss of Financial Support. Dependents of homicide
victims shall be eligible for loss of the victim's financial support in accordance with the
following requirements:
(a)
A dependent who is not a minor child of the victim must demonstrate that they were
living with the victim at the time of the crime.
(b) In order to demonstrate that they were living with the victim at the time of the crime,
a claimant must demonstrate that, at the time of the crime, the claimant and the victim shared
the same primary residence as shown by tax returns, utility bills, voting lists, school records,
residential leases, property deeds or other such documents evidencing primary residence.
Proof of frequent visitation does not constitute proof that the claimant was living with the
victim at the time of the crime.
(c) In order to be eligible for loss of financial support, the claimant must demonstrate that,
at the time of the crime, the claimant was wholly or partially dependent on the victim for
financial support. A claimant shall be presumed wholly financially dependent on the victim
if the claimant demonstrates that:
1. the claimant is a minor child of the victim who was living with the victim at the time
of the crime and receiving financial support from the victim or a minor child of the
victim who was not yet born at the time of the crime; or
at the time of the crime, was living with the victim and the victim's income
constituted the claimant's primary source of financial support.
(d) A claimant may establish that they were partially financially dependent on the victim
by demonstrating that:
1. they are a minor child of the victim who, at the time of the crime, was not living with
the victim but was either:
a. receiving financial support directly from the victim; or
b. the beneficiary of a court order or judicially enforceable agreement entitling them
to receive financial support directly from the victim; or
2. at the time of the crime, they were living with the victim and dependent on financial
support received directly from the victim as shown by joint loan agreements, bank
accounts or other documents evidencing financial dependence.
(e)
A mutual living arrangement does not, in itself, establish financial dependency. A
claimant shall not be eligible for compensation for loss of the victim's rent payments, or
room and board payments, to the claimant.
(9)
Calculation of Award for Loss of Financial Support. A loss of support award shall be
calculated based on the annual financial support provided by the victim to the claimant,
multiplied by the number of years for which the claimant would have remained financially
dependent on the victim.
(a)
If the claimant was wholly dependent on the victim for financial support, the
determination of annual financial support shall be based on the victim's earnings. The
determination of the victim's earnings shall be based on the victim's net earnings at the time
of the crime or the victim's average net earnings for one year preceding the crime, whichever
is greater.
(b)
If the claimant was partially dependent on the victim for financial support, the
determination of annual financial support shall be based on:
1. the actual amount of financial support received directly from the victim at the time
of the crime; or
2. if the claimant is a minor child of the victim, the greater of:
a.
the actual amount of financial support received directly from the victim at the
time of the crime; or
b. the amount the claimant was entitled to receive from the victim as a result of a
court order or judicially enforceable agreement.
(c)
The claimant must demonstrate the number of years for which they would have
remained financially dependent on the victim. In making this determination, the following
limitations shall apply:
1. if the claimant is a minor, the period of dependency shall continue until the claimant
reaches the age of 18 or until such time as the claimant was legally entitled to receive
support from the victim as a result of a court order, judicially enforceable agreement, or
other court
2.06: continued
2. determination of dependence due to disability, whichever is greater.
3. the period of dependency shall not exceed the life expectancy of either the victim or
the claimant, whichever is sooner.
(d) If two or more claimants seek compensation for loss of financial support from the same
victim, the award shall be apportioned based on each claimant's loss of financial support
from the victim.
(e) As a condition of making an award to a minor dependent of a crime victim, the Agency
may require that such funds be placed in a trust account for the benefit of the minor
dependent. If, at the time of the award, a permanent guardian has not been appointed for the
minor dependent, the Agency may defer issuance of all or part of the award until such time
as a permanent guardian has been appointed, or until the dependent reaches the age of 18,
whichever is sooner.
(10) Attorneys' Fees. If the claimant is represented by an attorney in the filing of a claim for
compensation, the Agency may make an award of attorneys' fees. An attorney's fee award shall
be deducted from, and not in addition to, the total award for compensation.
