Hospital PIP Recovery

As the no-fault world continues to evolve and trends like Health Care-Primary policies and sub-$250,000 policy limits continue to grow, more money than ever is being left on the table. Personal Injury Protection (“PIP”) carriers often take advantage of increasingly complicated policies to avoid paying providers what is truly owed.

Combining over four decades of industry experience with an always up-to-date understanding of PIP trends, MMA have developed a unique, targeted approach to hospital PIP recovery.

Through countless hours of real-world research, we have identified six primary types of PIP accounts that most commonly tend to be unpaid or underpaid, outlined below.

Understanding the parameters of these accounts allows MMA to take a proactive approach to recovery, resulting in more money for our clients in the least amount of time.

POLICY EXPANSION ACCOUNTS

Nearly half of NJ automobile policyholders now possess less than the traditional $250,000 PIP limit that has been in existence since 1991.

The current minimum PIP coverage requirement is only $15,000, which many policyholders select simply because it costs the least and is typically the default limit that insurers depict when offering coverage amounts to consumers.

NJ law provides a catastrophic coverage component to the PIP statute. Any policy limit below $250,000 can be increased to that amount based upon the severity of a patient’s injury:

"Personal injury protection coverage" issued pursuant to this section means and includes payment of medical expense benefits, as provided in the policy and approved by the commissioner, for the reasonable and necessary treatment of bodily injury in an amount not to exceed $15,000 per person per accident; except that, medical expense benefits shall be paid in an amount not to exceed $250,000: (1) for all medically necessary treatment of permanent or significant brain injury, spinal cord injury or disfigurement or (2) for medically necessary treatment of other permanent or significant injuries rendered at a trauma center or acute care hospital immediately following the accident and until the patient is stable, no longer requires critical care and can be safely discharged or transferred to another facility in the judgment of the attending physician. [NJSA39:6A-3.1]

Most carriers will not voluntarily expand a patient’s policy. By understanding and targeting the types of accounts that are eligible for expansion, MMA are able to successfully pursue these claims for our hospital clients, compelling PIP carriers to pay upwards of $200,000 per claim that may have otherwise been adjusted off.

Let's see what we can recover for you.

info@mmanj.net