Recovering damages after a car accident is often a difficult and complicated process. Dealing with medical bills, insurance adjusters, co-pays, deductibles, and maximum coverage thresholds when you are struggling with an injury can be overwhelming. The following information is provided to help answer questions you might have regarding Personal Injury Protection insurance. For more detailed information regarding the facts of your accident, please contact our law firm to schedule a free initial consultation.
Q: What is Personal Injury Protection (PIP)?
A: Personal Injury Protection (PIP) is a form of no-fault insurance available to auto insurance policyholders and other qualifying people who are injured in auto accidents. PIP covers medical treatment expenses, wage loss, and death benefits, among other benefits. If you are injured in an accident, it is important to determine whether you qualify for PIP insurance benefits, given the extraordinary costs of medical treatment today.
Q: What does "No-Fault" insurance mean?
A: In a "no-fault" state like New Jersey, policyholders are entitled to receive PIP benefits immediately after an accident without regard to who was at fault for causing the accident. Thus, even if you are responsible for causing an automobile accident, you may be entitled to receive PIP benefits under your auto insurance policy. Of course, if you are responsible for causing an accident, you may not be able to sustain a separate personal injury claim against the other driver(s) involved in the accident.
Q: What does PIP Cover?
A: PIP insurance may cover some or all of the following, depending upon the type of policy you opted for:
- Medical expenses
- Lost wages or lost income
- Essential services
- Funeral expenses
- Survivor benefits
Q: Does PIP insurance cover pain and suffering?
Typically, under New Jersey's no-fault system, you cannot sue for pain and suffering unless you've suffered a "serious injury," which is defined by state law. However, it depends on the specifics of your insurance policy and the nature of your injuries. Consult a personal injury lawyer for advice tailored to your situation.
Q: What is the required PIP coverage amount in New Jersey?
A: Under New Jersey law, the current minimum is $15,000. You may purchase more coverage, up to a maximum of $250,000, typically in the following increments:
- $50,000
- $75,000
- $150,000
- $250,000
Basic PIP coverage covers up to $15,000 in medical expenses per person per vehicle accident.
Standard PIP coverage provides benefits in addition to medical expenses. This includes wage replacement, essential services, and death benefits.
Low-income motorists may qualify for a third class of PIP coverage, known as a Special PIP policy. This offers less coverage than the Basic PIP, but unlike the Basic, the Special class includes $10,000 in death benefits.
Catastrophic injuries are eligible for up to $250k in medical expense coverage.
Q: Can I choose lower coverage limits for my PIP insurance?
A: Yes, you have the option to select the lowest coverage basic policy PIP. The standard limit is $250,000, but you can choose a limit as low as $15,000. However, it's highly recommended that you opt for a more robust policy, as medical expenses from a serious car accident can quickly exceed this minimum coverage.
Q: What is PIP medical expense deductible in New Jersey?
A: In New Jersey, the PIP medical expense deductible is the amount you must pay out of pocket before your insurance company begins to pay for your medical expenses following a car accident.
When you choose a PIP policy, you'll have the option to select a deductible, typically ranging from $250 to $2,500. The deductible you select will affect your policy's premium. A higher deductible usually leads to a lower premium, but it also means you'll need to pay more out of pocket if you're involved in an accident.
For example, if you choose a $1,000 deductible and have $5,000 in medical expenses following a car accident, you would need to pay the first $1,000 yourself. Your PIP coverage would then cover the remaining $4,000, subject to your policy's coverage limits.
Q: Do I still need PIP coverage if I have health insurance?
A: Yes, PIP coverage is mandatory in New Jersey regardless of your health insurance coverage. In the event of an accident, PIP offers additional benefits like coverage for lost wages and essential services, which are typically not covered by health insurance. However, some auto insurance policies may allow you to select health insurance primary as part of your policy details.
Q: What happens if my health insurance is primary and denies coverage of my medical bills after an accident?
A: Not all health insurance policies will provide coverage for motor vehicle accidents. Moreover, your health insurer will likely require you to meet a certain deductible before your medical coverage is activated. If your health insurance policy refuses to pay a claim resulting from a car accident injury, your auto insurance company should cover your medical costs as if it were your primary coverage.
Q: What type of injuries qualify for catastrophic coverage?
A: Certain injuries that are deemed catastrophic are eligible for up to $250,000 of medical expense coverage. Examples include the following:
- Spinal cord injury
- Dismemberment
- Significant and permanent brain damage
- Disfigurement
- Acute injuries that require emergency hospital treatment
Q: What medical expenses are eligible under NJ PIP?
