Catastrophic Injury Claims: What They Cover and When to Get a Lawyer

A spinal cord injury, a severe brain injury, an amputation or a serious burn can change a life in an instant. If you’re trying to take that in while bills and insurance calls pile up, it’s normal to feel overwhelmed. Here is the plain answer. A catastrophic injury claim seeks payment for the losses of a lifetime: care for as long as it’s needed, changes to a home or vehicle, lost earning power, and pain and suffering. Future losses count when the evidence shows they’re reasonably certain (M Civ JI 50.01), so these claims rest on medical and expert proof. After a Michigan crash, no-fault insurance pays for care up to the policy’s limit, whoever was at fault, and deadlines start right away. Michigan rules below are current as of September 2026.

Hurt and not sure where you stand? Get a free case review. Four quick questions, no cost, no obligation.

What counts as a catastrophic injury?

There’s no single legal definition. The term is used for severe, lasting injuries that change how a person lives and works. The Michigan Catastrophic Claims Association (MCCA) expects these injuries often to qualify: a traumatic brain injury, a spinal cord injury causing quadriplegia or paraplegia, burns covering half the body or more, and the amputation of a major limb.

Some laws and programs give the term a precise meaning. In Michigan’s no-fault system, it’s a dollar figure: the MCCA considers an injury catastrophic when personal injury protection (PIP) benefits pass the amount the law sets (MCCA; MCL 500.3104), explained below. A federal benefit program for public safety officers defines it as an injury that permanently leaves a person unable to work, even at sedentary work (34 U.S.C. 10284(4)). For a head injury, see how to prove a brain injury claim.

What can a catastrophic injury claim cover?

Every loss the evidence proves, past and future. Michigan’s model civil jury instructions (the standard instructions judges read to jurors, cited as M Civ JI), for example, include the reasonable expenses of necessary medical care (M Civ JI 50.05), other reasonable expenses the injury requires (M Civ JI 50.08), loss of earning capacity (M Civ JI 50.06), disability and disfigurement (M Civ JI 50.03), and pain and suffering (M Civ JI 50.02).

For a permanent injury, jurors decide how long the person is likely to live, and they set an amount for each future year (M Civ JI 50.01, 50.21; MCL 600.6305). See how pain and suffering is valued and how to size up an injury case.

How are lifetime costs proven?

With evidence, much of it from experts. The claims process runs on documents: an insurer weighs only the future costs someone has written down and can support. One key document is a life-care plan: in the words of practice guidelines from the federal court that hears vaccine-injury claims, “a professionally prepared report detailing what treatment and care the injured party will need for the rest of his or her life and the estimated cost” of each item. It can include structural changes to a home, typically backed by an architect’s or builder’s report. The guidelines add that the planner must be able to support each item in writing and through testimony, and that a vocational expert’s reports and testimony can support a claim for lost earnings (U.S. Court of Federal Claims, Office of Special Masters).

In Michigan, the judge, not the jury, reduces future damages to present value (what they’re worth today), at 5% a year compounded, with exceptions (M Civ JI 53.03A; MCL 600.6306(2)).

How does Michigan no-fault pay for a catastrophic injury?

After a Michigan crash, no-fault insurance pays personal injury protection (PIP) benefits whoever was at fault (MCL 500.3105(2)). PIP pays for reasonably necessary products, services and accommodations for your care, recovery or rehabilitation. The law sets no time limit on these; only wage-loss and household-help benefits stop after three years (MCL 500.3107(1)). The Department of Insurance and Financial Services (DIFS) lists attendant care, vehicle modifications, case management and long-term care among what PIP covers. For a wheelchair van, the insurer has to pay only for the modifications, not the van’s base price, which is an ordinary transportation expense (Admire v Auto-Owners Insurance Co, Michigan Supreme Court, 2013).

How much it pays depends on the policy:

• Coverage level. On policies issued or renewed after July 1, 2020, the policyholder chooses a medical limit: unlimited, $500,000 or $250,000, or, for some people with Medicaid, Medicare or other qualifying health coverage, less or none (MCL 500.3107c(1); DIFS). Insurers must offer limited policies a rider for attendant care above the limit (MCL 500.3107c(8)).
• Family attendant care. For care after July 1, 2021, the insurer only has to pay for 56 hours a week of in-home attendant care by a relative, a household member or someone you knew before the injury, unless it agrees to more (MCL 500.3157(10), (11), (14); MCL 418.315). DIFS says all medically necessary care is still covered up to your limit.
• Older policies. The 56-hour limit, and the payment caps for services Medicare doesn’t cover, don’t apply to anyone injured while covered by a policy issued before June 11, 2019 (Andary v USAA Casualty Insurance Co, Michigan Supreme Court, 2023).

See what Michigan PIP pays after the 2019 reform.

What is the Michigan Catastrophic Claims Association?

