The difference between a claim and a lawsuit is that a claim is the informal stage where you ask the insurance company for compensation, while a lawsuit is the formal legal action filed in court when either negotiations fail or the insurer isn’t open to offering you a fair outcome.
Claims typically start with legal paperwork, medical records, and conversations with an adjuster. A lawsuit, on the other hand, triggers strict court procedures, structured exchanges of evidence, and a level of accountability that often affects how the insurance company responds.
Before you understand what to expect, how long the process will take, and what options you have, you’ll need to figure out whether to pursue a claim or file a lawsuit. Talking to Boston personal injury lawyers will help you make the right decision for you.
Every Injury Case Starts With a Claim
After an accident, the first step almost always begins outside the courtroom. A claim is the starting point. This is the moment your injury is reported to the insurance company that covers the at-fault person or business.
This could be an auto insurer after a crash on the Mass Pike, a property owner’s policy after a fall on icy steps in Quincy, or a dog owner’s homeowner’s insurance after a bite in Malden. A claim is the opportunity for the insurance company to review what happened.
How Much Is the Insurer Willing to Pay?
From there, they will decide whether they’re willing to pay for your pain and suffering, lost income, medical care, or other losses. Here’s what this review includes:
- Police reports
- Medical records
- Photos of the scene
- Witness statements
- Traffic camera video
- Surveillance footage from local businesses
- Body cam recordings
- Black box data from the vehicles involved
Insurance companies look at every detail because the claim process exists to handle cases without court involvement. Many injury cases in Massachusetts settle during this stage if the insurer takes your injury seriously and offers money that accurately reflects what you lost.
How Claims Work Behind the Scenes
People sometimes think claims are handled by a single adjuster, but it’s usually reviewed by a multi-person team. Together, they will analyze your medical treatment, pain levels, long-term symptoms, and newfound daily struggles.
The adjusters will also review liability, which matters in a state like Massachusetts, which abides by modified comparative negligence. This means the compensation you’ll receive will decrease if you are assigned any percentage of fault for the incident.
Claims rely heavily on documentation as well. If you visited a doctor at Mass General, followed up with physical therapy in Brookline, or saw a specialist in Worcester for long-term pain, those records show exactly how your life changed. From there, a claim ends one of two ways:
- A settlement offer arrives.
- The insurance company refuses to pay fair compensation.
If you find yourself in the second scenario, it will likely indicate that it’s time for you and your attorney to file a lawsuit.
When a Claim Is No Longer Enough
Insurance companies usually offer less money than victims are legally entitled to because it’s in their interest to pay as little as necessary. They usually base their first settlement offer on formulas, not your lived experience.
This means they will likely pay for part of your medical bills but ignore the real cost of your pain and suffering, like waking up stiff or skipping out on activities you once loved. When insurance companies deny your injuries or unfairly blame you, the claim process stops reflecting your needs. A lawsuit becomes the next step because it forces the other side to do the following:
- Respond to your legal action
- Exchange evidence with your lawyers
- Take your injuries seriously
At Jason Stone Injury Lawyers, we recognize when it’s time to make this shift. It’s part of why we emphasize the importance of your overall peace of mind. If the claim doesn’t go anywhere, we will file on your behalf in an effort to get answers and move your case forward.
What Changes the Moment You File a Lawsuit
A lawsuit officially introduces your case into the Massachusetts civil court system. It becomes a formal action rather than an insurance conversation. The moment the lawsuit is filed, the dynamic often shifts, and the other side loses the freedom to ignore you.
Deadlines go into effect, consequences become enforceable, evidence is prioritized, and settlement discussions are more serious. The lawsuit begins with a complaint filed in court, usually in the county where the accident or injury occurred.
From there, the defendant—which is the person or the company you’re suing—will receive a notice regarding the lawsuit. They must respond in a timely manner. Once the lawsuit is filed, the following phases unfold.
The Discovery Stage
At this point, both sides exchange evidence. This includes documents, medical records, photos, video footage, professional evaluations, and depositions. Depositions are sworn statements where you explain what happened and describe how your injuries have affected your life.
Motions and Court Procedures
Attorneys are able to file motions asking the court to rule on certain issues. The judge will decide what evidence will be allowed and how the case will move forward.
Negotiations Continue
Many lawsuits still settle without having to go to trial. Insurance companies tend to increase their offers during this stage because the risk of losing at trial becomes real.
Trial, if Necessary
If your attorneys are not able to settle with the other party’s insurance company, your case will likely be heard before a judge or jury. At that point, they will review the evidence and decide how much compensation you should receive.
All in all, lawsuits create pressure for accountability. Insurance companies care deeply about avoiding trial, which means the lawsuit phase often leads to higher settlement offers.
Call Jason Stone Injury Lawyers to Learn More About the Difference Between a Claim and a Lawsuit
A claim is an informal request for compensation through an insurance company. Meanwhile, a lawsuit is a formal legal action that is filed in court when negotiations fail. These are two separate stages that operate differently and, as a result, require different strategies.
Whether you should pursue a claim or a lawsuit is hard to figure out on your own, especially if you aren’t familiar with the legal system. At Jason Stone Injury Lawyers, our attorneys will help you make the decision that’s right for you.
Contact us as soon as possible. As part of our Stone Cold Guarantee®, there’s no obligation, just information®. We have 21–plus years of experience helping people just like you explore your options. We take care of our own because Massachusetts is our home, and we’re here for you.
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