Personal Injury Settlement Amounts: What Injuries Are Worth
Independently fact-checked against primary sources (last audited August 5, 2026). · Law checked current as of August 9, 2026. · 7 primary sources cited on this page. How we verify our legal content
There is no fixed average personal injury settlement. Realistically, minor soft-tissue claims often resolve in the low four to five figures, while serious injuries with surgery or permanent harm can reach six figures or more. The honest answer: value equals your economic losses plus a pain-and-suffering amount, scaled to how badly you were hurt, then adjusted for fault and state caps.
How much is a personal injury settlement worth?
There is no reliable nationwide average, because settlements are private, mostly unreported, and badly skewed by a handful of catastrophic outliers. Instead of a fake "average," start with the formula every adjuster uses: settlement value = economic damages + non-economic damages. Economic damages are your hard, receipted costs (medical bills, lost wages, future treatment). Non-economic damages cover pain and suffering. A common way to estimate pain and suffering is the multiplier method: take your medical bills and multiply by a severity factor, usually 1.5 to 2 for minor injuries, 2 to 3 for moderate ones, and 3 to 5 or higher for severe or permanent harm. Those bands are an informal convention used in negotiation. No statute sets them and no public data set measures them, so treat them as a starting point for discussion, not an entitlement. For example, $6,000 in bills at a 2x multiplier suggests roughly $12,000 in pain and suffering, for about $18,000 total before any fault reduction. Treat every figure here as illustrative, not a guarantee.
How settlement value is actually calculated
A personal injury settlement is built from two buckets of damages. Understanding the split is the key to understanding why a broken femur settles for far more than a sprained ankle even when both involve "an injury."
Economic damages (the hard numbers)
Economic damages are the losses you can prove with paper. They include past and future medical bills, lost wages and lost earning capacity, medical equipment, and out-of-pocket costs like mileage to appointments. These are not estimated with a multiplier; they are added up from records. The bigger and better-documented this number, the larger the foundation of your claim.
Non-economic damages (pain and suffering)
Non-economic damages compensate for physical pain, emotional distress, loss of enjoyment of life, and permanent limitation. There is no receipt for this, so insurers and attorneys estimate it two main ways.
The multiplier method. Add up your medical bills (and sometimes lost wages), then multiply by a severity factor. Minor, fully-healing injuries sit near 1.5 to 2. Moderate injuries with lingering effects sit near 2 to 3. Severe, surgical, or permanent injuries reach 3 to 5 or beyond. These bands come from negotiating practice rather than from a statute or an official data set, and an adjuster is free to argue for a lower one. Our pain and suffering calculator walks through this step by step.
The per-diem method. Assign a reasonable daily dollar value to your suffering and multiply by the number of days you were affected. This works best for injuries with a clear recovery timeline rather than permanent conditions.
Neither method is law. They are negotiating tools, and the final number is whatever the parties agree to or a jury awards.
What different injuries are typically worth (illustrative)
The table below ranks common injuries by their typical relative settlement value and the multiplier band commonly quoted for them in negotiation. No statute or official data set fixes these bands. These are NOT dollar averages, and the bands are the informal ranges used in negotiation rather than measured outcomes. Relative value reflects how much pain, treatment, and permanence the injury usually involves, which drives the multiplier and therefore the pain-and-suffering portion. Two people with the same injury can land far apart depending on bills, fault, insurance limits, and venue.
| Injury type | Relative value | Multiplier band commonly quoted in negotiation | Learn more |
|---|---|---|---|
| Soft tissue injury (sprains, strains, contusions) | Low | ~1.5 to 2 | Soft tissue injury settlements |
| Whiplash | Low to moderate | ~1.5 to 3 | Whiplash settlements |
| Back and neck injury | Moderate to high | ~2 to 5 | Back and neck injury settlements |
| Herniated disc | Moderate to high | ~2 to 5 | Herniated disc settlements |
| Knee injury | Moderate to high | ~2 to 4 | Knee injury settlements |
| Shoulder injury | Moderate to high | ~2 to 4 | Shoulder injury settlements |
| Broken bone / fracture | Moderate to high | ~2 to 4 | Broken bone and fracture settlements |
| Concussion / brain injury | High | ~3 to 5+ | Concussion and brain injury settlements |
The pattern is consistent: soft-tissue-only injuries that heal on their own sit at the bottom because they involve lower bills, no objective imaging, and full recovery. Injuries that require surgery, leave permanent deficits, or appear clearly on imaging (a brain bleed on a CT, a herniated disc on an MRI, a displaced fracture on an X-ray) sit at the top because they support both higher economic damages and higher multipliers.
