Section 14.06 - Compensable ExpensesThe following expenses are compensable in accordance with the following requirements:
(1)Fund of Last Resort. A claimant must demonstrate that his compensable losses or legal liability exceed reimbursements or eligibility for reimbursement or compensation from any other source including all sources listed in 940 CMR 14.08(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 incurred as a result of crimes occurring before November 5, 2010, shall be regulated by 940 CMR 14.00 effective on May 5, 1995. The maximum award for funeral and burial expenses incurred as a result of crimes occurring on or after November 5, 2010, shall be $6,500. For crimes occurring on or after July 1, 2013, the maximum award for funeral and burial expenses shall be $8,000. 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 $800. For purposes of 940 CMR 14.06(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 program director in accordance with 940 CMR 14.00.(d) in order to receive payment under 940 CMR 14.06(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. It does not include compensation for public transportation, or for mileage or parking when private transportation is used.(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 service or taxi service obtained when public transportation is unavailable or unsuitable for medical needs. 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;2. 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;3. comply with all reasonable requests by the Division to secure information and verifications necessary to investigate the claim.(d) Upon request by the Division, medical providers are required to: 1. 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 Division 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 medical providers must be licensed by the Massachusetts Board of Registration in Medicine or an equivalent state licensing authority, or must be certified by the recognized national certification body for that profession.(f) The Division may authorize an award for outstanding medical expenses payable directly to the medical provider, but only if the provider has fully cooperated with the Division in the investigation 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 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 he or she qualified under the provider's sliding scale fee structure.(h) Any medical 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 Division, the treating mental health provider must submit a mental health treatment plan on a form prescribed by the Division. If mental health treatment extends beyond six months or 30 sessions (whichever is greater), the Division may require, as a condition of further payment, the submission of a current mental health treatment plan by the treating mental health provider.(b) All mental health providers must be licensed by, or under the direct supervision of a person who is licensed by, either the Massachusetts Board of Registration in Medicine, the Massachusetts Board of Registration of Social Workers, the Massachusetts Board of Registration of Psychologists, the Massachusetts Board of Registration of Allied Mental Health Professionals or by an equivalent state licensing authority.(c) In making determinations regarding claims for mental health counseling, the Program Director may obtain an advisory opinion of a peer review panel consisting of volunteer members of the mental health provider community.(d) The Division shall compensate mental health counseling expenses based on reasonable rates charged by a mental health provider. If the mental health 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 he or she qualified under the provider's sliding scale fee structure.(e) 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 mental health provider;3. non-therapeutic investigatory consultations;4. photocopying and report writing;5. tele-therapy or dial-for-therapy services unconnected to any face-to-face consultation or diagnosis.(f) The Division may authorize payment directly to a mental health provider, but only if the provider has fully cooperated with the Division in the investigation of the claim. Any mental health 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.(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, he or she 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, he or she is medically disabled from working and, further, the period of time for which he or she will be disabled from working. Upon request by the Division, the victim must submit a disability letter from a treating physician or mental health provider demonstrating that the victim is disabled from working 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 Division 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.(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 Division 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, he or she shall be eligible for compensation for lost wages after the age of 18 if he or she provides a disability letter from a treating physician or mental health provider demonstrating that he or she will be disabled from working after the age of 18 as a direct result of the crime and specifying when, if ever, he or she will be able to commence working. An award for lost wages issued under 940 CMR 14.06(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 will be disabled from working beyond the age of 18, the Division shall not make an award for lost wages.(f) Upon request by the Division, the claimant must provide: 1. verification from his or her employer (or, if self-employed, from his or her own records) that he or she was employed at the time of the crime; and of the dates he or she was absent from work, his or her net weekly earnings at the time of the crime, and any sick and vacation benefits used in his or her absence;2. verification from his or her 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 he or she would have been entitled;3. proof of employment and earnings history for 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, and sick and vacation 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 Division 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 Division 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 Division, 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 940 CMR 14.06(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; or2. where the claimant demonstrates that he or she is unable to purchase homemaker services prior to receipt of an award for compensation, a bona fide contract for services to be provided. In this circumstance, the initial award shall be made payable to the claimant but shall not exceed $200. In order to be eligible for a supplemental award under 940 CMR 14.06(7)(e), the claimant must demonstrate that compensation already received was actually 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 Division may reimburse the claimant for actual losses resulting from the assumption of homemaker responsibilities. In order to qualify for compensation under 940 CMR 14.06(7)(f), the claimant must demonstrate that:1. the victim qualifies as an eligible homemaker under 940 CMR 14.06(7)(a) through (c);2. 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; and3. the claimant has assumed homemaker duties and responsibilities that were previously performed by the victim. Reimbursement under 940 CMR 14.06(7)(f) is limited to lost earnings directly attributable to the assumption of replacement homemaker services. Reimbursement shall be based on the claimant's net lost earnings but shall not exceed a maximum rate of $15.00 per hour.
(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 he was living with the victim at the time of the crime.(b) In order to demonstrate that he or she was living with the victim at the time of the crime, a claimant must demonstrate that, at the time of the crime, he 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, he or she was wholly or partially dependent on the victim for financial support. A claimant shall be presumed wholly financially dependent on the victim if he or she demonstrates that: 1. he or she 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; or2. at the time of the crime, was living with the victim and the victim's income constituted his or her primary source of financial support.(d) A claimant may establish that he or she was partially financially dependent on the victim by demonstrating that:1. he or she is 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; orb. the beneficiary of a court order or judicially enforceable agreement entitling him or her to receive financial support directly from the victim; or2. at the time of the crime, he or she was 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; or2. 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; orb. the amount the claimant was entitled to receive from the victim as a result of a court order or judically enforceable agreement.(c) The claimant must demonstrate the number of years for which he 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 or judicially enforceable agreement, whichever is greater.2. 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 Division 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 Division 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 Division 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 Division in the investigation of the claim, including fully and promptly responding to all requests for information and verification; and2. 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 Program Director 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 940 CMR 14.06(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 Division.(b) In order to be eligible for reimbursement under 940 CMR 14.06(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 Division.(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 940 CMR 14.06(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 940 CMR 14.06(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 division that1. 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 940 CMR 14.06(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 940 CMR 14.06(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 940 CMR 14.06(13)(a), the Division 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 940 CMR 14.06(13) shall not exceed $500.(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 Program Director 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 940 CMR 14.06.(b) Compensation for catastrophic injury 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.(c) Upon request of the Division, the treating medical provider must submit verification of the catastrophic injury and resulting permanent disability of the claimant on a form prescribed by the Division.(d) 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;2. 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;3. comply with all reasonable requests by the Division 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.(e) All medical providers must be licensed by the Massachusetts Board of registration in Medicine or an equivalent state licensing authority or must be certified by the recognized national certification body for that profession.(f) The Division may authorize an award for outstanding medical expenses payable directly to the medical provider, but only if the provider has fully cooperated with the Division in the investigation 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 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 he qualified under the provider's sliding scale fee structure.(h) Any medical 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.(i) In making determinations regarding claims for catastrophic injury, the Program Director 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)Maximum Award. The maximum award for compensation to a claimant is defined by M.G.L. c.258C.