G.L. c. 231, §§ 60B, 60D, 60H, 60L; G.L. c. 260, § 4; G.L. c. 231, § 85K
Medical malpractice in Massachusetts — the tribunal, the bond, and the $500,000 cap
A claim in Massachusetts trial courts · Last verified August 26, 2026
Massachusetts screens medical malpractice claims before they reach a jury. Every case goes to a tribunal of a judge, a physician and an attorney, which decides whether the evidence is enough to raise a legitimate question of liability appropriate for judicial inquiry.
If the tribunal finds against the plaintiff, the case is not dismissed — but continuing requires a $6,000 bond. That structure, plus a $500,000 cap on non-economic damages and a seven-year repose period, is what separates a Massachusetts malpractice claim from an ordinary negligence case.
What the claim is
A doctor, nurse, hospital or other health care provider fell below the accepted standard of care and injured you.
Where the right comes from
Common law negligence, with a statutory overlay in G.L. c. 231, §§ 60B through 60L.
What a plaintiff has to prove
- A provider-patient relationship, creating a duty;
- Breach of the applicable standard of care — what the average qualified practitioner in that speciality would have done, judged on a national standard rather than a local one;
- Causation — that the breach caused the injury; and
- Damages.
Expert testimony is required for all but the rare case where the negligence is obvious to a layperson. Causation is usually the harder element, because a patient who was already sick has to show the outcome would have differed.
The tribunal — § 60B
Within 15 days after the defendant's answer, the case goes before a tribunal consisting of a Superior Court judge, a physician in the relevant field, and an attorney.
The plaintiff presents an offer of proof — records, expert opinion and a statement of the theory. The tribunal does not decide who wins. It decides whether the evidence, if properly substantiated, "is sufficient to raise a legitimate question of liability appropriate for judicial inquiry," or whether the case is merely an unfortunate medical result.
If the tribunal finds for the plaintiff, the case proceeds normally.
If it finds against the plaintiff, the case continues only if the plaintiff files a bond of $6,000 within 30 days, running to the defendant for costs. The court may reduce the bond for a plaintiff who is indigent, but it may not eliminate the requirement. Failure to post it means dismissal.
Section 60L adds a separate step in many cases: a 182-day notice to the provider before filing, with the required contents, subject to the statute's exceptions and shortening provisions.
How long you have to file
Three years under G.L. c. 260, § 4, from the injury or from when the plaintiff knew or should have known of it. The discovery rule matters here more than anywhere else in Massachusetts tort law, because a patient often has no way to know that a bad outcome was a negligent one.
Seven years of repose. Whatever the discovery date, no action may be brought more than seven years after the act or omission — with the statutory exception for a foreign object left in the body. Fraudulent concealment tolls a limitations period but does not extend a repose period, and the SJC has said so.
Minors. The general three-year rule applies, except that a child under six has until their ninth birthday. The seven-year repose still applies, which means a claim arising from an infant's care can expire before the child is old enough to know about it.
What has to happen before you file
The § 60L notice, 182 days, where it applies.
Presentment under G.L. c. 258, § 4 where the provider is a public employer — two years, with suit within three. This reaches public hospitals and state medical facilities.
Then the tribunal, after the answer.
What the claim pays
Economic damages without a cap — past and future medical expenses, lost earnings, lost earning capacity, the cost of future care.
Non-economic damages capped at $500,000. Section 60H directs the court to instruct the jury that it may not award more than five hundred thousand dollars for "pain and suffering, loss of companionship, embarrassment and other items of general damages."
The cap lifts where the jury finds "a substantial or permanent loss or impairment of a bodily function or substantial disfigurement, or other special circumstances in the case which warrant a finding that imposition of such a limitation would deprive the plaintiff of just compensation." That exception is broad enough that the most serious cases regularly escape the cap — and the "special circumstances" clause is deliberately open-ended.
Multiple plaintiffs share one cap. Where two or more plaintiffs recover general damages totalling more than $500,000 from a single occurrence, and the exception findings are not made, each plaintiff's recovery is reduced proportionately.
