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Ask the Attorney: PIP Is Behind Medical Deductibles and Copays after NJ Car Accidents


Asker: In New Jersey, do I have to pay medical bills for an accident that wasn’t my fault? If I go through my insurance, I have to pay the $2,500 deductible before they pay for anything. I didn’t even know when signing up for this policy that there was a medical deductible. I don’t feel like I should be paying for an accident I didn’t cause.

Attorney: I’m sorry to hear about your injuries and financial struggles. You’re not alone in feeling that the system is unfair. In New Jersey, no-fault laws require that auto insurance policies include a portion of coverage called “personal injury protection” or PIP. Insurance policies are so confusing that you, like most policyholders, may not fully understand your coverage, your responsibilities, or your legal rights.

Your Responsibilities

You don’t have to pay the medical bills in their entirety, but yes, you have to pay deductibles and copayments toward your medical bills even though the accident wasn’t your fault.

The deductible and copays are part of your policy. It’s not surprising, though disturbing, that you didn’t know you would be on the hook for paying this steep deductible. If you told the insurance agent or online quote generator that you wanted lower premium payments, they gave you a policy with a high deductible and probably never explained what that deductible meant. Unfortunately, not understanding the policy doesn’t excuse you from having to pay the deductible. After you hit your deductible, your insurance company covers 80 percent of the medical expenses up to your coverage limit, leaving you with the remaining 20 percent balance up to your out-of-pocket maximum.

Unfortunately, it doesn’t matter to the insurance company that you didn’t cause the accident or that the situation is unfair. They’re not giving up a couple thousand dollars just because it’s unfair to you – but that doesn’t mean you can’t do something about the situation.

Your Options as a Claimant

You’re absolutely right that it’s unfair to have to pay thousands of dollars when your only mistake was being in the wrong place at the wrong time. That’s precisely why it’s important fight for the compensation you deserve. You should talk to an accident lawyer in NJ as soon as possible, because your damages could be serious enough that you will need a substantial amount of compensation. That $2,500 deductible is an immediate problem, but you may soon find that it’s not the only challenge you’re facing.

PIP covers your medical bills, but your insurer leaves you on the hook for a good deal of your medical expenses, which can be particularly stressful on top of everything else you’re going through. When you hire a lawyer to help, you can focus on what’s most important: getting better.

Disclaimer: Results may vary depending on your particular facts and legal circumstances.

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This article was professionally reviewed by Richard P Console Jr, an attorney licensed to practice in New Jersey, New York, and Pennsylvania.

Mr. Console has more than twenty years experience practicing personal injury law and successfully resolving vehicle accident claims on behalf of his clients.

Learn more About Richard P Console Jr.

While this information was reviewed for accuracy, it should not be considered legal advice. Every claim is different. If you are thinking of pursuing a personal injury claim and have a question contact us directly. 

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