The Basics of PIP: Setting Up a Medical Claim

Car Accidents Caused by a Negligent Driver in New Jersey

If you are involved in a car accident in New Jersey, making sure that your medical bills get paid may seem like a nightmare.   Although it may seem counter-intuitive, when a New Jersey driver is injured in a car accident caused by another negligent driver, the injured driver’s own car insurance company is responsible for paying their medical bills, as opposed to the auto insurance company of the at-fault driver.  This is because New Jersey is a no-fault state.  What this means is that, regardless of who is at fault for the auto accident, the injured driver must make a claim for medical expenses – also known as a Personal Injury Protection claim (PIP) – with their own car insurance company.

Therefore, if you were involved in an auto accident and need medical treatment, you will contact your own insurance company to set up a claim.  When setting up your claim the adjuster would probably ask you for basic information including your policy number, contact information, the location of the accident, property damage, questions regarding the other vehicle and driver, and a description of the accident.  With respect to the description of the accident, you can give a brief explanation (“I was rear ended”), but you should not have to give a detailed description.  Although as mentioned above you do not have to prove fault in order for your medical expenses to be covered by your auto insurance company, you should never admit to being at fault for the accident.

Insurance Adjusters After a New Jersey Car Accident

The adjuster should also ask you if you were injured.  You do not need to talk to the adjuster in detail regarding your injuries, however, now is the time to tell the adjuster that you are injured and that you do want medical treatment.  If they push for more information, you can always tell them that, until you see a doctor, you won’t know any further information about your injuries.

If the accident happened some time ago and you still haven’t sought treatment, the adjuster may inquire as to why you suddenly want treatment.  Any gaps or delays in receiving treatment may make your case seem weak in the eyes of the insurance company.  You could simply explain to the adjuster, however, that your pain has gotten worse since the accident, as many injuries are known to do.

Unlike most health insurance companies, your auto insurance company is not allowed to require that you see certain doctors or that you see providers in you network. With PIP, you can see any doctor you want to.

You should be aware that your responsibilities under PIP include the following:

  • Deductible: the PIP deductible is a minimum of $250. Your deductible, however, be as high as $2,500, depending on your policy coverage limits.  If you also have health insurance, you should list your health insurance secondary to the auto insurance, as they may cover all or some of your deductible.
  • Co-payments: it is your responsibility to pay 20% of the first $5,000 of your medical bills.   Again, if you have health insurance, you should try to list them as a secondary insurer as they could cover these co-payments as well.
  • Out-of-Pocket Maximum: if you chose the minimum policy, the maximum out-of-pocket payments you would have to make would be $1,200

As you can see, your health insurance might be able to cover some of your out-of-pocket expenses through PIP.  You should note though, that when choosing up your auto policy, you may have made a choice regarding whether to make PIP or your health insurance company your primary source of medical insurance coverage.  We always recommend making PIP primary.  If you make your health insurance primary, you may be responsible for paying back your health insurance company from any settlement amounts you receive.  You would not, however, have to do that if your auto insurance was primary.

Experienced Auto Accident Attorneys in New Jersey Can Help

Once you have opened a medical claim and have started getting treatment, you will need to put the insurances companies for any at-fault parties on notice of the accident.  If you were involved in an auto accident in New Jersey and have questions about your medical expenses, contact the experienced personal injury attorneys at Harrell, Smith and Williams today at (908) 264-7228 to scheduled a no-cost consultation.

Posted in Auto Accident, automobile insurance, Medical Claim.