Section 60H does not apply to wrongful death. The statute expressly excludes "actions brought under section two of chapter two hundred and twenty-nine," so a wrongful death claim arising from malpractice is not subject to the $500,000 cap.
The charitable cap may apply instead, and it is far lower. Under G.L. c. 231, § 85K, a medical malpractice claim against a non-profit organisation providing health care is capped at $100,000, exclusive of interest and costs. Most Massachusetts hospitals are non-profit. This number, not the $500,000 figure, is often the real ceiling — subject to the statute's exclusion for activities primarily commercial in character.
Twelve percent prejudgment interest from the date of filing.
No punitive damages in a survival action. Attorney's fees are not shifted, and § 60I limits the contingent fee a plaintiff's lawyer may charge, on a sliding scale.
Who can be sued
The physician, nurse, technician or other provider.
The hospital or practice, for its employees' negligence and for its own — negligent credentialing, staffing or systems.
A non-profit provider, subject to the $100,000 charitable cap.
A public provider, subject to presentment and the Tort Claims Act.
Common defenses
- The standard of care was met — the central battleground, fought with experts.
- No causation — the outcome would have been the same.
- The tribunal found against the plaintiff, and the bond was not posted.
- Limitations, and the seven-year repose, which is absolute outside the foreign-object exception.
- Comparative negligence, where the patient did not follow instructions or delayed care.
- The § 60H cap and the § 85K charitable cap.
What people get wrong
A bad outcome is not malpractice. Medicine has bad results without negligence, and the tribunal exists to sort one from the other.
The tribunal is not optional, and an adverse finding is not the end. It is a $6,000 bond, which the court can reduce for an indigent plaintiff.
The cap that matters is often $100,000, not $500,000. Against a non-profit hospital, the charitable statute may control.
The repose period cannot be extended by discovery. Seven years, whatever the plaintiff knew, with the foreign-object exception.
A child's claim can expire before the child grows up, because repose runs regardless of the minority tolling.
A death case is not capped by § 60H. The wrongful death statute is expressly carved out.
Where it came from
Massachusetts built this structure in 1975, during a national malpractice insurance crisis in which carriers withdrew from the market and premiums rose beyond what many physicians could pay. The Legislature's response was to filter claims before trial rather than to bar them.
The tribunal is the distinctive piece. It does not decide the merits, and its adverse finding does not end a case — it prices continuation at $6,000. The design was meant to deter claims with no expert support while leaving a route for a plaintiff who believed in the case.
The $500,000 cap came from the same period and has never been indexed, so its real value has fallen by most of its original worth. The exceptions have absorbed that pressure: a jury that finds substantial or permanent impairment, substantial disfigurement, or "other special circumstances" may award beyond it, and in catastrophic cases they generally do.
The charitable cap is the older layer, and it produces the odd result that the general tort statute limits a claim against a non-profit hospital more severely than the malpractice statute written for exactly these cases.
Common questions
How long do I have to sue for medical malpractice in Massachusetts?
Three years from the injury or its discovery, with an absolute seven-year repose period — except for a foreign object left in the body.
What is the medical malpractice tribunal?
A panel of a judge, a physician and an attorney that reviews the plaintiff's offer of proof within 15 days after the answer, to decide whether the evidence raises a legitimate question of liability.
What happens if the tribunal rules against me?
The case continues only if you post a $6,000 bond within 30 days. The court can reduce it for indigency but cannot waive it.
Is there a cap on damages?
Non-economic damages are capped at $500,000, with exceptions for substantial or permanent impairment, substantial disfigurement, or other special circumstances. Against a non-profit provider, the charitable cap of $100,000 may apply instead. Economic damages are not capped.
Does the cap apply to a death case?
No. Section 60H expressly excludes wrongful death actions.
How long does a child have?
Generally three years, but a child under six has until their ninth birthday — subject to the seven-year repose.