PIP stands for personal injury protection. PIP is a mandatory component of auto insurance policies that covers medical treatments for injuries resulting from auto accidents. In New Jersey, all motorists are required to carry a minimum of $15,000 PIP coverage up to a maximum of $250,000. However, if a patient has a traumatic brain or spinal cord injury, these limits may not be applicable pursuant to court settlements. Beyond liability insurance coverage paid by the liable party’s insurance company, PIP insurance covers funeral expenses, home health care, and physical therapy. While coverage mandates may vary by state, a New Jersey motorist’s PIP coverage may even be applicable if they are injured by another vehicle as a passenger or pedestrian. If a motorist has health insurance in addition to auto insurance, they have the option to choose between PIP Primary and PIP Secondary coverage. Motorists without adequate health insurance may only choose PIP Primary coverage.
For motorists with PIP Primary coverage, the insurer is primarily responsible for paying for the cost of medical treatments resulting from an auto accident after the deductible is satisfied. For motorists with PIP Secondary coverage, their auto insurance policy only covers health care expenditures beyond the scope of their health insurance coverage after all deductibles have been satisfied. Since annual deductibles continue to rise for most health insurance policies while limiting provider networks and the types of treatments that are covered, injured patients with PIP Secondary coverage typically fare worse. The modest cost savings on auto insurance premiums are almost always superseded by the cost of insurance deductibles and out-of-pocket expenses following an accident. Based on our experience working with personal injury attorneys and advocating on behalf of patients suffering from accident related injuries, we strongly recommends all motorists carry adequate PIP coverage above the state minimum and elect PIP Primary coverage.
If a patient needs an X-ray, Ultrasound or MRI as the result of an accidental injury resulting from the negligence of another person or party, personal injury protection (PIP) insurance or workers’ compensation will likely cover most or all of the cost of treatment. Optimum Diagnostic Imaging has a terrific relationship with the most prominent injury lawyers in the community, along with a thorough understanding of the laws regulating insurance payouts. We will work diligently on behalf of all injury patients to ensure that cost will not be a barrier to receiving quality x-ray image, ultrasound and/or MRI images.
Auto insurance policies have numerous components, including personal injury protection (PIP), liability, collision, and comprehensive coverage. Individuals who are injured in an auto accident may develop serious injuries from the accident, and it is vital to maintain adequate insurance to cover medical expenses. In New Jersey, all motorists driving a vehicle are required to carry a minimum PIP coverage of $15,000 and minimum liability coverage of $15,000 per person, $30,000 per accident, and $5,000 in property damages. New Jersey motorists must also purchase uninsured/underinsured motorist coverage at a minimum of $15,000 per person, $30,000 per accident, and $5,000 in property damages. Beyond the minimum coverage requirements, collision and comprehensive insurance are only mandatory if the vehicle is financed or leased and such coverage requirements are stipulated in the lessee/borrower contract with the lienholder. Auto insurance policies may offer roadside assistance, towing reimbursement, and rental reimbursement coverage, but these additional components are completely optional for all motorists.
The primary distinction with PIP coverage is the payment of medical expenses to the affected policyholder regardless of fault. PIP coverage is effective even if the policyholder was injured as a passenger in another personÔÇÖs vehicle or as a pedestrian. Liability coverage only pays for medical expenses and vehicle and property damages resulting from an auto accident to the affected parties. Liability coverage is paid directly from the liable partyÔÇÖs insurance policy. However, liability insurance does not cover medical expenses for the motorist liable for the accident. For medical coverage, the liable motorist would be covered by the PIP component of their auto insurance policy.
The collision component of an auto insurance policy covers damages to the liable partyÔÇÖs vehicle resulting from an accident, even if there were no other passengers, motorists, vehicles, and/or pedestrians involved. Comprehensive auto insurance pays for damages to the insured partyÔÇÖs vehicle resulting from flooding, acts of nature, tornados, hurricanes, wind damage, vandalism, and theft. If a vehicle is severely damaged beyond repair or if the cost of repair would exceed a given percentage of the current fair market value, the vehicle may be declared a total loss. For total losses, the motorist would be paid for the fair market value of the vehicle minus their deductible.
