A flat cap vs. a four-step one
Illinois caps medical malpractice attorney fees at a single flat 33⅓%, regardless of how large the recovery is. Massachusetts's approach under G.L. c. 231, § 60I is structurally different, and more granular than most sliding-scale states: 40% on the first $150,000, 33⅓% on the next $150,000, 30% on the next $200,000, and 25% on everything above $500,000. The result is an effective overall rate that declines meaningfully as the total recovery grows.
What genuinely sets Massachusetts apart: the medical-expense floor
Beyond the tiered percentages themselves, Massachusetts adds something distinctive: if the standard fee calculation would leave the plaintiff with less money than their own unpaid medical bills included in the recovery, the fee agreement becomes unenforceable until it's adjusted — to 20% or less, or to whatever figure actually lets the plaintiff cover those bills. This isn't a feature most states' fee-cap statutes include; it specifically targets the scenario where a technically-compliant fee would still leave a client in a worse financial position than before the recovery.
Two separate mechanisms, one triggering condition
It's worth distinguishing this fee cap from Massachusetts's separate $500,000 noneconomic damages cap. Both are triggered by the same underlying fact — that the claim involves medical malpractice — but they operate on entirely different things: the damages cap limits what the plaintiff can recover for pain and suffering; the fee cap limits what the attorney can charge out of whatever is recovered.
Downward flexibility, not upward
The statute is explicit that an attorney remains free to agree to a fee below the schedule, and that a court can still find even a schedule-compliant fee unreasonably high on the facts of a specific case. The four tiers function as a ceiling the law won't let an attorney exceed, not a floor the attorney is entitled to.