What drives settlement value up
Certain facts reliably increase the value of any injury claim:
- Surgery. An operation raises medical bills, signals seriousness, and creates a documented, hard-to-dispute injury.
- Permanence. Lasting limitation, chronic pain, or disability justifies a higher multiplier because the suffering does not end.
- Objective imaging and tests. A herniated disc on an MRI or a brain bleed on a CT scan is far harder for an insurer to argue away than self-reported soreness.
- Long, consistent treatment. Ongoing, gap-free care documents the injury's real impact.
- Lost income and reduced earning capacity. Time off work and any long-term effect on your ability to earn add directly to economic damages.
- Clear liability. When the other side is plainly at fault, the insurer has less leverage to lowball.
What drives settlement value down
The same factors in reverse cut the number, sometimes sharply:
- Treatment gaps. Long delays between the injury and care, or stretches with no treatment, let insurers argue you were not really hurt.
- Pre-existing conditions. A prior injury to the same body part invites the argument that the accident did not cause your current pain.
- Soft-tissue-only injuries. Without objective imaging, value rests on your word, which limits the multiplier.
- Shared fault. If you were partly responsible, your recovery shrinks or, in a few states, vanishes (see below).
- Low insurance limits. A settlement cannot reliably exceed the at-fault party's available coverage, no matter how severe the injury.
How the multiplier method applies across injuries
Here are three illustrative walk-throughs. The dollar figures are examples only, not predictions or measured averages.
Minor soft-tissue claim. Suppose you have $4,000 in medical bills for a sprain that fully heals. At a 1.5x multiplier, pain and suffering is about $6,000, for roughly $10,000 total. Whiplash that resolves in weeks often lands in a similar zone. Compare the details on the whiplash settlements page.
Moderate injury with imaging. Suppose a knee or shoulder injury runs $15,000 in bills, including imaging and physical therapy, with lingering stiffness. At a 3x multiplier, pain and suffering is about $45,000, for roughly $60,000 total before fault.
Severe or permanent injury. Suppose a herniated disc requires surgery and $60,000 in bills, with permanent restrictions. At a 4x multiplier, pain and suffering is about $240,000, for roughly $300,000 total. The permanence is what unlocks the higher multiplier.
Run your own numbers with the pain and suffering calculator, then layer in fault and your state's rules using the personal injury settlement calculator.
How fault and state caps change the number
Two legal rules can move your settlement far below the multiplier math.
Comparative and contributory fault. Most states use comparative negligence, which reduces your recovery by your percentage of fault. If your claim is worth $100,000 and you are 20 percent at fault, you net $80,000. States following pure comparative negligence let a plaintiff "claim damages for the 1% they are not at fault even when they are 99% at fault," while modified comparative negligence states apply a bar: under the 50 percent bar rule a plaintiff "may not recover damages if they are found to be 50% or more at fault," and under the 51 percent bar rule the cutoff is 51 percent or more. The Cornell Legal Information Institute describes the modified approach as the one the majority of states follow. The two versions split at an exact 50/50 apportionment, one of the most common outcomes in a contested two-car crash. Kansas is a 50 percent bar state: K.S.A. 60-258a allows recovery only "if that party's negligence was less than the causal negligence" of the parties claimed against, so a plaintiff found exactly half at fault takes nothing. Wisconsin is a 51 percent bar state: Wis. Stat. § 895.045(1) allows recovery so long as the plaintiff's negligence "was not greater than the negligence of the person against whom recovery is sought," so that same 50/50 plaintiff recovers, with damages cut in half.
Four states and the District of Columbia are the exception. They follow contributory negligence, under which "a plaintiff who is at all negligent cannot recover." Cornell names them as Alabama, Maryland, North Carolina, and Virginia, plus D.C. Two qualifications keep that bar from being truly absolute. D.C. carved out its most vulnerable crash victims by statute: under the Motor Vehicle Collision Recovery Act of 2016, D.C. Code § 50-2204.52, a pedestrian, cyclist, or other vulnerable user involved in a collision with a motor vehicle may recover unless their own negligence was a proximate cause of the injury and "greater than the aggregated total negligence of all the defendants," which is a comparative standard for those collisions. And in all five jurisdictions, the common-law last clear chance doctrine can defeat the defense: as Cornell puts it, "a negligent plaintiff may recover damages if they can show that the defendant had the last clear chance to avoid the accident" (the D.C. statute expressly preserves that doctrine). Even so, if your accident happened in one of those five jurisdictions, liability carries enormous weight, because outside these narrow exceptions even a small share of blame can end the claim.
