PIP Arbitrations: To file or not to file

In the State of New Jersey claims for medical bills incurred as a result of a motor vehicle accident are are generally paid by the Personal Injury Protection (hereinafter “PIP”) provision of one’s car insurance policy. Forthright currently administers the PIP claims that have been filed. Forthright employs a number of attorneys with extensive PIP experience as arbitrators. The party who files the Demand for Arbitration is known as the Claimant and the party who defends against the claim, the insurance carrier, is known as the Respondent.

Before filing a PIP arbitration, the Claimant needs to determine the PIP policy limits, the Statute of Limitations and whether the Claimant has properly adhered to the terms and conditions of the Decision Point Review Plan.

In order to determine the policy limits, the claimant may call the PIP carrier or send a letter to the PIP carrier requesting the information. It is also suggested that the Claimant find out how much coverage is available on the PIP policy. For example, if the policy has PIP medical expense benefit limits of $15,000.00 and has $600.00 remaining, it may not be wise to file the Demand for Arbitration as the policy will likely be exhausted before the hearing and the claimant would have to withdraw the claim. If the policy has already been exhausted, the claimant should generally not file the claim.

Next, the Claimant must determine whether the Statute of Limitations has run. In PIP claims, the Statute of Limitations runs 2 years from the date of last payment or if no payments are made, 2 years from the date of accident. As the Statute of Limitations can constantly change, it is important to check with the carrier to determine how much time remains to file a claim.

Last, but perhaps most important, claimants must adhere to the terms and conditions of the Decision Point Review Plan. The Decision Point Review Plan sets forth how the insured and in turn, the medical provider must submit claims to the carrier, including but not limited to, the address to where claims should be sent, the address or fax number to where pre-certification requests should be sent and to where appeals should be sent.

Once a provider or insured determines that there is unpaid money remaining on the policy, that the Statute of Limitations has not run, and that claimant adhered to the Decision Point Review Plan, the claim may be ripe for arbitration.

By: Patricia Lynn Howlett, Esq.