To challenge an at-fault accident surcharge in Massachusetts, complete the appeal form printed on the back of the surcharge notice your insurer mailed you, enclose a $50 check or money order payable to the Commonwealth of Massachusetts, and send it to the Division of Insurance so it arrives within 30 days of the notice date. The Massachusetts surcharge appeal form is a one-page document, and the Board of Appeal on Motor Vehicle Liability Policies and Bonds will not schedule a hearing without both the completed form and the fee.1Mass.gov. Appeal an At-Fault Accident
Where to Get the Form
The form is on the reverse side of the surcharge notice your insurance company sent you. The front of that notice carries the policy, claim, and accident information you need to complete it. If the original notice has been lost or thrown away, a blank copy is available for download on Mass.gov.2Mass.gov. Massachusetts At-Fault Surcharge Appeal Form There is no online filing option. Paper and mail are the only accepted method.
What the Form Asks For
Most of the identifying information you need is pre-printed on the front of the surcharge notice; your job is to copy it accurately onto the back. The form requires:
- Accident date and the notice date (the notice date starts your 30-day filing clock)
- Policy number and claim number
- The Standard of Fault code the insurer applied under 211 CMR 74.04
- Driver’s license number for the operator, and separately for the policyholder if that is a different person
- Your statement of facts describing the accident
Match the names on the form to the names on the driver’s license exactly. Small discrepancies can delay processing.
Writing the Statement of Facts
The statement of facts is the only part of the form where you tell your side, and it is the part that decides whether the appeal has a chance. Describe the physical details: where each vehicle was positioned, the direction each was traveling, road and weather conditions, visibility, and what the other driver did. Keep it specific and keep it short. A common mistake is using the space to complain about the insurer’s decision instead of describing the accident. The Hearing Officer reads hundreds of these, and a clear, factual narrative stands out.
If a police report exists, read it before you write so your statement does not contradict it on basic points like location, time, or direction of travel. Do not attach the police report, photographs, diagrams, or anything else to the appeal form. The form warns in bold that any supporting documents mailed in with it will be destroyed.2Mass.gov. Massachusetts At-Fault Surcharge Appeal Form Hold your evidence for the hearing.
Target your statement to the Standard of Fault code the insurer used. If the code is for a rear-end collision, explain what made the collision unavoidable or show that the other vehicle reversed into you. If the code is for a collision while backing up or a left turn across traffic, address those specific facts. The code creates a rebuttable presumption of fault, and the Hearing Officer wants to see evidence that undoes that presumption.3Legal Information Institute. 211 CMR 74.04 – Standards of Fault
The $50 Fee and Where to Mail It
Enclose a non-refundable $50 filing fee with the completed form. Payment must be by check or money order payable to the Commonwealth of Massachusetts. Cash and credit cards are not accepted. If the fee is missing or incorrect, the Board returns the application without scheduling a hearing.1Mass.gov. Appeal an At-Fault Accident
Mail the form and fee to:
At-Fault Accident Appeals
Division of Insurance
One Federal St., Suite 700
Boston, MA 021101Mass.gov. Appeal an At-Fault Accident
The 30-Day Deadline
The 30 days run from the notice date printed on the front of the surcharge notice, not from the day you opened the envelope.4Mass.gov. Appeal an At-Fault Accident Determination The form must be received by the Board within that window, so dropping it in the mail on day 29 is risky. Use a mail service with tracking so you have proof of delivery.
Make Sure the Accident Is Appealable
Before you spend the $50, confirm that a surcharge was actually warranted. Under 211 CMR 134.00, an at-fault accident requires a claim payment over $1,000, exclusive of any deductible, for accidents on or after July 1, 2015.5Mass.gov. 211 CMR 134 – Safe Driver Insurance and Merit Rating Plans The threshold applies to property damage, collision, and limited collision claims, and to bodily injury liability claims over $1,000 when there is no separately surchargeable property damage or collision claim from the same accident.6Mass.gov. Surchargeable Incidents If the claim payment on your accident was below $1,000, the surcharge should not have been issued, and that is itself grounds for the appeal.
What Happens After You Mail It
Once the Board receives your form and fee, you will get a written acknowledgment that the appeal is in the system. A separate Hearing Notice follows roughly three weeks before your hearing date, with the date, time, and instructions for appearing.4Mass.gov. Appeal an At-Fault Accident Determination Wait for that notice before sending any evidence. Everything you then submit becomes part of the official record and will not be returned.
All hearings are virtual. A single Hearing Officer presides, and you have three ways to participate:4Mass.gov. Appeal an At-Fault Accident Determination
- Appear by video or telephone and present your case live. Send in copies of all photographs, police reports, diagrams, and other evidence you want considered.
- Submit a written statement in place of appearing. It must reach the Board at least five days before the hearing, along with your signed Hearing Notice (which serves as your waiver of personal appearance) and copies of any supporting evidence.
- Send a representative, which can be an attorney or any other authorized person. The Board must receive a written, signed authorization from you plus your own written testimony describing the accident at least five days before the hearing.
If the Board Rules Against You
A driver who disagrees with the Board’s decision has 30 days from receiving the written decision to appeal to Superior Court under M.G.L. c. 30A, ยง 14, either in the county where the driver lives or in Suffolk County Superior Court in Boston.4Mass.gov. Appeal an At-Fault Accident Determination That court reviews the administrative record from the Board hearing rather than hearing the case fresh, so the evidence you presented to the Hearing Officer is the evidence the court will see.