Injured in a NJ Car Accident? – The Basics of Medical Benefit (PIP) Claims

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Getting medical bills paid after a car accident in New Jersey can seem like a nightmare. Arguably, New Jersey car accident medical bill law, or what is known as PIP (personal injury protection), is one of the most complex in the country.

The following are five aspects of NJ PIP law that most people misunderstand and have questions about:

  1. New Jersey is a no-fault state.
  2. Only certain types of benefits are covered under PIP.
  3. Only certain classes of people can make PIP claims.
  4. The maximum amount payable is usually $250,000, but may vary.
  5. A deductible/co-insurance must be paid.

The first two aspects will be discussed below.

New Jersey is a no-fault state.

Many residents of New Jersey are surprised to learn that New Jersey is a no-fault state. When people buy car insurance, this is one of the last things ever explained to them.  No-fault means that when it comes to getting medical bills paid after a car accident, fault is taken out of the equation. In other words, if you get into a car accident in New Jersey and need to seek medical treatment, you will make the claim with your car insurance company, not the car insurance company of the person who caused the accident.

Although it is counterintuitive, the at-fault driver is not legally responsible for paying the PIP claims of the other injured driver. That’s the basis of the no-fault principle pertaining to PIP benefits in New Jersey.

Only certain types of benefits are covered under PIP. 

Only certain benefits are payable under New Jersey’s PIP statute:

  • reasonable and medically necessary medical expenses,
  • lost wages (also known as “income continuation”),
  • essential services (i.e., home care),
  • death or survivor benefits, and
  • funeral expenses.

See New Jersey Statutes Annotated Section 39:6A-4 which is entitled, “Personal injury protection coverage, regardless of fault.”

Under New Jersey car insurance law, car insurance companies are required to pay medical bills pursuant to the New Jersey Fee Schedule. This fee schedule lays out the maximum cost for medical procedures based on the region of the state where the treatment is rendered.

Suggested reading: New Jersey Car Truck Accidents – What Can You Recover?

In addition, treatment for certain spinal injuries must follow specifically designated “care paths.” Care paths are specially designated treatment courses which apply to spinal sprains/strains, herniations, etc. Deviation from a care path may let a car insurance company off the hook when it is time to pay for a specific medical bill. Also, it is important to note that pre-certification is required for certain procedures, such as CT scans, MRIs, etc.

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If you were injured in a car accident in New Jersey and have questions about your medical bills, feel free to contact Phil T. Ciprietti, Esquire for a free initial consultation. 800.281.8695

Mr. Ciprietti places the interests of his clients first in all matters.  Since 1982, Mr. Ciprietti has been certified by the New Jersey Supreme Court as a Certified Civil Trial Attorney. He is an experienced personal injury lawyer who has helped many injured car and truck accident victims in New Jersey.

In addition to helping residents of New Jersey in all types of accident cases, Mr. Ciprietti also represents residents of other states such as Pennsylvania, New York, Maryland, and Virginia who are injured in car, truck or bus accidents while driving on New Jersey roadways such as, the NJ Turnpike, AC Expressway, Interstate 295 or the Garden State Parkway.

*Disclaimer: Every case is unique and you should not take any action or make decisions in your case without speaking to a qualified car and truck accident lawyer in New Jersey. This website page does not provide any legal advice or create any attorney-client relationship. Use of the contact form on this website or emailing Mr. Ciprietti does not create any attorney-client relationship. In addition, confidential information should not be sent through the contact form.

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