NJ No fault

[zonk1972]

What is the name of your state? My daughter was involved in Auto accident. Her car was rear ended and the person admitted it was his fault. We both have Allstate Insurance. A claim has been opened on his policy for the auto part of it. Anyhow, NJ is a No Fault state and therefore if I have a medical claim I have to open up a claim with MY PIP. To make it worse I have Health Insurance Primary for my Medical. So, Allstate is telling me if I open up a medical claim then they will deny it. So, why would I do that and get my insurance raised with a claim on my end even if it will be $0. So, since I am Health Insurance Primary do I have to pay through my health insurance the full amount and get no reimbursement from the other person responsible? What actions can i take to get her checked out without me paying and to get the other person resonsible to pay?

 

[FlyingRon]

You get rid of the corrupt state legislature and get the state's cronyistic insurance rules changed. Getting away from that was one of the big joys of moving out of NJ.

You submit her medical bills to the health insurance and whatever you don't pay you submit to Allstate. That's the way it works. You have no course of action on the other driver for medical claims. If you have problems with the insurers paying, there are separate procedures to pursue there.

 

[adjusterjack]

I have Health Insurance Primary for my Medical.

You CHOSE that option when you bought the policy. You had a choice to make your auto insurance primary at a higher cost. See Page 12:

https://www.state.nj.us/dobi/division_consumers/pdf/autoguide02.pdf

do I have to pay through my health insurance the full amount and get no reimbursement from the other person responsible?

That depends. Did you choose "unlimited right to sue" or "limited right to sue"? That was another option you had when you took out your policy. If you chose "limited right to sue" your daughter gets nothing from the other driver unless she suffered a "permanent injury." See Page 11 at the link posted above for an explanation. Then read your policy to see which one you chose.

 

[FlyingRon]

Note that the "right to sue" in either case isn't for the medical treatment expenses. It's for the additional "pain and suffering" and other non-economic losses. Such is NJ's half-assed no fault. This is what comes from having the legislature staffed part time with a bunch of personal injury lawyers. There's not enough contingent fee money in simple economic damages for medical treatment. The lawyers eliminated those suits from consideration, only allowing for the (more fee-rich) others.