State caps on non-economic damages. Some states limit non-economic damages by statute, and where caps exist they most often apply to medical-malpractice claims rather than to general personal-injury claims. The National Conference of State Legislatures counts 37 states plus four U.S. territories that have "enacted limitations or caps" on at least one type of damages in medical liability cases. California is a concrete example: Civil Code § 3333.2 capped non-economic damages in professional-negligence actions against health care providers at $350,000 as of January 1, 2023 ($500,000 in wrongful-death cases), rising each year on a statutory schedule. Those limits differ from state to state in what they cover and how much they allow, and they change through legislation and court decisions, so this page does not attempt to list them. Where a cap applies, the multiplier method can produce a number the law will not allow, and the cap controls. Confirm the current rule in your state, or ask a licensed personal-injury attorney there, before you treat any pain-and-suffering estimate as achievable. The personal injury settlement calculator lets you apply fault and see a fault-adjusted estimate for your situation.
What comes out of a settlement before you get paid
The figure you agree to is not the figure that reaches your bank account. If Medicare paid for any of your accident-related care, federal law gives it a right to be repaid out of your settlement. Under the Medicare Secondary Payer provisions at 42 U.S.C. § 1395y(b), the Secretary may pay conditionally where a primary plan "has not made or cannot reasonably be expected to make payment ... promptly." Once that plan's responsibility is established, a primary plan and "an entity that receives payment from a primary plan, shall reimburse the appropriate Trust Fund for any payment made by the Secretary."
Settling without admitting fault does not avoid this. The statute provides that responsibility "may be demonstrated by a judgment, a payment conditioned upon the recipient's compromise, waiver, or release (whether or not there is a determination or admission of liability)," at § 1395y(b)(2)(B)(ii). The same subsection lets the United States sue "any or all entities that are or were required or responsible" to pay and "collect double damages," and it subrogates the United States to the injured person's own right to payment from the primary plan.
The practical point is a risk, not a technicality. A conditional-payment demand that surfaces after you have spent the settlement is still owed. Before you sign a release, find out in writing what is being claimed against the money, and ask whether any other payer is asserting reimbursement rights under its plan terms or under your state's law. Do not assume the gross number is yours to keep.
Is a personal injury settlement taxable?
Usually not, for the physical-injury portion. IRC § 104(a)(2) excludes from gross income damages "(other than punitive damages) received (whether by suit or agreement and whether as lump sums or as periodic payments)" on account of personal physical injuries or physical sickness. The IRS applies that exclusion to compensatory damages stemming from a personal physical injury, including lost wages that flow from the injury.
The exceptions are where people get caught:
- Punitive damages are generally not excludable. The IRS notes one narrow exception under IRC § 104(c) for wrongful-death cases where state law allows only punitive damages.
- Emotional distress qualifies for the exclusion only where it results from a personal physical injury or physical sickness. Reimbursement of actual medical expenses for emotional distress can be excluded where those expenses were not previously deducted under IRC § 213.
- Non-physical-injury claims are includable in gross income. The IRS lists damages from discrimination suits (age, race, gender, religion, disability), emotional distress unrelated to a physical injury, and lost wages from wrongful termination.
- Interest on a settlement is taxable, per IRS Publication 4345.
How a settlement is allocated across these categories drives its tax treatment, which means the wording of the release matters. This page is general information and not tax advice. Confirm the treatment of your own settlement with a tax professional or against current IRS guidance before you file.
Disclaimer
This page is general legal information, not legal advice, and it is not a prediction of any specific settlement. It is not tax advice. Reading it does not create an attorney-client relationship. RecordingLaw.com is not a law firm and does not provide legal representation. Every injury claim turns on its own facts, evidence, liability, insurance coverage, venue, and applicable state law. For advice about your situation, consult a licensed personal-injury attorney in your state, and consult a tax professional about the tax treatment of any settlement. Information is current as of 2026.
Frequently Asked Questions
What is the average personal injury settlement?
