Following an automobile accident, it can be difficult to understand how the insurance process works. When a back injury and medical bills are involved, things can become even more complicated. In the State of New Jersey, there is also the added element of personal injury protection (PIP) insurance, further confusing the situation.
The following information is designed to help you better understand what PIP is and how it will affect your spinal surgery following your automobile accident. By having a clearer idea of how the system works and what it means for you, you can reduce some of the stress of your situation and focus more on your treatment and recovery.
What is PIP insurance?
PIP is a special form of auto insurance that is required in some states, including New Jersey. You may have also heard of it referred to as no-fault insurance. This is because PIP insurance is paid out no matter which party is at fault in an automobile accident.
When someone in New Jersey is injured in an accident involving an automobile, whether as a driver, passenger or pedestrian, PIP insurance helps cover the cost of medical expenses. This includes not only direct medical bills but also indirect expenses like lost wages.
In New Jersey, you must decide if your primary source of this coverage will be your health insurer or a PIP policy on your automobile insurance. However, nearly all drivers are required to carry PIP insurance in New Jersey as part of their automobile insurance, whether you choose it as your primary or secondary coverage.
Whose Policy Covers PIP Insurance Surgery in New Jersey?
For people who are unfamiliar with how PIP insurance coverage works in New Jersey, it can be a little tricky to understand. Essentially, if you are injured in an accident involving an automobile, no matter who is at fault (recall, PIP is no-fault insurance), your medical expenses are going to be paid for by your insurance.
To illustrate the idea with an example, say you are driving along responsibly and you are struck by a driver who was busily texting. You are injured and require medical attention. Whose insurance is going to cover your medical expenses?
While the other driver is clearly negligent and at fault, it is your insurance policy that is going to pay for any medical treatment and related costs. Keep in mind that this is entirely separate from any personal injury claim you may have against the negligent driver.
What if You Don’t Have Auto Insurance?
Most people who have an insured vehicle registered in the State of New Jersey are required to carry PIP insurance as part of an auto insurance policy. But, what happens if you are a non-driver injured as a passenger or pedestrian?
You might expect that the negligent driver’s insurance would cover your medical expenses at this point. However, this isn’t the case in New Jersey. Instead, the first source of PIP insurance would be any registered, insured family member that you live with. If you do not live with a covered family member and were a passenger with another driver, only then would that driver’s PIP insurance provide you with coverage.
Finally, what happens if you are a non-driver, do not live with a covered family member, and were a passenger with someone who is uninsured or injured as a pedestrian? At no point is the negligent driver’s insurance coverage going to pay. Instead, people injured in New Jersey are covered by NJPLIGA, which will provide medical benefits unless you happen to be the owner of an uninsured vehicle.
Though it may seem a little confusing, the purpose of PIP insurance is to ensure that if you are injured in an automobile accident, your medical expenses will be covered no matter who is at fault and whether or not the other driver is insured.
Putting it Together
Insurance is never simple to understand, so do not be discouraged if it seems somewhat overwhelming. Generally speaking, your PIP insurance surgery is going to be paid for by:
- You, if you are the owner of a registered, insured vehicle
- A family member, if you live with them, they are the owner of a registered, insured vehicle and you are a not covered yourself
- The driver of the vehicle, if you were a passenger, do not live with a covered family member and you are not covered yourself
- The NJPLIGA program, if you were not a passenger in a covered vehicle, do not live with a covered family member, are not covered yourself and do not own an uninsured vehicle
As you are considering PIP insurance surgery in New Jersey for your spinal injury, you may want to consider selecting a surgeon whose practice has an insurance benefits specialist on hand. Having the assistance of an expert can help you navigate the insurance system and explain the nuances of your individual policy, allowing you to focus more on your upcoming surgery and recovering from your injury.