(a) In order to be eligible for an attorney's fee award, the following conditions must apply:
1. the attorney must fully cooperate with the Agency in the investigation of the claim,
including fully and promptly responding to all requests for information and verification;
and
the attorney must submit an affidavit which sets forth hours worked and services
rendered for representing the claimant in the claim for compensation.
(b)
In determining the amount of an attorney's fee award, the Agency shall make a
determination, based on the attorney affidavit and a review of the file, of a reasonable amount
of time spent representing the claimant in the claim for compensation. Attorneys shall be
compensated at a rate of no more than $75 per hour. In no event shall an attorney's fee award
exceed 15% of the total award for compensation.
(11) Professional Crime Scene Clean Up Services. Expenses incurred for professional crime
scene clean up services necessary as the direct result of the commission of a crime at a private
residence or in a motor vehicle that is owned or leased by a victim, family member, or other
dependent shall be compensable.
(a) In order to be eligible for reimbursement under 124 CMR 2.06(11)(a) claimants must
provide documentation demonstrating the residence or motor vehicle was owned or leased
by the victim, family member, or other dependent. Acceptable methods of proof include, but
are not limited to, purchase and sale agreements, lease or rental contracts, law enforcement
reports or correspondence, or other methods at the discretion of the Agency.
(b) In order to be eligible for reimbursement under 124 CMR 2.06(11), "professional crime
scene clean up services" providers must act in compliance with 105 CMR 480.000: Minimum
Requirements for the Management of Medical or Biological Waste (State Sanitary Code
Chapter VIII). Additionally, providers must act in compliance with applicable standards of
29 CFR 1910 including but not limited to Bloodborne Pathogen Standard 1910.1030,
Personal Protective Equipment 1910.132, and Hazard Communication 1910.1200, which can
be found at www.osha.gov. Providers must provide verification of adherence to each of
these standards to the Agency.
(c) In order to receive payment the victim must submit receipts, cancelled checks, bills for
services provided, or other proof of payment or liability for services. An award for crime
scene cleanup may be based on a bona fide contract for services.
(d) No compensation under 124 CMR 2.06(11) will be paid for the replacement or repair,
of property damaged as a result of the crime or follow up investigation.
(e) The maximum compensation amount under 124 CMR 2.06(11) shall not exceed $1,500.
(12) Replacement of Clothing and Bedding. A victim shall be eligible for compensation for the
reasonable replacement costs of clothing and bedding seized as evidence or rendered unusable
as the result of a criminal investigation that is the direct result of a crime provided that:
(a)
The claimant can demonstrate by way of police reports, law enforcement
correspondence, or other case related documentation, at the discretion of the Agency that
1. the clothing/bedding was in their possession at the time of the crime;
2. the items were seized by law enforcement officials or rendered unusable as a result
of the criminal investigation.
(b) In order to receive payment, the victim must submit receipts, cancelled checks, bills or
other proof of payment or liability for replacement of the items seized or rendered unusable.
(c) The maximum compensable amount under 124 CMR 2.06(12) shall not exceed $250.
(13) Security Measures. A victim, or a family member residing with the victim at the time a
crime is committed, shall be eligible for compensation for the costs associated with the
implementation of security measures.
(a) In order to be eligible for compensation under 124 CMR 2.06(13), the victim, or family
member residing with the victim at the time of the crime, must demonstrate that, as a result
of a crime or, in conjunction with the circumstances surrounding a crime, the implementation
of security measures would reasonably address their safety concerns. In determining
eligibility under 124 CMR 2.06(13)(a), the Agency shall consider factors including but not
limited to the location of the crime, the relationship of the offender to the victim, and access
of the offender to the claimant or the residence
(b)
Security measures may include but are not limited to, external and internal doors and
locks, exterior windows and locks, security systems, and reprogramming security codes.
(c) In order to receive payment the claimant must submit receipts, cancelled checks, bills
for products and services provided, or other proof of payment or liability for products or
services. Determination of allowable expenses may be based on a bona fide contract for
services.
(d) The maximum compensable amount under 124 CMR 2.06(13) shall not exceed $3,000.
