Selecting Your NJ Health Insurer for NJ PIP Option on your NJPAIP car insurance policy.
You may be able to save considerable money and get much higher coverage limits on auto insurance by opting to have your health coverage provide benefits for injuries from an automobile accident. Please consider the factors below to see if this option is right for you.
Does your health coverage cover injuries from automobile accidents? Call them and ask them, they are required to tell you.
Health coverage may be issued by an insurance company, an HMO or a self-funded plan. Since self-funded plans and plans issued out of state may exclude coverage for injuries resulting from auto accidents, you should make sure that your health coverage will provide benefits for automobile accident injuries. If you are covered by any of the insurers or HMO listed here, you may be eligible for this cost-saving option. Other insurers and self-funded plans might also cover automobile accident injuries. Contact your employee benefits department to determine if your health coverage provides benefits for automobile accident injuries.
What limits and deductibles apply?
Your health carrier will provide benefits for injuries from auto accidents subject to the deductibles, coinsurance, copayments and benefit maximums (if any) of your health plan. If your health plan covers your spouse or family, these cost-sharing features will also apply to them. In short, your health carrier will provide benefits for injuries from auto accidents in the same manner that it covers injuries from other causes.
What about expenses not covered by my health care plan?
Your automobile insurer will pay for necessary expenses not covered by your health care plan, including the deductible, coinsurance, co payment and amounts above the benefit maximum of your health plan, and will also pay for passengers and others not covered by your health care plan. However, this payment will be reduced by the deductible, benefit maximums and other cost-sharing provisions of your PIP coverage.
What if I lose my health coverage?
If you are in an accident and your health coverage is no longer in effect, your auto insurer will pay PIP medical benefits. However, you will be required to pay an additional $750 deductible.
How do I choose the health coverage option?
This is done by selecting the “health insurer for PIP option” on the Coverage Selection Form provided when you apply for or renew your auto insurance. You will need to know the name and policy number of your health care plan to answer that question on the Coverage Selection Form.
About the NJ Auto Insurance No-Fault PIP Insurance Arbitration Program
The National Arbitration Forum administers arbitrations for No-Fault Insurance Personal Injury Protection (PIP) disputes under New Jersey’s Automobile Insurance Cost Reduction Act of 1998 (AICRA). AICRA requires that all automobile insurers provide any party with a dispute concerning personal injury protection benefits the option of submitting the dispute to binding arbitration. The National Arbitration Forum has been the appointed administrator for the New Jersey No-Fault Insurance PIP Arbitration Program since January 2004, when the New Jersey Department of Banking and Insurance awarded National Arbitration Forum the contract. Additional information about this program is available at the National Arbitration Forum’s Web site at http://www.arb-forum.com/nj/.
N.J.S.A. 39:6A-5
g. Personal injury protection coverage benefits pursuant to section 4 of P.L.1972, c.
70 (C.39:6A-4) and medical expense benefits pursuant to section 4 of P.L.1998, c.21
(C.39:6A-3.1) shall be overdue if not paid within 60 days after the insurer is furnished
written notice of the fact of a covered loss and of the amount of same. If such written
notice is not furnished to the insurer as to the entire claim, any partial amount supported
by written notice is overdue if not paid within 60 days after such written notice is
furnished to the insurer. Any part or all of the remainder of the claim that is subsequently
supported by written notice is overdue if not paid within 60 days after such written notice
is furnished to the insurer; provided, however, that any payment shall not be deemed
overdue where, within 60 days of receipt of notice of the claim, the insurer notifies the
claimant or his representative in writing of the denial of the claim or the need for
additional time, not to exceed 45 days, to investigate the claim, and states the reasons
therefor. The written notice stating the need for additional time to investigate the claim
shall set forth the number of the insurance policy against which the claim is made, the
claim number, the address of the office handling the claim and a telephone number,
which is toll free or can be called collect, or is within the claimant’s area code. Written
notice to the organization administering dispute resolution pursuant to sections 24 and 25
of P.L.1998, c.21 (C.39:6A-5.1, 39:6A-5.2) shall satisfy the notice request for additional
time to investigate a claim pursuant to this subsection. For the purpose of determining
interest charges in the event the injured party prevails in a subsequent proceeding where
an insurer has elected a 45-day extension pursuant to this subsection, payment shall be
considered overdue at the expiration of the 45-day period or, if the injured person was
required to provide additional information to the insurer, within 10 business days
following receipt by the insurer of all the information requested by it, whichever is later.
For the purpose of calculating the extent to which any benefits are overdue, payment
shall be treated as being made on the date a draft or other valid instrument which is
equivalent to payment was placed in the United States mail in a properly addressed,
postpaid envelope, or, if not so posted, on the date of delivery.
h. All overdue payments shall bear interest at the percentage of interest prescribed in the
Rules Governing the Courts of the State of New Jersey for judgments, awards and orders
for the payment of money.
i. All automobile insurers and the Unsatisfied Claim and Judgment Fund shall provide
any claimant with the option of submitting a dispute under this section to dispute
resolution pursuant to sections 24 and 25 of P.L.1998, c.21 (C.39:6A-5.1, 39:6A-5.2).