Personal Injury Protection (PIP) Law

Pursuant to the changes made by the Automobile Insurance Cost Reduction Act of 1998 (AICRA), payment of medical expense benefits will be made according to the benefit plan provided in the policy and approved by the Commissioner of the Department of Banking and Insurance for reasonable, necessary and appropriate treatment and provision of services to persons sustaining bodily injury.

Medical expense payments are subject to any deductible or copayment as specified in the automobile insurance policy providing benefits.

Medical treatments, diagnostic tests and services provided by the policy will be rendered according to commonly accepted medical protocols, standards and practices. Medical protocols, standards and practices, and lists of valid diagnostic tests which are deemed to be commonly accepted according to this section, will be those:

• Recognized by national standard-setting organizations,
• National or state professional organizations of the same discipline as the treating physician or health care professional, or
• Those designated or approved by the Commissioner of the Department of Health and Senior Services, in consultation with the professional licensing boards in the Division of Consumer Affairs in the Department of Law and Public Safety.

New Jersey PIP laws and regulations require precertification of certain procedures, treatments, diagnostic tests and other services, including the purchase of durable medical goods, as approved by the state, provided that the requirement for precertification is not unreasonable. No precertification requirement will apply within 10 days of the insured event.