NJ PIP Recovery for Personal Injury Protection

If you were injured as a result of an accident in New Jersey involving a private passenger automobile, you are entitled to benefits. The law is complicated, and your attorney will determine if you qualify for these benefits, known as “PIP”. The rest of this guide assumes that you are entitled to receive PIP benefits.

PIP is a package of benefits including medical expense benefits, income continuation benefits, essential service benefits, funeral benefits and death benefits. The extent of your benefits is determined in part by New Jersey law, and in part by the coverage limits of the policy providing benefits to you. You must notify your insurance company and file an Application for Benefits in order to begin receiving benefits.

Medical Expense Benefits: Pay all reasonable hospital, medical, and related expenses incurred for treatment of your injuries. This benefit will pay for in-patient and out-patient hospital visits; doctors; chiropractors; dentists; psychologists; therapists; skilled nursing care; prescriptions; appliances; diagnostic tests such as X-rays, MRIs, CAT Scans, Bone Scans and EMGs; ambulances and medical transportation. There is an automatic deductible of $250.00, and you may have selected a higher deductible of up to $2,500.00, in exchange for a premium reduction. You will be subject to the coverage in effect on the date of your accident, even if you change your coverage before you incur expenses related to that accident. Additional medical expense benefits are available as an option and you may also select a lesser amount of coverage in exchange for a premium reduction. All medical expenses are subject to a fee schedule developed by the New Jersey Department of Insurance. As an injured party, you are not responsible for charges billed in excess of the amounts allowed under the fee schedule. You can see how complicated the law is, so ask your lawyer any questions you have.

Income Continuation Benefit: Pay for lost wages for a minimum of 52 weeks in the amount of $100.00 or more per week. This amount can be greatly increased in both weekly amount and time period of payments by selecting available options. These benefits receive a credit for any Temporary Disability Benefits you are entitled to receive (whether or not you actually receive them). Therefore you must apply for Temporary Disability Benefits immediately upon stopping work.

Essential Service Benefits: Reimburse you for payments made to others performing tasks such as housework, child care, shopping, food preparation or transportation, up to $12.00 per day for up to 365 days. Higher coverage limits are available.

Funeral Benefit: Pays up to $1,000 for funeral bills incurred as a result of a death caused by an auto accident.

Death Benefit: Pays the combined total of available income continuation benefits and essential service benefits that would have been available to a person who dies as a result of an auto accident, up to a maximum of $10,000.00.

Can Your  Insurance Company Stop Paying My Benefits Before  You Use Them Up? New Jersey law gives insurance companies providing P.I.P. benefits the opportunity to have you examined by a doctor of their choice in your municipality, to determine whether you have a continuing need for P.I.P. benefits. These examinations are known as “PIP exams”, and are generally performed by physicians who devote a substantial portion of their practice to working for insurance companies. Typically, the doctor determines that any injury you may have sustained has been cured by the treatment you have been receiving, and offers the opinion that you are not in need of further treatment. If your injury is serious and obvious, the doctor may conclude that additional treatment will not result in additional improvement or pain relief. In either case, the insurance company notifies you that they are terminating your entitlement to benefits, and will not pay for any additional treatment. You are not obliged to accept this decision, and if your treating physician is willing to support your need for on-going care, I will aggressively fight for your right to continue to receive treatment. Claims for these benefits which are challenged by a PIP carrier are resolved either through binding arbitration under N.J. Department of Banking & Insurance contracted vendor(currently Forthright), or by filing a law suit in Superior Court. I usually resolve these controversies through the arbitration process, because Forthright claims are concluded in a shorter time and complications.

NJ PIP Recovery for Health Care Providers