NJ Auto Insurance consumers have control over a variety of factors that influence the cost of auto insurance. Before you buy, check out:

NJ Auto Insurance Rating Examples

• Principal Operator
• Driver Training, no good student discount
• No accidents within the past 3 years
• No motor vehicle violations within the past 3 years
• Pleasure use (12,000 annual miles)
• Verbal Threshold
• $250,000 Standard Personal Injury Protection (PIP), $250 deductible
• With a Category II Anti-theft device discount, and active seatbelt and dual airbags (front only)
• Without any defensive driving course discount
• Liability only policy:
  • Bodily Injury limits of $15,000/$30,000
  • Property Damage liability $5,000 (or combined single limit of $35,000)
• Uninsured Motorist Coverage:
  • Bodily Injury limits of $15,000/$30,000
  • Property Damage liability $5,000 (or Combined Single Limit of $35,000)
• 2003 Buick Century Custom – 4 door sedan
• ISO rating symbol 8

NJ Auto Insurance Example 1-B

Driver: Use same criteria as 1-A, except one at-fault accident
 
Example 2-A
Driver: Married couple, both between ages of 30 and 49 with newly licensed 17-year-old daughter in household

• No driver training, no good student discount
• No accidents within the past 3 years
• No motor vehicle violations within the past 3 years
• Pleasure use (12,000 annual miles)
• Verbal Threshold
• $250,000 Standard Personal Injury Protection (PIP), $250 deductible
• With a Category II Anti-theft device discount, and active seatbelt and dual airbags (front only)
• Without any defensive driving course discount
• Liability:
  • Bodily Injury limits of $100,000/$300,000
  • Property Damage liability $25,000 (or combined single limit of $300,000)
• Uninsured Motorist Coverage:
  • Bodily Injury limits of $100,000/$300,000
  • Property Damage liability $25,000 (or combined single limit of $300,000)
• 2003 Buick Century Custom – 4 door sedan
• ISO rating symbol 8
• $750 deductibles for Comprehensive and Collision

NJ Auto Insurance Example 2-B
Driver: Use same criteria as 2-A, except husband has one at-fault accident
NJ Auto Insurance Example 3-A
Driver: Married couple, both between ages of 30 and 49

• 2 vehicles on policy and no inexperienced operator in household
• No accidents with the past 3 years
• No motor vehicle violations within the past 3 years
• Continuous insurance with same company for 10 years
• Car #1: Driven by husband to work 10 or more miles, 20,000 annual miles
• Car #2: Driven by wife to work less than 3 miles, 12,000 annual miles
• Verbal Threshold
• $250,000 Standard Personal Injury Protection (PIP), $250 deductible
• With a Category II Anti-theft device discount, and active seatbelt and dual airbags (front only)
• Without any defensive driving course discount
• Liability:
  • Bodily Injury limits of $100,000/$300,000
  • Property Damage liability $25,000 (or combined single limit of $300,000)
• Uninsured Motorist Coverage:
  • Bodily Injury limits of $100,000/$300,000
  • Property Damage liability $25,000 (or combined single limit of $300,000)
• Car #1: 2003 Buick Century Custom – 4 door sedan, ISO rating symbol 8
• Car #2: 1999 Chevrolet Astro Van 4 x 2, ISO rating symbol 6
• $750 deductible for Comprehensive only

NJ Auto Insurance Example 3-B

Driver: Use same criteria as 3-A, except husband has a four-point moving violation and two

comprehensive claims over $750 each; wife has one at-fault accident

NJ Auto Insurance  Example 3-C

Driver: Use same criteria as 3-A, except:

 

• Have no at-fault or not at-fault accidents within the past 5 years
• No motor vehicle violations within the past 5 years
• No Schedule 1 offense (refer to N.J.A.C. 11:3-34.5) within 5 years
• Has no comprehensive claims, including theft, within 5 years
• One operator has at least 20 years of driving experience
• Has companion policy
   