There is no reliable average. Settlements are private, mostly unreported, and skewed by rare catastrophic cases, so any single 'average' figure is misleading. A more honest estimate adds your economic damages (bills and lost wages) to a pain-and-suffering amount from the multiplier method, then adjusts for fault and any state caps.
How is pain and suffering calculated in a settlement?
The two common approaches are the multiplier method (medical bills times a severity factor of roughly 1.5 to 5+) and the per-diem method (a daily dollar value times the number of days affected). Neither is law, no official data set sits behind those bands, and both are negotiating tools. Our pain and suffering calculator walks through the multiplier version.
What injury gets the highest settlement?
As a general pattern, brain injuries and other severe, permanent, or surgical injuries support the highest values because they involve large medical bills, objective imaging, and lasting harm, which justifies a higher multiplier. Minor soft-tissue injuries that fully heal sit at the bottom. The injury type sets the range, but your specific bills, fault, and insurance limits set the actual number.
Does being partly at fault lower my settlement?
Usually yes. Most states use comparative negligence and cut your recovery by your share of fault. Modified comparative states bar recovery entirely at a threshold, and the two versions differ at exactly 50 percent: in a 50 percent bar state such as Kansas you recover nothing once you are 50 percent or more at fault, while in a 51 percent bar state such as Wisconsin you can still recover at exactly 50 percent and are barred only above that. Alabama, Maryland, North Carolina, Virginia, and D.C. follow contributory negligence, under which a plaintiff who is at all negligent generally cannot recover, though the last clear chance doctrine and D.C.'s statutory rule for pedestrians and cyclists struck by motor vehicles are exceptions. Liability matters most in those five jurisdictions.
Do all states cap injury settlements?
No. Whether a cap applies, and what it covers, is a state-by-state question, and where caps exist they most often target medical-malpractice claims rather than general injury claims. These limits are set by statute and change through legislation and court decisions, so a general rule of thumb is not a safe basis for planning. Confirm your state's current statute or ask a licensed attorney in your state before you rely on any estimate.
Do I have to pay Medicare back out of my settlement?
If Medicare paid for accident-related care, it generally has a right to reimbursement from your settlement under the Medicare Secondary Payer provisions at 42 U.S.C. 1395y(b). Settling without admitting liability does not avoid it: the statute says responsibility can be demonstrated by a payment conditioned on a compromise, waiver, or release, whether or not there is any determination or admission of liability. Find out what is being claimed before you sign a release.
Is a personal injury settlement taxable?
Generally not for the physical-injury portion. IRC 104(a)(2) excludes damages other than punitive damages received on account of personal physical injuries or physical sickness, and the IRS applies that to compensatory damages including lost wages that stem from the injury. Punitive damages are generally taxable, interest on a settlement is taxable, and emotional distress qualifies only when it results from a physical injury. Ask a tax professional about your specific allocation.
Should I take the insurance company's first offer?
A first offer is typically a starting point and is often well below what the multiplier method and your documented damages support. This page is general information, not legal advice. For a serious or permanent injury, a licensed personal-injury attorney can evaluate whether an offer is fair.
How long does a personal injury settlement take?
It varies widely, from a few weeks for a small, clear-liability claim to a year or more for a serious injury that is still healing. Many attorneys advise against settling until you reach maximum medical improvement, because settling early can leave future treatment costs uncovered.
Updates
Governing law re-checked for recent changes
Added sourced sections explaining what comes out of a settlement before you are paid, covering Medicare's statutory right to reimbursement under 42 U.S.C. Section 1395y(b) and the tax treatment of settlement proceeds under IRC Section 104(a)(2). Corrected the contributory-negligence discussion: D.C.'s Motor Vehicle Collision Recovery Act (D.C. Code Section 50-2204.52) applies a comparative standard to pedestrians and cyclists in motor-vehicle collisions, and the last clear chance doctrine can defeat the defense in all five contributory-negligence jurisdictions. Distinguished the 50 percent and 51 percent modified-comparative bar rules with statutory examples (Kansas and Wisconsin), restored the sourced medical-malpractice damages-cap pattern citing NCSL and California Civil Code Section 3333.2, and replaced a mirror citation for the Medicare statute with the official U.S. Code text.
Independently fact-checked against the cited primary sources
The Law Behind This Article
This article rests on the statutory provisions below, held in our own legal record and retrieved from the official source. Tap a section to read the operative text.
