WHAT ARE PIP BENEFITS?
Why do I have to use my auto insurance to pay my bills when I wasn't at fault?
It happened again today. Another client wanted to speak to me about why their insurance company and not the responsible driver’s company had to pay for their medical treatment. This is just one of many confusing pieces of a personal injury case progression. Don’t even get me started on pre-certification or care paths (but stay tuned).
Most people are vaguely aware that they selected either auto primary or health primary for PIP on their auto insurance policy. For many, they have no idea what they selected. Health primary refers to the fact that when you are involved in a car accident and are in need of medical treatment, that you have selected (for the savings of about $50.00 per premium period) to use your health insurance as the primary coverage, which means you are responsible for the copays and deductibles, which reset yearly. But this is not the soapbox I’m on today, so I’ll get off and return to the topic at hand: why doesn’t the responsible driver’s insurance pay?
In the 1990s, New Jersey passed what is referred to as AICRA or the Automobile Insurance Cost Reduction Act. New Jersey is known as a “no-fault” state and requires your insurance to cover your medical bills, not the other party’s insurance. So the short answer is: Because New Jersey set it up that way.
Here is my opinion, also known as the longer answer: New Jersey set it up that way to supposedly ensure prompt medical treatment, without “investigation” delay by the other party’s insurance. In theory, this seems to make a lot of sense. For those of us who were involved in a motor vehicle accident and used the other party’s insurance for the property damage claim, didn’t it seem to take a while to get paid? The same is true for medical treatment claims. But if you take away the “fault” and “we need to investigate and accept liability” defenses, you are left with the fact that to the extent the treatment is related to the car accident, reasonable, and medically necessary, it should be approved promptly and paid for promptly. The change allowed for that to occur (I have my complaints about this too, see care paths and pre-certification) in a way that allowed injured drivers to get the medical treatment they needed and without a long delay.
So, whether you agree with it or not, do you understand a little bit more about why it maybe isn’t the best idea to have the other party’s insurance in charge of your medical treatment or payment for that medical treatment? If not, no worries because this is a complicated topic and we here at Drinkwater & Goldstein, LLP are here to help you navigate the process if you’ve been in a motor vehicle accident. I’m stepping off this particular soapbox now, but stay tuned for the next one.
Additionally, if you or a loved one have been involved in an accident and sustained an injury, it is important that you seek the advice of an experienced and knowledgeable personal injury attorney who can help ensure that you receive any compensation you are entitled to. Our personal injury attorneys here at Drinkwater & Goldstein, LLP know the law regarding the obligations of motorists on the roadway and your rights in relation to treatment and will fight to get you the financial recovery you deserve along with the treatment that you are entitled to have. We provide free, immediate consultations over the telephone and there is no cost to you unless we secure a recovery on your behalf. Call us today at (856) 753-5131.