• No accidents within the past 3 years
• No motor vehicle violations within the past 3 years
• Pleasure use (12,000 annual miles)
• Verbal Threshold
• $250,000 Standard Personal Injury Protection (PIP), $250 deductible
• With a Category II Anti-theft device discount, and active seatbelt and dual airbags (front only)
• Without any defensive driving course discount
• Liability:
  • Bodily Injury limits of $100,000/$300,000
  • Property Damage liability $25,000 (or combined single limit of $300,000)
• Uninsured Motorist Coverage:
  • Bodily Injury limits of $100,000/$300,000
  • Property Damage liability $25,000 (or combined single limit of $300,000)
• 2003 Buick Century Custom – 4 door sedan
• ISO rating symbol 8
• $750 deductibles for Comprehensive and Collision

• No accidents within the past 3 years
• No motor vehicle violations with the past 3 years
• Please use (12,000 annual miles)
• Verbal Threshold
• $250,000 Standard Personal Injury Protection (PIP), $250 deductible
• With a Category II Anti-theft device discount, and active seatbelt and dual airbags (front only)
• Without any defensive driving course discount
• Liability:
  • Bodily Injury limits of $100,000/$300,000
  • Property Damage liability $25,000 (or combined single limit of $300,000)
• Uninsured Motorist Coverage:
  • Bodily Injury limits of $100,000/$300,000
  • Property Damage liability $25,000 (or combined single limit of $300,000)
• 2002 Saturn Sedan L300
• ISO rating symbol 10
• $750 deductibles for comprehensive and collision

• No at-fault or not-at-fault accidents within the past 5 years
• No motor vehicle violations within the past 5 years
• No Schedule 1 offenses (refer to N.J.A.C. 11:3-34.5) within 5 years
• Has no comprehensive claims, including theft, within 5 years

• No motor vehicle points within 3 years
• No at-fault or not-at-fault accidents within the past 3 years
• Drive to work less than 3 miles; 10,000 annual miles
• Verbal Threshold
• $250,000 Standard Personal Injury Protection (PIP), $250 deductible
• With a Category II Anti-theft device discount, and active seatbelt and dual airbags (front only)
• Without any defensive driving course discount
• Liability:
  • Bodily Injury limits of $15,000/$30,000
  • Property Damage liability $5,000 (or combined single limit of $35,000)
• Uninsured Motorist Coverage:
  • Bodily Injury limits of $15,000/$30,000
  • Property Damage liability $5,000 (or combined single limit of $35,000)
• 2003 Buick Century Custom – 4 door sedan
• ISO rating symbol 8
• $750 deductibles for Comprehensive and Collision

• Bodily Injury limits of $100,000/$300,000
• Property Damage liability $25,000
• No motor vehicle points within 3 years
• No at-fault or not-at-fault accidents within the past 3 years

• No motor vehicle points within the past 3 years
• No at-fault or not-at-fault accidents with the past 3 years
• Drive to work less than 3 miles; 10,000 annual miles
• Standard Tier (1.00)
• With active seatbelt and dual airbags (front only)
• Without any defensive driving course discount
• 1 year with company
• BASIC POLICY
  • $5,000 Property Damage
  • $15,000 Personal Injury Protection (PIP)
  • No physical damage coverage
  • No optional Bodily Injury coverage

Selecting Your NJ Health Insurer for NJ PIP Option

• Does your health coverage cover injuries from automobile accidents?
  
  Health coverage may be issued by an insurance company, an HMO or a self-funded plan. Since self-funded plans and plans issued out of state may exclude coverage for injuries resulting from auto accidents, you should make sure that your health coverage will provide benefits for automobile accident injuries. If you are covered by any of the insurers or HMO listed here, you may be eligible for this cost-saving option. Other insurers and self-funded plans might also cover automobile accident injuries. Contact your employee benefits department to determine if your health coverage provides benefits for automobile accident injuries.
  
   
• What limits and deductibles apply?
  
  Your health carrier will provide benefits for injuries from auto accidents subject to the deductibles, coinsurance, copayments and benefit maximums (if any) of your health plan. If your health plan covers your spouse or family, these cost-sharing features will also apply to them. In short, your health carrier will provide benefits for injuries from auto accidents in the same manner that it covers injuries from other causes.
  
   
• What about expenses not covered by my health care plan?
  
  Your automobile insurer will pay for necessary expenses not covered by your health care plan, including the deductible, coinsurance, co payment and amounts above the benefit maximum of your health plan, and will also pay for passengers and others not covered by your health care plan. However, this payment will be reduced by the deductible, benefit maximums and other cost-sharing provisions of your PIP coverage.
  
   
• What if I lose my health coverage?
  