California Civil Code
§ 3333.2In forcecited in 2 of our articles
(a) In any action for injury against a health care provider or health care institution based on professional negligence, the injured plaintiff shall be entitled to recover noneconomic losses to compensate for pain, suffering, inconvenience, physical impairment, disfigurement and other nonpecuniary damage, subject to the limitations in this section. (b) In any action for injury that does not involve wrongful death against one or more health care providers or health care institutions based on professional negligence, the following limitations shall apply: (1) Civil liability for damages for noneconomic losses against one or more health care providers, collectively, shall not exceed three hundred fifty thousand dollars ($350,000), regardless of the number of health care providers, which does not include any unaffiliated health care providers that are responsible for noneconomic losses pursuant to paragraph (3).
Official text (excerpt) · last checked 2026-07-28 · Read the full text in our law library · Verify at leginfo.legislature.ca.gov
Cited in 180 court opinionsMost recently applied by a court: 2026
Leading cases:
- Fein v. Permanente Medical Group (California Supreme Court 1985, 38 Cal. 3d 137)“…the Medical Injury Compensation Reform Act of 1975 (MICRA): Civil Code section 3333.2, which limits noneconomic damages in me…”
- Delaney v. Baker (California Supreme Court 1999, 82 Cal. Rptr. 2d 610)“…negligence....' (Civ.Code, § 3333.1, subd. (a).) Similarly, Civil Code section 3333.2, [limiting recovery of noneconomic dama…”
- Bigler-Engler v. Breg, Inc. (California Court of Appeal 2017, 7 Cal. App. 5th 276)“…the Medical Injury Compensation Reform Act of 1975 (MICRA) (Civ. Code, § 3333.2) and Proposition 51 (Civ. Code, § 1431…”
Identified automatically from the court opinions citing this section — not a ranking of which case controls.
Also relied on in: Medical Malpractice Laws in California (2026): Deadlines & Caps
Code of the District of Columbia, Title 50: Motor and Non-Motor Vehicles and Traffic. - Chapter 22: Regulation of Traffic. - Subchapter II-B: Motor Vehicle Collision Recovery.
§ 50-2204.52Contributory negligence limitation.In forcecited in 5 of our articles
(a) Unless the plaintiff's negligence is a proximate cause of the plaintiff's injury and greater than the aggregated total negligence of all the defendants that proximately caused the plaintiff's injury, the negligence of the following shall not bar the plaintiff's recovery in any civil action in which the plaintiff is one of the following: (1) A pedestrian or vulnerable user of a public highway or sidewalk involved in a collision with a motor vehicle or another vulnerable user; or (2) A vulnerable user of a public highway or sidewalk involved in a collision with a pedestrian. (b) Nothing in this subchapter shall be construed to: (1) Change or affect the doctrine of joint and several liability or the last clear chance doctrine; or (2) Reduce the legal protections provided to pedestrians and cyclists under: (A) § 7-1004; or (B) § 50-1606.
Official text (excerpt) · last checked 2026-07-30 · Read the full text in our law library · Verify at github.com
Cited in 1 court opinionsMost recently applied by a court: 2021
Leading cases:
- Ehab Asal v. Estate of Mina (District of Columbia Court of Appeals 2021)“…a “right to presume that he can pass over in safety”). D.C. Code § 50-2204.52(a) (2012 Repl. & 2020 Supp.). The statu…”
Identified automatically from the court opinions citing this section — not a ranking of which case controls.
Also relied on in: Motorcycle Accident Laws in Washington DC (2026): Helmets, District of Columbia Slip and Fall Laws: Proving Premises Liability in DC, Truck Accident Laws in Washington, D.C. (2026): Deadlines & Liability
Kansas Statutes Annotated, Chapter 60: PROCEDURE, CIVIL
§ 60-258aComparative negligence.In forcecited in 10 of our articles
(a) Effect of contributory negligence. The contributory negligence of a party in a civil action does not bar that party or its legal representative from recovering damages for negligence resulting in death, personal injury, property damage or economic loss, if that party's negligence was less than the causal negligence of the party or parties against whom a claim is made, but the award of damages to that party must be reduced in proportion to the amount of negligence attributed to that party. If a party claims damages for a decedent's wrongful death, the negligence of the decedent, if any, must be imputed to that party. (b) Special verdicts or findings required. When the comparative negligence of the parties is an issue, the jury must return special verdicts, or in the absence of a jury, the court must make special findings, determining the percentage of negligence attributable to each party and the total amount of damages sustained by each claimant. The court must determine the appropriate judgment. (c) Joining additional parties.