The MCCA is a nonprofit association created by state law, and every Michigan no-fault insurer must belong to it (MCL 500.3104(1)). It reimburses insurers for PIP benefits above a set amount: $675,000 for policies issued or renewed from July 1, 2025 through June 30, 2027 (MCCA; MCL 500.3104(2)(o)). It covers policies issued or renewed before July 2, 2020 and newer ones with unlimited PIP medical coverage, not those with a limit (MCL 500.3104(2), (27)). You don’t claim from the MCCA; your insurer handles your claim and pays for your care (MCCA).

Not sure what your policy will pay for? Get a free case review. Four quick questions, no cost, no obligation.

Can you claim more than no-fault pays?

Often, from whoever caused the injury. No-fault’s limits on lawsuits apply only to motor vehicle injuries (MCL 500.3135(1)); a fall or a medical error brings an ordinary negligence or malpractice claim.

Are damages capped for a catastrophic injury?

In Michigan, noneconomic damages are capped in medical malpractice and product liability cases. An ordinary claim against a negligent driver has no such cap unless a statute says otherwise.

How long do you have to file a catastrophic injury claim?

The clock usually starts at the injury, not when you learn how serious it is: in Michigan, a claim accrues when the wrong is done “regardless of the time when damage results” (MCL 600.5827).

Do you need a catastrophic injury lawyer?

You’re not required to hire one. But a catastrophic claim has features that are hard to handle alone:

1. Expert proof of lifetime care and lost earning capacity, year by year. A lawyer can advance experts’ fees and other case costs, but in Michigan the client is ultimately responsible for repaying them, though a lawyer may pay them for an indigent client (MRPC 1.8(e)).
2. Several claims at once, each with its own insurer and deadline: PIP, the at-fault driver, any underinsured motorist coverage you have, perhaps a vehicle maker.
3. Liens. If Medicare paid for care, it must be repaid within 60 days after a settlement is received (42 CFR 411.24(h)), and state Medicaid programs generally must seek repayment when someone else is liable (42 U.S.C. 1396a(a)(25)). See who gets paid from your settlement.
4. How the money is paid. A structured settlement pays damages over time and can be funded by an annuity (MCL 691.1302), which, the federal vaccine court’s guidelines note, can keep paying even if the person outlives the estimate. In a lawsuit for a child or a legally incapacitated adult, the judge must approve any settlement (MCR 2.420). For someone on Medicaid, the federal rules that count trusts against eligibility don’t apply to a trust for a disabled person under 65 that repays the state’s Medicaid costs from what’s left at death (42 U.S.C. 1396p(d)(4)(A)).

What does a catastrophic injury lawyer cost?

On a contingency fee, the lawyer is paid a share of what’s recovered, and nothing if nothing is. In Michigan, the fee can’t be more than one-third of the recovery after case costs. On a settlement paid in installments, it’s figured on present value, which is the annuity’s actual cost when one funds the payments (MCR 8.121(B), (C)). The agreement must be in writing, with a copy for you (MCR 8.121(F)); see how injury lawyers get paid.

To choose a catastrophic personal injury lawyer, ask how they would prove future care, who pays the experts, and how liens and any structured settlement would be handled. Our directory of Michigan personal injury lawyers lists firms by city with their Google ratings and the $1M+ verdicts and settlements each firm reports on its own website; most of those results aren’t independently verified, and past results do not guarantee a similar outcome. See how to find the right lawyer for your case.

What to do next

1. Keep every record of care, and ask the medical team what long-term care, equipment and home changes they expect.
2. After a crash, send your auto insurer written notice within one year, and get the declarations page and signed PIP coverage form to learn your medical limit and whether you have an attendant care rider.
3. If the injured person can’t manage their own affairs, ask about a conservator or next friend (MCR 2.201(E)).
4. Don’t sign a release or accept a lump sum until future costs are known and every lien is listed.
5. Get a free case review, and the fee in writing. Get a free case review, or in Michigan, compare injury lawyers near you.

What waiting can cost

• PIP benefits, without written notice or a payment within a year of the crash (MCL 500.3145(1)).
• Your lawsuit, usually after three years in Michigan (MCL 600.5805(2)).
• Evidence. Vehicles get repaired, and products get thrown away.
• Future care, if you settle too soon. A release essentially gives up your right to sue (Cornell Law School’s Legal Information Institute).

What a good outcome looks like

PIP pays for care as it comes, and whoever else is responsible pays for the rest. Your future needs are in a plan your doctors support, liens are settled before the money goes out, and any settlement is paid in a way that lasts. From facing a lifetime of care with no map to knowing what your claim covers, what it has to prove and who can pay.

For the bigger picture, see our guide to personal injury claims.

Updated September 29, 2026

This guide is general information, not legal advice, and laws change. For advice about your situation, talk to a lawyer licensed in your state. Reading this page or contacting us does not create an attorney-client relationship.