Motorists with adequate health insurance have the option to select PIP Primary or PIP Secondary coverage. For motorists without health insurance, the only option is to select PIP Primary coverage. PIP Primary coverage ensures that the auto insurance policy will pay for medical expenses up to the coverage limit after the deductible is satisfied, regardless of fault and the affected partyÔÇÖs health insurance coverage. PIP Secondary coverage would only pay for expenses not covered by health insurance after the patientÔÇÖs annual deductible and out-of-pocket maximum were exhausted. Fortunately, PIP insurance covers most treatments for TMDs resulting from auto accidents. PIP also covers the costs of x-rays, ultrasound, MRIs, medical evaluations, and ongoing physical therapy and chiropractic treatments.
To further discourage you from choosing PIP secondary coverage, please understand that your health insurance company may use liens to recover the expenses that have already been paid for your medical care. If you sue the at-fault party and ultimately receive a settlement from the at-fault party for pain and suffering, your health insurance company may place a lien on the settlement amount which would have to be satisfied before the settlement could be distributed. This would proportionally reduce the amount that both you and your injury attorney would ultimately receive in an auto accident settlement. If you have PIP primary coverage instead, auto insurance companies are prohibited by law from placing a lien on your settlement from the at-fault party. Your auto insurance is required to cover all the aforementioned expenses if they are medically necessary and you would have a wider choice of doctors because you would not be limited by insurance networks.
In recent years, health insurance companies have narrowed their networks of providers and increased their deductibles, copays, and out-of-pocket maximums before paying anything to cover the cost of medical care. The modest cost savings from electing PIP Secondary may be easily outweighed by the medical expenses resulting from treatments not covered by health insurance. For this reason, ODI NJ encourages all motorists to elect PIP Primary coverage up to the maximum New Jersey state limit of $250,000. If you believe you are suffering injuries after a traumatic car accident, please call our office as soon as possible to schedule a consultation.
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If you have been involved in an automobile accident, you should not be concerned about the impact of your personal injury protection (PIP) coverage on your auto insurance liability premiums. Liability insurance premiums are calculated based on risk factors including at-fault accidents in which the policyholder was responsible for injuring others or damaging property. The PIP component of auto insurance covers hospital bills, medical expenses, and lost wages regardless of liability. PIP is also more comprehensive than health insurance, because it may cover funeral expenses, home health care, and physical therapy following an accident. In New Jersey, motorists with PIP coverage are also covered as passengers in another vehicle or pedestrians on the road.
While all emergency health care expenses following an accident may be covered by PIP coverage, future health care expenses may need to be preapproved by a claims administrator assigned to review the case. PIP is different from liability, collision, and comprehensive insurance because it covers the policyholder regardless of fault. Unlike the aforementioned types of insurance, PIP does not cover damage to the injured policyholder’s vehicle, vehicle theft, property damage, or medical expenses which exceed the coverage limits. If policyholders incur medical expenses in excess of these limits, they may have to pursue legal action directly against the individual responsible for the accident or the estate of the responsible party if they are deceased.
In New Jersey, policyholders with PIP coverage have the option to elect a limited right to sue or an unlimited right to sue. As expected, policies with a limited right to sue will charge lower PIP premiums. However, policyholders should weigh the pros and cons of both options before finalizing their coverage parameters. In New Jersey, the limited right to sue is officially known as a limitation on lawsuit and policyholders who are injured in an auto accident may not seek reimbursement beyond the limits of their PIP coverage cap except in limited circumstances. These extenuating circumstances may include death, dismemberment, loss of a fetus, and permanent injuries. The unlimited right to sue is officially known as no limitation on lawsuit in New Jersey. Policyholders who elect this option may directly pursue legal action against the party responsible for their injuries in addition to claiming PIP benefits, regardless of the type or severity of their injuries. However, merely pursuing further legal action does not guarantee a successful outcome.
For patients suffering from the onset of severe injuries following an accident who require long-term care, Optimum Diagnostic Imaging will work with their attorneys and testify in court to advocate on their behalf to obtain full compensation to cover the duration of treatment required. In some circumstances, even patients who elected the limited tort option may be able to sue and obtain additional compensation for treatments if their injuries are severe and permanent. Given the uncertainty in long-term outlook for traumatic injuries, we recommend that you choose the unlimited tort by default in the PIP component of your policy. If you already have PIP coverage through an insurance company and believe you are suffering from traumatic injuries following an automobile accident, please contact our office. Personal injury attorneys often refer their clients to Optimum Diagnostic Imaging based on our experience in evaluating and diagnosing injuries suffered from an auto accident. You may be entitled to more compensation than your insurance company wants to settle for and we always put our patients first to ensure they are fully compensated.
