© 2017 by Kearns Duffy & Vaccaro, P.C.

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Personal Injury and Medical Bills

One of the most complicated, and important, responsibilities of an injured person after an accident is to arrange to have their medical bills paid. Unfortunately, this is usually the last thing on an injured party’s mind. If at all possible, they should seek assistance from a loved one. We usually give this talk to plaintiffs on their initial visit to our office but we will detail this procedure here for their later assistance.

The typical car insurance policy contains four sections; comprehensive (theft, deer impacts, etc.) collision (to compensate to you for the damages to your motor vehicle.) liability (for when people make claims against you) and personal injury protection a .k. a. “PIP” (medical bills). New Jersey is a “no fault state”. This means all of your medical bills should be submitted to your own automobile insurance carrier for payment regardless of who was at fault. Automobile insurance is primary. All medical bills must be submitted to car insurance first. Most policies contain a $250.00, deductible and 20% co-pay on all bills until the bills reached $5,000.00. Assuming this is the coverage that was selected, the most an injured party should pay as deductible and co-pay is $ 1,200.00. Unfortunately, the deductible and co-pay cannot be recovered from the person that caused the accident (“the tortfeasor”). Uncompensated PIP deductibles and co-payments have been found by the New Jersey Supreme Court not to constitute “uncompensated economic loss” within the meaning of NJSA 39:6A-12, thereby precluding this loss as an element of damages in a civil suit. Roig v. Kelsey 135 N. J. 500 (1994).

An injured party must, to the most extent possible keep track of all the bills that come in and how much has been paid. A legal pad or journal would be a great help. How each bill is paid this will all be explained on the PIP payment ledger sent to you by your insurance company regarding each bill. For instance:

Assuming the bill was $60.00 and the fee schedule indicates the fee should have been $40.00, the insurance company will pay $32.00 (80%) and you will pay $8.00 (20%). The reduced amount, $20.00, is not recoverable. Your Doctor cannot ask you to pay this $20.00.

If you pay this $20.00 in error, it is nearly impossible to have a reimbursement of this expense. Concise record keeping is critical.

If you have difficulty with your medical payments, please make sure you call our office so that we may assist in the processing of these claims. It may be necessary during or at the conclusion of your personal injury lawsuit, for us to file a PIP arbitration claim to seek the payment of these bills. On rare occasions, in an Order to Show Cause is also required.

Your insurance carrier may ask you to be examined by a doctor of their choice. These examinations are called “Independent Medical Examinations” or an “IME.” You must attend these IMEs or your policy will be cancelled for non-cooperation.