(14) Catastrophic Injury Loss. Expenses incurred for treatment and services related to an injury
that creates a permanent impairment for the victim, as defined pursuant to M.G.L. c. 258C,
including medically necessary expenses, crime related expenses, medical, hospital, mental health
counseling, or any other service or treatment that would otherwise qualify pursuant to M.G.L.
c. 258C as determined by the Agency, may be compensable up to the maximum amount defined
in M.G.L. c. 258C.
(a)
Compensation for "Catastrophic Injury" is limited to those expenses incurred and
allowable pursuant to 124 CMR 2.06.
(b)
Compensation for catastrophic injury expenses is limited to services, supplies and
equipment that are medically necessary as a direct result of the crim
(c)
Compensation shall not be awarded for unrelated conditions or services or for
preexisting conditions except to the extent they were exacerbated by the crime.
(d) Upon request of the Agency, the treating medical provider must submit verification of
the catastrophic injury and resulting permanent disability of the claimant on a form
prescribed by the Agency.
(e) The claimant must demonstrate an out-of-pocket loss or legal liability for payment of
compensable catastrophic injury expenses that are not reimbursed or reimbursable by any
other source. In order to make this demonstration, the claimant must:
1. submit all bills to insurance providers;
exhaust all other sources of public reimbursement including Medicaid, Medicare,
workers compensation, social security, veterans benefits, and care funded by the Health
Safety Net Trust Fund under M.G.L. c. 118G;
comply with all reasonable requests by the Agency to secure information and
verifications necessary to investigate the claim.
4. provide current billing and balance information, including information about amounts
covered by insurance, public benefits or other sources, and current information about any
amounts paid and by whom;
5. certify whether the services rendered are reimbursable by Medicaid;
6. in the case of hospitals, assist the claimant in applying for health insurance or care
funded by the Health Safety Net Fund under M.G.L. c. 118G.
(f) All health care providers must be licensed in accordance with 124 CMR 2.03.
(g) The Agency may authorize an award for outstanding medical expenses payable directly
to the health care provider, but only if the provider has fully cooperated with the Agency in
the investigation of the claim. Otherwise, awards shall be made payable solely to the
claimant.
(h)
If an acute or non-acute hospital provides compensable medical services, any award
made payable jointly to the claimant and the hospital shall be based on payment rates
established by the contract between the hospital and the Executive Office of Health and
Human Services in accordance with M.G.L. c. 118E, § 12 and c. 118G, § 11 at the time the
claim is filed. Amounts awarded for all other medical services shall be based on reasonable
fees charged. If the provider employs a sliding scale fee structure for any category of patient
or service, the award shall not exceed the amount the claimant would be charged if they
qualified under the provider's sliding scale fee structure.
(i)
Any health care provider that receives payment from the Commonwealth for medical
services, supplies, or equipment pursuant to an award under M.G.L. c. 258C shall, as a
condition of the receipt of such payment, accept such payment as discharging in full any and
all obligations of the claimant to pay, reimburse, or compensate the provider for medical
services, supplies, or equipment, that have been reimbursed under M.G.L. c. 258C.
(j)
In making determinations regarding claims for catastrophic injury, the Agency may
obtain an advisory opinion of a peer review panel consisting of volunteer experts in the
medical, rehabilitative, communities or those who specialize in working with people with
disabilities.
(15) Forensic Sexual Assault Examinations. Expenses incurred for medical care in response
to reports in accordance with 124 CMR 2.04 and 2.05(1)(d), including the provision of forensic
sexual assault examinations and/or surrounding medical care shall be compensable.
(a)
Health Care Providers who provide services to victims that report sexual assault in
accordance with M.G.L. c. 112, § 12A½ may seek
(b) compensation for allowable costs directly from the Agency. Victims are not required
to receive a forensic sexual assault examination for expenses to be deemed eligible under this
section.
(c) Requests for compensation under this section are initiated by the health care provider
submitting to MOVA an "Attachment B Application" as provided in the Forensic Sexual
Assault Exam Kit and issued by the Executive Office for Public Safety and Security
(EOPSS) along with the bills.