A: Medical treatment must be deemed “reasonable and medically necessary” in order to be covered by PIP insurance. Some of the following treatments may be covered by PIP:
- Medical treatment
- Surgery
- Rehabilitative care
- Diagnostic services
- Hospital expenses
- Ambulance services and other necessary transportation
- Medication
- Remedial or non-medical treatments that are recognized as religious methods of healing
Insurance carriers may require precertification for some of the treatments you receive for your injury. Typically, emergency room care and medically necessary services you receive during the first 10 days after your auto accident are exempt from the precertification requirement.
Q: How much does PIP pay for wage replacement?
A: If you opted for a Standard PIP Policy, wage replacement is available. For the standard $15,000 policy, these benefits may not exceed $100 per week, up to a maximum overall limit of $5,200. This coverage must not exceed the net income of the disabled party receiving the wage benefits during the benefit receipt period.
Q: Can I collect wage reimbursement from other sources while I am receiving PIP wage income continuation benefits?
A: Double-dipping is not permitted. If you receive other wage replacement benefits, the amount of PIP wage replacement you receive may be set off by the amount you are receiving from other sources. These collateral sources may include the following:
- State temporary disability
- Workers' compensation
- Military personnel benefits provided under federal law
- Medicare
Q: What types of services qualify as essential under PIP?
A: Essential services benefits are those that would normally be performed by the injured party and must be reasonable and necessary. Examples include:
- Childcare
- House cleaning
- Laundry
- Lawn care
These services are performed for the benefit of the injured person and household family members. The daily reimbursement limit is generally $12, and the maximum limit is $4,380. Proof of payment to a third party for rendering these essential services is typically required.
Q: What do I need to prove my injuries in a PIP claim?
A: The documents needed to support your PIP claim may include an accident or police report, medical bills, documentation of lost wages, and any proof of other expenses related to your injury. A skilled car accident attorney can help you acquire all necessary documents related to your claim, ensuring that all expenses are accounted for such that you can receive maximum compensation for your injuries.
Q: Am I legally required to talk to an insurance agent after a car accident in New Jersey?
A: You may not be legally required to talk to an insurance agent immediately after a car accident. Still, it is generally required by your insurance policy to report the accident to your insurance company as soon as possible to ensure your eligibility for PIP benefits.
However, if you're contacted by the other party's insurance agent or adjuster, you're not legally required to speak with them. You should consult an attorney before doing so in order to avoid saying anything that could potentially be used to diminish your claim.
Q: What happens when my PIP coverage is exhausted?
A: When your Personal Injury Protection (PIP) coverage is exhausted, meaning you've reached the limit of what your car insurance policy will cover for medical services and other related costs, you'll need to look to other sources to cover your remaining costs.
A skilled attorney can investigate your claim and identify other potential avenues of compensation. For example, if your injuries are severe and the other driver was at fault, you may be able to file a claim against their liability insurance or file a personal injury lawsuit to recover additional damages.
Regardless of how your accident happened, a personal injury lawyer can help you understand your options and navigate the process of seeking additional compensation.
Q: Is it possible to sue for damages after an auto accident in New Jersey?
A: Yes. Under certain circumstances, you may be able to sue the negligent motorist who caused your motor vehicle accident injuries. This depends on a number of factors, including the extent of your injuries and whether the limited right to sue, or verbal threshold, applies to your claim. If you are interested in initiating a lawsuit against the negligent parties who caused your injuries, you should contact an experienced motor vehicle accident lawyer to learn your rights and options.
You may be entitled to monetary damages for your injuries. The law limits the time for you to bring forth a suit, so don't wait.
Q: Do I need an attorney if I have car insurance?
A: Yes. Regardless of whether or not your claim meets the limited right to sue, a car accident lawyer can be instrumental in ensuring that you receive everything you're entitled to after a serious accident.
An experienced personal injury lawyer can help you understand your New Jersey PIP coverage, navigate the complexities of insurance claims, negotiate with the auto insurer on your behalf, and ensure you receive the full compensation you're entitled to.
In addition, if your injuries resulted in significant medical bills, permanent injury or disability, loss of earning potential, or other long-term costs, a lawyer can help you understand and pursue all potential sources of compensation to see that your needs are met now and in the future. If the insurance company denies your claim, offers a settlement that you believe is too low, or acts in bad faith, a lawyer can protect your rights and interests.
