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No Fault State = injured victim pays for everything?

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Stuvious

Junior Member
What is the name of your state (only U.S. law)? NJ

Should be simple right? Not so much.

Short version: I was in my friends car she was the driver, i was the passenger. We were rear ended on the parkway by a driver that admitted to police on the scene that she WAS NOT WEARING HER NECESSARY PRESCRIPTION EYE WEAR and SHE WAS "TOO TIRED TO BE DRIVING".

i thought it would be a smart idea to go to the hospital and get checked out by a physician...

I'm getting billed from the hospital as well as the physician that saw me. (two separate bills). As it has been explained to me since NJ is a NO FAULT STATE i need to have my car insurance pay for my hospital bills.

my car insurance only covered about $150, at this point my car insurance company told me to go through my health insurance which covered absolutely nothing!


After that my car insurance told me to contact the insured's company and ask them to pay. the insured's insurance said b/c I have a limited insurance policy from MY PROVIDER they're not gonna pay for any of my bills. They said they would only pay for my bills if i had been paying my insurance company more money for a No-Limit/Unlimited policy!!!

how does this make any sense!!! How does how much i pay my insurance company have any bearing on the fact that I was just fine and dandy until their negligent driver injured me.

I have been told i need to sue their insured in small claims court as they are obligated to defend them and it is going to cost them much more then just paying for my out of pocket medical expenses.

Has anyone gone through this? Any tips?

AND MOST IMPORTANTLY DOES ANYONE KNOW OF A CASE WHERE A PASSENGER OF A CAR SUED THE INSURED FOR OUT OF POCKET MEDICAL EXPENSES IN NJ??


thank you in advance.
 
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ecmst12

Senior Member
In NJ, a lawyer is pointless if there are no permanent damages due to the high injury threshold.

If you did not carry sufficient PIP on your own policy (which was dumb, but no matter), next in line would be PIP from any of your household members if available, and then PIP from the vehicle you were riding in. Have those avenues been explored?
 

Stuvious

Junior Member
my insurance company and the insured's insurance company.


my medical bills are not extensive they could easily be covered in small claims court($480) i was only in the hospital once and left with a simple prescription for muscle relaxers which did their job very well b/c i went to work the day after and since then the lingering pain has completely dissipated.

I'd rather not obtain a lawyer although I'm sure many would recommend it. but if i have to pay a lawyer $500 to recoup $480 there is something wrong with the system.

i want to know about other peoples experiences with this in the state of NJ


and if anyone knows of a case where a passenger of a car SUE'd THE INSURED b/c no one else would pay their medical bills due to being in a NO FAULT STATE


(i'm not talkin about suing the driver of my car but the girl that rear ended us)

also i did confirm from the other persons insurance that they are obligated to defend her in small claims court if i sue her.
 

Stuvious

Junior Member
there is no one else in my household...i rent and I'm single.


what if i didn't have car insurance b/c i take take the bus?
what would i do then?

why should i pay more for something like that on my insurance policy when it only applies if I'm not at fault?If it was free I'd opt for it.


Either way I'm sure someone in NJ has been in a passenger in a car and not been covered by their personal auto insurance or their regular insurance. Then b/c NJ is a no fault state had to file a small claims suit against the insured b/c their insurance company would not settle with me in good faith.
 
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ecmst12

Senior Member
PIP coverage is very inexpensive, for what you get, and it is available REGARDLESS of fault. Even if you rear end someone else, your own injuries will be covered by PIP. But even if you had MORE PIP, there would still be a deductible and coinsurance for you to pay.

If you did not have any auto insurance, then you would be able to claim PIP from the policy covering the car you were in.

The law in NJ states that you can't make a BI claim on the other person's policy unless you have permanent damage as a result of your injuries. If the amount you are going after is the DEDUCTIBLE (and/or copay) for your PIP, that money is NOT recoverable from the at fault party, which is also the law in New Jersey. This is because before deductibles and copays on PIP were enacted, there was massive fraud and abuse of these benefits, and the insurance companies could not afford to pay and were refusing to offer coverage in your state. There is still fraud of course, but these laws reduced it and reduced what it was COSTING the insurance companies.

When you submitted the bill to your health insurance coverage, did you include a copy of the explanation of benefits from your auto insurance?
 

FlyingRon

Senior Member
It just moved the corruption from one area to another. The NJ half-assed no-fault just causes more lawsuits. This is what happens when you have a state legislature composed of personal injury lawyers. Glad to be the hell out of there.
 

ecmst12

Senior Member
Well either way, OP still can't get his deductible back from the other driver, in small claims court or otherwise, with or without a lawyer.
 

ecmst12

Senior Member
And if you had READ the thread, you'd know that suing would do no good, because the other driver is NOT LIABLE for the deductible and coinsurance on his PIP coverage.
 