(d) Compensation for forensic sexual assault examinations and surrounding medical care
expenses is limited to services, supplies, equipment and medications that are medically
necessary or established protocol in the provision. Compensation shall not be awarded for
unrelated conditions or services, or for preexisting conditions except to the extent they were
exacerbated by the crime. Allowable costs may include, but aren't limited to:
1. Physician fees that are part of or assigned to the facility and included in the overall
facility fee;
2. Facility fees;
Emergency Department Room and Board, Nursing and ancillary staff costs,
Non-SANE staff (hospital clinicians) who administer the Sexual Assault Evidence
Collection Kit (SAECK) costs;
4. Ancillary services (labs, tox screens, etc.);
5. Imaging services;
6. and Medications provided during treatment and prior to discharge.
(e) Costs that may not be eligible for compensation include, but aren't limited to:
1. Ambulance services;
2. Inpatient medical/surgical/post-acute treatment after the administration of the kit
3. Follow-up outpatient and/or inpatient visits
(f) Unallowable costs under 124 CMR 2.06(15)(d) may be compensable upon acceptance
of an application from the victim by the Agency.
(g) Compensation paid under 124 CMR 2.06(15) will be considered only toward a claim
relating to the forensic sexual assault exam and surrounding services offered to a victim. To
ensure compliance with 28 CFR § 90.13 requiring states to provide forensic sexual assault
examinations without cost to the victim, compensation paid in this section will not be
considered toward the maximum award for victim's other related claims.
(16)
Maximum Award. The maximum award for compensation to a claimant is defined by
M.G.L. c. 258C.
2:07: Limitations on Compensation
(1)
Contribution. To the extent the victim's acts or conduct provoked or contributed to the
victim's injuries, the Agency may reduce or deny the award to the claimant or claimants.
(a)
Definition of Contributory Conduct. Contributory conduct is intentional conduct,
willingly and knowingly engaged in by the victim, that is both a direct cause, and a proximate
cause, of the victim's injuries.
(b) Circumstances that, in general, do not warrant the denial or reduction of an award based
on contributory conduct include:
1. acts of negligence or poor judgment such as entering a motor vehicle operated by an
intoxicated person;
2. crimes in which the victim is a victim of sexual assault;
3. acts of self defense or defense of others;
4. acts attributable to reasonable efforts by the victim to aid a crime victim, to prevent
a crime from occurring in their presence, or to apprehend a person who has committed
a crime in their presence.
(c) Circumstances that may warrant a reduction or denial of an award based on contributory
conduct include:
1. crimes in which the victim deliberately provoked the offender by means of fighting
words, racial or other bias-motivated taunting, or by threats coupled with overt actions
indicating the victim's intent to carry out the threat and the victim significantly escalated
a physical altercation with the offender;
2. crimes in which the victim acted as an accomplice to the offender;
(d) If the Agency finds that a victim knowingly and willingly engaged in intentional conduct
that was a direct cause of the victim's injuries, the Agency shall determine the proximate
cause of the victim's injuries and may deny, reduce or allow the award as follows:
1. if it was reasonably foreseeable that the victim's contributory actions would result in
injuries of the type and nature sustained, the claim shall be denied (e.g. an implicit or
explicit agreement to fight, in which a physical altercation ensued resulting in mutual
injuries).
2. if it was reasonably foreseeable that the victim's contributory conduct would result
in injuries to the victim, but it was not reasonably foreseeable that the victim's actions
would result in injuries of the nature and type sustained by the victim, the award may be
reduced by 50%.
3. if the victim's injuries were not reasonably foreseeable, the award shall not be reduced
or denied even though the victim's actions were an actual and direct cause of the injuries.
(2) Unjust Enrichment.
(a) A claimant shall not be eligible for compensation if such compensation would unjustly
benefit the offender.
(b) In no event shall a claimant be denied compensation solely because of the claimant's or
the victim's familial relationship with the offender or because of the sharing of a residence
by the victim or claimant and the offender.