A Guide to Personal Injury Protection Benefits in New Jersey
New Jersey is a no fault state. That means that if you are involved in an automobile accident, your own automobile insurance company will pay for your medical bills. If you did not own an automobile on the day of the accident, you would first look to the policies of anyone with whom you reside and who you are related to by blood or marriage. This is called being a "resident relative." If you live with anyone that you are related to, and they own an automobile, then you may have coverage for your medical bills through that insurance policy. Lastly, if you do not own an automobile and you do not live with anyone that has automobile insurance, you may be eligible through the policy of the person whose car you were in at the time of the accident.
Personal Injury Protection provides coverage under a standard policy of up to $250,000.00. This coverage, however, can be limited by the choices you make when you purchase the insurance policy. Typically, companies that advertise heavily on television, such as GEICO and Progressive, will reduce your automobile insurance premiums by giving you much less in coverage. For example, GEICO often provides only $10,000.00 in medical benefits. This is grossly inadequate in most cases. In addition, New Jersey law mandates that there by a deductible, and a co-payment amount. The standard deductible and co-payment amounts are a $250.00 deductible and a 20% co-payment up to $5000.00.
This means that you can be responsible for up to $1,200.00 in deductibles and co-payments even if you have $250,000.00 in coverage. Your deductible amounts can also be increased when you select your Personal Injury Protection benefits. Once again, GEICO and those kind of companies will tell you that you can save money by picking a much higher deductible, such as $2,500.00 or even $5,000.00. Imagine a simple trip to the emergency room because of an automobile accident that was not your fault. If you select a $5,000.00 deductible, you would be responsible for that initial $5,000.00, plus a possible co-payment on additional amounts.
Personal Injury Protection is not expensive in New Jersey when compared to the benefits that you receive. When you purchase your automobile insurance, it is strongly recommended that you select the lowest deductible that is allowed by law, which is $250.00.
Finally, it is important to keep in mind that all medical care is subject to "pre-certification" in New Jersey. This means that the insurance company must approve medical testing, such as an MRI or any other procedure. Your treating physician must submit a request for pre-certification to the insurance company and that insurance company has an obligation to respond within a very short period of time, normally 72 hours. If the insurance company denies the request, then your doctor may apply for re-consideration or file an appeal. If the appeal is denied then your case is eligible to proceed to mandatory arbitration. If you have been denied treatment, it is strongly recommended that you seek the services of an attorney to assist you with the claim.
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