Official text (excerpt) · last checked 2026-07-29 · Read the full text in our law library · Verify at ksrevisor.gov
Cited in 247 court opinionsMost recently applied by a court: 2026
In the courts (editorial summary, independently checked):Brown v. Keill (1978) held that under K.S.A. 60-258a joint and several liability no longer applies, each defendant paying in proportion to its own fault, with the fault of persons not joined still compared. Kennedy v. City of Sawyer (1980) applied those comparative fault principles to strict liability and implied warranty claims.
Leading cases:
- Brown v. Keill (Supreme Court of Kansas 1978, 224 Kan. 195)✓A car owner sued the other driver over damage to his Jaguar; his son drove it and drew 90 percent of the fault at trial. The court held K.S.A. 60-258a abolished joint and several liability, capping the defendant at 10 percent, and let the unjoined son's fault be compared.
- Kennedy v. City of Sawyer (Supreme Court of Kansas 1980, 228 Kan. 439)✓A city employee sprayed an arsenic herbicide by its sewage lagoons and neighboring cattle died. Reading K.S.A. 60-258a, the court held its fault comparison reaches products claims joined with negligence, and replaced all-or-nothing implied indemnity with apportionment.
- Wooderson v. Ortho Pharmaceutical Corp. (Supreme Court of Kansas 1984, 235 Kan. 387)✓A woman who suffered kidney failure after taking an oral contraceptive won a failure-to-warn verdict. Applying K.S.A. 60-258a, the court held the trial judge properly refused to compare the fault of her settled physicians or of the plaintiff, since no causal negligence was shown.
Identified automatically from the court opinions citing this section — not a ranking of which case controls.
Also relied on in: Kansas Dog Bite Laws: Liability and Victim Rights, Kansas Hit and Run Laws: Penalties and What to Do, Kansas Dashcam Laws: Mounting Rules, Audio Recording, and Evidence (2026)
Wisconsin Statutes, Chapter 895: Damages, Liability, And Miscellaneous Provisions Regarding Actions In Courts
§ 895.045Contributory negligence.In forcecited in 9 of our articles
(1) Comparative negligence. Contributory negligence does not bar recovery in an action by any person or the person’s legal representative to recover damages for negligence resulting in death or in injury to person or property, if that negligence was not greater than the negligence of the person against whom recovery is sought, but any damages allowed shall be diminished in the proportion to the amount of negligence attributed to the person recovering. The negligence of the plaintiff shall be measured separately against the negligence of each person found to be causally negligent. The liability of each person found to be causally negligent whose percentage of causal negligence is less than 51 percent is limited to the percentage of the total causal negligence attributed to that person. A person found to be causally negligent whose percentage of causal negligence is 51 percent or more shall be jointly and severally liable for the damages allowed. (2) Concerted action. Notwithstanding sub. (1), if 2 or more parties act in accordance with a common scheme or plan, those parties are jointly and severally liable for all damages resulting from that action, except as provided in s.
Official text (excerpt) · last checked 2026-07-29 · Read the full text in our law library · Verify at docs.legis.wisconsin.gov
Cited in 69 court opinionsMost recently applied by a court: 2024
Leading cases:
- Industrial Risk Insurers & Quad Graphics, Inc. v. American Engineering Testing, Inc. (Court of Appeals of Wisconsin 2009, 318 Wis. 2d 148)“…g to Leavitt, the policy reasons for the 1995 amendment to Wis. Stat. § 895.045 , which changed the common law on joint…”
- Richards v. Badger Mutual Insurance (Wisconsin Supreme Court 2008, 309 Wis. 2d 541)“…me or plan" that invokes joint and several liability under Wis. Stat. § 895.045 (2) (2005-06). [2] We affirm the court…”
- Fuchsgruber v. Custom Accessories, Inc. (Wisconsin Supreme Court 2001, 244 Wis. 2d 758)“…o the compara *763 tive negligence statute, Wis. Stat. § 895.045 (1) (1999-2000), 1 applies…”
Identified automatically from the court opinions citing this section — not a ranking of which case controls.
