Overview of Personal Injury Protection Benefits
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 P.I.P benefits.
What Is PIP?
P.I.P. 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 and file an Application for Benefits with your insurance company in order to begin receiving benefits.
What Benefits Does P.I.P. Provide?
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, and you may have selected a higher deductible of up to $2500, 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.
There is an 80%/20% co-payment provision on expenses incurred above your selected deductible, and up to $5000. This means that your P.I.P. carrier is responsible for 80% of your medical expenses above your deductible, up to a total of $5000 in medical expenses. You are responsible for the other 20%. These balances may be submitted to any health insurance available to you, subject to their deductible and co-pays. P.I.P. will make full payment of all expenses in excess of $5000, up to a standard maximum of $250,000. Additional medical expense benefits up to $1 million 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 and may be subject to prec. 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 BENEFITS pay for lost wages for a minimum of 52 weeks in the amount of $100 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 (T.D.B.) you are entitled to receive (whether or not you actually receive them). Therefore you must apply for T.D.B. 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 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.
Can My Insurance Company Stop Paying My Benefits Before I 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 "P.I.P. 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, we will aggressively fight for your right to continue to receive treatment.
Claims for these benefits which are challenged by a P.I.P. carrier are resolved either through binding arbitration under N.J. Department of Banking & Insurance contracted vendor, currently National Arbitration Forums (NAF), or by filing a law suit in Superior Court. We usually resolve these controversies through the arbitration process, because NAF claims are concluded in a shorter time and complications.
LEGAL SERVICES FOR PIP ARBITRATIONS
The Law Offices of Sean T. Hagan, LLC opened its doors in 2002 specifically devoted to PIP ARBITRATION/PIP DISPUTE RESOLUTION. Sean Hagan has handled thousands of PIP arbitrations on behalf of Individual Insureds and Medical Providers and Suppliers since 1998 and for a brief time as defense counsel for insurance carriers. Today representing only CLAIMANTS demanding payment for medical expenses causally related to a motor vehicle accident from the responsible insurance carrier, Sean Hagan has successfully arbitrated thousands of cases under an assignment of benefits on behalf of hospitals, surgeons, surgery centers, dentists, anesthesiologists, pain management specialists, chiropractors, physical therapists, diagnostic facilities and medical supply companies and directly on behalf of individuals.
When the Law Offices of Sean T. Hagan, LLC represents you in your PIP DISPUTE RESOLUTION, all costs connected with the commencement and resolution of the PIP DISPUTE RESOLUTION will be advanced by the law firm and any reimbursement of costs and legal fee will be paid by the automobile insurance carrier as determined by the arbitrator called the DISPUTE RESOLUTION PROFESSIONAL. There will NEVER be any costs or legal fee demanded from the client regardless of the outcome of the PIP DISPUTE RESOLUTION.
In addition to PIP DISPUTE RESOLUTION, the office handles municipal court/DWI/motor vehicle matters, and Collection Law. For other areas of law, we will provide a free consultation and provide a proper referral to an attorney with expertise who specializes in that field.
DISCLAIMER The information provided herein is in no way intended to establish an Attorney-Client relationship. Given the changing nature of the Law, business and the legal profession, the Law Offices of Sean T. Hagan, LLC does not and cannot warrant or assure that the information herein is complete, accurate or up to date. We do not assume, and therefore disclaim, any responsibility or liability for loss or damage caused by errors or omissions, whether resulting from negligence or any other cause. The material contained herein is not intended for, nor may it be used for legal advice in any general or particular sense. Readers are encouraged to consult us directly as to the current law applicable to particular situations.
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