Stuvious

Junior Member
IDK about that as soon as they say NJ is a no fault state they always follow it up with anyone can sue anyone... I have to assume that i'm going to be able to recoup the money i spent on my medical bills by sueing her in small claims court.

I'm sure someone has done it.

i know as soon as i start too the insurance company is going to offer to at least pay some of it.

I'm gonna keep you all posted as to my success in this matter as an FYI but if anyone knows of anyone that has sued the insured after no one paid the medical bills please let me know as that knowledge will make it much easier to proceed with my case
 

Stuvious

Junior Member
I don't see how the no fault can possibly prevent fraud...it seems like the only thing it does is force people to have to pay more for their car insurance for no reason.

I swear what is the point of even driving safely? I can hit all the people I want and only get stuck with a bunch of traffic tickets…. What stops every ******* from rear ending the person that just cut them off out of spite…

If someone operates their vehicle negligently and does harm they should be personally responsible for it. If they have hired an insurance firm to protect their interests that’s all well and good but if your insurance refuses to pay for the harm you do then you should be responsible to pay me for my medical expenses and you can go and sue your insurance company if they were obligated to have paid those bills in the first place.

Am I psychotic? Or does that make sense? Is there really no recourse built into the no fault system?

Can someone explain how ‘no fault’ states prevent fraud ??? (I read the above but it wasn’t very informative)


oh and ecmst12 i checked i have tons of PIP(250k). but why should i have to pay the deductable?
 
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Stuvious

Junior Member
as i read more into the idea's behind no fault i'm starting to understand it (this is what im reading BTW American University Law Review ) its very well written.

What stands out among everything that im reading is that i feel that my argument is that "the incident- was not an accident" i am of the opinion that b/c the dirver was admittenly "too tired to be driving" and "failed to wear perscription eye wear" that when she got behind the wheel she knowingly intended on getting into an accident by negligently failing to perform her duty. And if she intentionally used her car to harm someone she should be responsible for the damages and that my personal responsibility to be insured for an unavoidable act of negligence on the insured's part is irelevent... pardon my typos its late.


but then again maybe I'm the crazy one.


this is where i think it applies

(1) [O]ne injured by the tort of another is not entitled to recover damages for any harm that he could have avoided by the use of reasonable effort or expenditure after the commission of the tort.
i went to the hospital and had a doctor make sure i was alright, he assessed my condition and let me know thus far i had not suffered any major damages but if i did not take the extra strength ibuprofen he perscribed that i would further damage my muscles.

(2) One is not prevented from recovering damages for a particular harm resulting from a tort if the tortfeasor intended the harm or was aware of it and was recklessly disregardful of it, unless the injured person with knowledge of the danger of the harm intentionally or heedlessly failed to protect his own interests.
ummm yea i was in the passenger seat and i buckeled myself in place for safety...she was recklessly driving without her glasses and she was tired...now i suppose you could also argue that i could have purchessed reckless jerk insurance ahead of time but why should I have needed to assume i would be in a situation like that moreover have assummed it could happen and have been paying someone incase it one day happened to me. if a comet came down from the sky landed infront of the car causing our accident i'd pay the $500 and move on with my life. she could have prevented the accident she chose not to.

Whats next maybe i should purchase HIV insurance pay for it every month until someone with aids decides to rape me in a dark alley. Then i will rejoice b/c I had the forsight to be covered.
 
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ecmst12

Senior Member
No fault doesn't prevent fraud, in some ways it makes it easier. The addition of deductibles and coinsurance to PIP coverage was done to reduce fraud. I don't know if it worked. You did not answer my most important question - WHEN YOU SUBMITTED THE BILL TO YOUR HEALTH INSURANCE, DID YOU INCLUDE THE EXPLANATION OF BENEFITS FROM YOUR AUTO INSURANCE? The deductible is SPECIFICALLY designed to NOT be recoverable from any at fault party.

No fault means that for minor injuries with no permanent damage, the injured person's own insurance pays the medical bills. It IS possible to recover from the other party, but ONLY when there is serious and permanent injury. That is called the "injury threshold". If you don't meet it, you can't sue. Well, you can, but it would be a waste of time and money because you can't get anything.

There are plenty of reasons to not go around hitting people and driving like a moron. You'll lose your license from too many points. Your insurance will drop you. Property damage is not no fault. So your insurance will still be paying out to fix the other cars and will get annoyed with you after a while. Not to mention that even ONE at fault accident in NJ will raise your rates a ton.
 

Stuvious

Junior Member
yea i sent my health insurance a copy of the bill showing what my auto insurance paid, i also sent them a copy of my "deck sheet" which explains my health benefits.

furthermore I can not find a company that has a plan that has ZERO deductable for personal injury protection...i checked geico and esurance. I'm sure the premium would be insane if this does exist. If it does not exist that would mean no matter what happens if someone hits you and is the negligent driver you would always have to pay some monies out of pocket no matter what unless you could sue them for your deductable.
 
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