Also relied on in: Wisconsin Car Accident Laws: Fault, Insurance, and Your Claim, Medical Malpractice Laws in Wisconsin (2026): Deadlines & Caps, Motorcycle Accident Laws in Wisconsin (2026): Deadlines
United States Code Title 42
§ 1395yExclusions from coverage and medicare as secondary payerIn force
Notwithstanding any other provision of this subchapter, no payment may be made under part A or part B for any expenses incurred for items or services— which, except for items and services described in a succeeding subparagraph, additional preventive services (as described in section 1395x(ddd)(1) of this title), or multi-cancer early detection screening tests (as defined in section 1395x(nnn) of this title), are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member, in the case of items and services described in section 1395x(s)(10) of this title, which are not reasonable and necessary for the prevention of illness, in the case of hospice care, which are not reasonable and necessary for the palliation or management of terminal illness, in the case of clinical care items and services provided with the concurrence of the Secretary and with respect to research and experimentation conducted by, or under contract with, the Medicare Payment Advisory Commission or the Secretary, which are not reasonable and necessary to carry out the purposes of section 1395ww(e)(6) of this title,1 See References in Text…
Official text (excerpt) · last checked 2026-07-28 · Read the full text in our law library · Verify at uscode.house.gov
Cited in 1,042 court opinionsMost recently applied by a court: 2026
Leading cases:
- Heckler v. Ringer (Supreme Court of the United States 1984, 466 U.S. 602)“…barring payment for BCBR surgery violate the requirement in 42 U. S. C. § 1395y(a)(l) that payment be made for “reasona…”
- Brooks v. Blue Cross & Blue Shield of Florida, Inc. (Court of Appeals for the Eleventh Circuit 1997, 116 F.3d 1364)“…ondary Payer statute (the “MSP statute” or the “MSP laws”), 42 U.S.C. § 1395y(b), as well as claiming violations of t…”
- Stalley Ex Rel. United States v. Orlando Regional Healthcare System, Inc. (Court of Appeals for the Eleventh Circuit 2008, 524 F.3d 1229)“…action for damages under the Medicare Secondary Payer Act, 42 U.S.C. § 1395y(b)(3)(A) (“MSP”). Plaintiff-appellant…”
Identified automatically from the court opinions citing this section — not a ranking of which case controls.
Search our full record of US law — 2.1 million sections, every state + federal →
Sources and References
- Comparative Negligence, Legal Information Institute, Cornell Law School (pure vs modified comparative negligence; 50% and 51% bar rules; the four states and D.C. that follow contributory negligence)(law.cornell.edu)
- Contributory Negligence, Legal Information Institute, Cornell Law School (a plaintiff who is at all negligent cannot recover; Alabama, Maryland, North Carolina, Virginia)(law.cornell.edu)
- 42 U.S.C. Section 1395y(b), Medicare as Secondary Payer, official U.S. Code, Office of the Law Revision Counsel (conditional payments, reimbursement of the Trust Fund, demonstration of responsibility by compromise, waiver or release, double damages, subrogation)(uscode.house.gov).gov
- D.C. Code Section 50-2204.52, Contributory negligence limitation (Motor Vehicle Collision Recovery Act of 2016: comparative standard for pedestrians and vulnerable users in motor-vehicle collisions; expressly preserves the last clear chance doctrine)(code.dccouncil.gov).gov
- Last Clear Chance, Legal Information Institute, Cornell Law School (a negligent plaintiff may recover if the defendant had the last clear chance to avoid the accident; treated as an exception to contributory negligence)(law.cornell.edu)
- K.S.A. 60-258a, Kansas comparative negligence (recovery only if the claimant's negligence was less than the causal negligence of the parties claimed against: the 50 percent bar rule)(ksrevisor.gov).gov
- Wis. Stat. Section 895.045(1), Wisconsin contributory negligence (recovery allowed if the plaintiff's negligence was not greater than the defendant's: the 51 percent bar rule)(docs.legis.wisconsin.gov).gov
- National Conference of State Legislatures, Medical Liability/Medical Malpractice Laws (37 states and four U.S. territories have enacted limitations or caps on at least one type of damages in medical liability cases)(ncsl.org)
- California Civil Code Section 3333.2 (MICRA noneconomic damages cap in professional-negligence actions against health care providers: $350,000 as of January 1, 2023, $500,000 in wrongful-death cases, with annual statutory increases)(leginfo.legislature.ca.gov).gov
- Internal Revenue Service, Tax Implications of Settlements and Judgments (IRC Section 104(a)(2) exclusion, punitive damages, emotional distress, non-physical-injury claims)(irs.gov).gov
- IRS Publication 4345, Settlements: Taxability (treatment of settlement proceeds, including interest)(irs.gov).gov