If you are experiencing injuries sustained in an auto accident, your treatment costs should be covered by the personal injury protection (PIP). This is a component of your auto insurance policy. All licensed motorists in New Jersey are required to have bodily injury liability as well as PIP coverage in order to drive. Collision and comprehensive insurance coverage may be required by the vehicle’s lender if you are financing or leasing your vehicle. Though they are optional if you own your vehicle outright.
Since New Jersey is a no-fault state, you will actually be covered under your own auto insurance coverage for medical expenses regardless of who is ultimately determined to be at fault for the collision. The at-fault party may ultimately be sued by the injured party to recover additional damages for pain and suffering. While the minimum coverage threshold for PIP is only $15,000 in an auto insurance policy in New Jersey; We strongly recommend choosing the standard coverage of $250,000 and also selecting PIP Primary to ensure that your medical expenses would be covered in the unfortunate event of an auto accident. The annual premium difference between $250,000 and $15,000 in PIP coverage is only about $50 for most drivers, but the additional $50 ensures that you will receive $235,000 in additional coverage.
If you elected the unlimited right to sue (unlimited tort) option on your PIP coverage and you are not at fault in an auto accident, you can seek compensation for pain and suffering in addition to medical expenses. These damages are typically paid from the at-fault motorist’s bodily injury liability coverage. If the other motorist is uninsured or does not have adequate insurance coverage, you can seek additional compensation from the uninsured/underinsured motorist component of your own policy. Since the unlimited tort option may cost about $500 more in annual premiums, most drivers in New Jersey select the limited tort option. However, we strongly recommend all motorists select the unlimited tort option because medical expenses and pain and suffering may easily amount to hundreds of thousands of dollars if you sustain severe injuries in an auto accident. By selecting the unlimited tort option, you are more likely to receive adequate compensation.
It is important to emphasize the importance of selecting PIP primary coverage as opposed to PIP secondary coverage in regards to medical expenses for auto accident injuries. The difference between PIP primary and PIP secondary may only be about an additional $50 for PIP primary coverage. From a risk standpoint however, PIP primary coverage is strongly recommended because you will be covered for your medical expenses regardless of who is at fault. Unlike health insurance, you will not be subjected to a high deductible, out-of-network expenses, and expenses for care that is not covered under your health insurance. While standard health insurance policies will provide coverage for emergency care and surgical treatments in an auto accident, you may have to satisfy a high deductible and coinsurance threshold before you receive full coverage. Once a patient has been stabilized, health insurance may not offer coverage for physical therapy, chiropractic care, or mental health care following an auto accident.
To further discourage you from choosing PIP secondary coverage, please understand that your health insurance may use liens to recover the expenses that have already been paid for your medical care. If you sue the at-fault party and ultimately receive a settlement from the at-fault party for pain and suffering, your health insurance company may place a lien on the settlement amount which would have to be satisfied before the settlement could be distributed. This would proportionally reduce the amount that both you and your injury attorney would ultimately receive in an auto accident settlement. If you have PIP primary coverage instead, auto insurance companies are prohibited by law from placing a lien on your settlement from the at-fault party. Your auto insurance is required to cover all the aforementioned expenses if they are medically necessary and you would have a wider choice of doctors because you would not be limited by insurance networks.
If you have experienced an injury following an auto accident, please contact Optimum Diagnostic Imaging office immediately to schedule an emergency evaluation. In addition to auto insurance, our office can also work with workersÔÇÖ compensation insurance if you sustained a injuries while working. We understands that auto insurance may be complicated, but we are well-versed in the inner workings of insurance companies. Our staff will work with your auto insurance or even coordinate your case with an injury attorney in your area to ensure that you are adequately compensated for your medical expenses. We will submit narrative reports in the precertification process so that you can be approved for medical coverage under PIP. If you have selected the unlimited tort option in your auto insurance policy, your attorney can also fight on your behalf to ensure that you receive the maximum compensation that you are entitled to for pain and suffering following an auto accident.