Personal Injury Protection (PIP)
Medical providers who treat automobile accident victims are eligible to have all bills paid pursuant to their usual, customary and reasonable rate or the New Jersey PIP Fee Schedule, N.J.A.C 11:3-29.6. If bills are unpaid or underpaid, Barrett & Pavluk, LLC can obtain payment directly from the insurer by filing a PIP arbitration with the National arbitration forum (NAF).
Providers who have obtained Assignment of benefits from their patient are entitled directly file an arbitration in order to get properly paid. For more than 15 years, the attorneys at Barrett & Pavluk, LLC have specialized in working with medical providers in obtaining appropriate reimbursement form automobile carriers. Having filed and participated in thousands of PIP arbitrations, Barrett & Pavluk, LLC is recognized as a leader in the area of medical collection and NJ PIP arbitrations.
New Jersey law requires that an insurer that has not properly paid a provider’s bill will be obligated to pay a successful arbitration claimant attorney’s fees together with interest and costs. In other words, medical providers who are successful at arbitration will not pay fees or costs for the collection of their auto accident related bills as these bills are paid by the insurer.
Barrett & Pavluk, LLC specializes in medical PIP collection, representing numerous physicians, professionals and institutions statewide in the collection of PIP arbitration claims. Barrett & Pavluk, LLC also works on a consultation basis with members of the medical profession on issues such as corporate and insurance compliance regulations.
Fast Facts About PIP Arbitration
- PIP Enables the provider to proceed independently agains an insurance company for any:
- Unpaid bills
- Denied bills
- Improperly reduced bills
- The language of the Assignment of Benefits is crucial, must assign the insured’s affirmative rights under the subject insurance policy (not merely an assignment of payment).
- Fee Shifting Provision – If provider/claimant is successful, insurer pays interest, attorney’s fees and costs.
Currently, virtually all claims on assignment are decided by binding arbitration. The NAF administrates these claims and disputes are decided by Dispute Resolution Professionals (DRP).
Overview of Personal Injury Protection Benefits
If you were injured as a result of an accident in New Jersey involving a private passenger automobile, you are entitled to Personal Injury Protection (PIP) benefits.
What Is PIP?
P.I.P. is a package of insurance benefits which include medical expense benefits, income continuation benefits, essential service benefits, funeral benefits and death benefits. The extent of such benefits is determined in part by New Jersey law, and in part by the coverage limits of the policy that you purchased or the policy providing benefits to you. You must notify and file an Application for Benefits with your insurance company in order to begin receiving benefits.
What Benefits Does P.I.P. Provide?
MEDICAL EXPENSE BENEFITS pay all reasonable hospital, medical, and related expenses incurred for treatment of your injuries. This benefit will pay for in-patient and out-patient hospital visits; doctors; chiropractors; dentists; psychologists; therapists; skilled nursing care; prescriptions; appliances; diagnostic tests such as X-rays, MRIs, CAT Scans, Bone Scans and EMGs; ambulances and medical transportation. There is an automatic deductible of $250, and you may have selected a higher deductible of up to $2500, in exchange for a premium reduction. You will be subject to the coverage in effect on the date of your accident, even if you change your coverage before you incur expenses related to that accident.
There is an 80%/20% co-payment provision on expenses incurred above your selected deductible, and up to $5000. This means that your P.I.P. carrier is responsible for 80% of your medical expenses above your deductible, up to a total of $5000 in medical expenses. You are responsible for the other 20%. These balances may be submitted to any health insurance available to you, subject to their deductible and co-pays. P.I.P. will make full payment of all expenses in excess of $5000, up to a standard maximum of $250,000. Additional medical expense benefits up to $1 million are available as an option and you may also select a lesser amount of coverage in exchange for a premium reduction. All medical expenses are subject to a fee schedule developed by the New Jersey Department of Insurance and may be subject to prec. You are not responsible for charges billed in excess of the amounts allowed under the fee schedule. You can see how complicated the law is, so ask your lawyer any questions you have.
INCOME CONTINUATION BENEFITS pay for lost wages for a minimum of 52 weeks in the amount of $100 or more per week. This amount can be greatly increased in both weekly amount and time period of payments by selecting available options. These benefits receive a credit for any Temporary Disability Benefits (T.D.B.) you are entitled to receive (whether or not you actually receive them). Therefore you must apply for T.D.B. immediately upon stopping work.
ESSENTIAL SERVICE BENEFITS reimburse you for payments made to others performing tasks such as housework, child care, shopping, food preparation or transportation, up to $12 per day for up to 365 days. Higher coverage limits are available.
FUNERAL BENEFIT pays up to $1,000 for funeral bills incurred as a result of a death caused by an auto accident.
DEATH BENEFIT pays the combined total of available income continuation benefits and essential service benefits that would have been available to a person who dies as a result of an auto accident, up to a maximum of $10,000.
Can My Insurance Company Stop Paying My Benefits Before I Use Them Up?
New Jersey law gives insurance companies providing P.I.P. benefits the opportunity to have you examined by a doctor of their choice in your municipality, to determine whether you have a continuing need for P.I.P. benefits. These examinations are known as "P.I.P. exams", and are generally performed by physicians who devote a substantial portion of their practice to working for insurance companies. Typically, the doctor determines that any injury you may have sustained has been cured by the treatment you have been receiving, and offers the opinion that you are not in need of further treatment. If your injury is serious and obvious, the doctor may conclude that additional treatment will not result in additional improvement or pain relief. In either case, the insurance company notifies you that they are terminating your entitlement to benefits, and will not pay for any additional treatment. You are not obliged to accept this decision, and if your treating physician is willing to support your need for on-going care, we will aggressively fight for your right to continue to receive treatment.
Claims for these benefits which are challenged by a P.I.P. carrier are resolved either through binding arbitration under N.J. Department of Banking & Insurance contracted vendor, currently National Arbitration Forums (NAF), or by filing a law suit in Superior Court. We usually resolve these controversies through the arbitration process, because NAF claims are concluded in a shorter time and complications.