  If you are in an accident and your health coverage is no longer in effect, your auto insurer will pay PIP medical benefits. However, you will be required to pay an additional $750 deductible.
  
   
• How do I choose the health coverage option?
  
  This is done by selecting the "health insurer for PIP option" on the Coverage Selection Form provided when you apply for or renew your auto insurance. You will need to know the name and policy number of your health care plan to answer that question on the Coverage Selection Form.
   

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Health Insurers that May Provide Coverage for Auto Accident Injuries
• NJ Large Group Insurers

  
  Aetna Life Insurance Company
  AmeriHealth Insurance Co of New Jersey
  Connecticut General Life Insurance Co
  Guardian Life Insurance Co of America
  GE Group Life Insurance Co
  Mutual/United of Omaha Insurance Companies
  Nippon Life Insurance Co of America
  Oxford Health Insurance Co
  Trustmark Insurance Co
  UniCare Life & Health Insurance Co
  United HealthCare Insurance Co
  Wellchoice Insurance Co of New Jersey


 
NEW JERSEY Insurance
NJ Auto Insurance NJ AUTO PHYSICAL DAMAGE CLAIMS
11:3-10.1 Scope
This subchapter applies to claims arising under motor vehicle collision and comprehensive coverages.
11:3-10.2 Definitions
The following words and terms, when used in this subchapter, shall have the following meanings unless the context clearly
indicates otherwise:
"Actual cash value", unless otherwise specifically defined by law or policy, means the lesser of the amounts for which the
insured or the designated representative can reasonably be expected to:
1. Repair the motor vehicle to its condition immediately prior to the loss; or
2. Replace the motor vehicle with a substantially similar vehicle. The amount shall include all moneys paid or payable as
sales taxes on the motor vehicle repaired or replaced. This paragraph shall not be construed to prevent an insurer from
issuing a policy where the amount of damages to be paid in the event of a total loss is a specified dollar amount.
"Agreed price" or "figure" means the amount agreed to by the insurer and the insured, or their representatives, as the
reasonable cost to replace the motor vehicle or to repair damages to the motor vehicle resulting from the loss, without
considering any deductible or deductions.
"Designated representative" means a person designated by the insured to represent the insured in negotiations with the
insurer in an attempt to settle the claim. The designated representative may be any person authorized by the insured who may
act legally in his or her behalf.
"Motor vehicle" shall have the meaning ascribed in N.J.S.A. 39:1-1.
"Substantially similar vehicle" means a vehicle of the same make, model, year and condition, including all major options of
the insured vehicle. Mileage must not exceed that of the insured vehicle by more than 4,000 miles. Mileage differences of
more than 4,000 miles may, at the option of the insured, be exchanged for the presence or absence of options or a cash
adjustment.
11:3-10.3 Adjustment of partial losses
(a) If the insurer intends to exercise its right to inspect, or cause to be inspected by an independent appraiser, damages prior
to repair, the insurer shall have seven working days following receipt of notice of loss to inspect the insured's damaged
vehicle, which is available for inspection, at a place and time reasonably convenient to the insured; commence negotiations;
and make a good faith offer of settlement.
(b) Negotiations must be conducted in good faith, with the basic goal of promptly arriving at an agreed price. Early in
negotiations, the insurer must inform and confirm in writing to the insured or the insured's designated representative all
deductions that will be made from the agreed price, including the amount of applicable deductible.
(c) If the insurer inspects the damaged vehicle or causes it to be inspected, the insurer shall promptly upon completing the
inspection furnish the insured or the designated representative of the insured with a detailed written estimate of the cost of
repairing the damage resulting from the loss, specifying all appropriate deductions.
(d) No insurer shall negotiate the settlement of any physical damage claim involving an automobile as defined at N.J.S.A.
39:13-1b with an unlicensed auto body repair facility or in any manner utilize an unlicensed facility in the adjustment,
negotiation or settlement of such a claim. It shall be the responsibility of the insurer to make a reasonable and diligent effort
to determine whether the facility is properly licensed.
(e) Subject to the requirements of (d) above, the insured may use any repair facility of his or her own choice. With respect to
automobile damage claims, the insurer shall notify in writing any insured who elects to use his or her own repair facility that,
pursuant to law, any entity engaged in the business of auto body repairs must be duly licensed. The notice shall further
advise the insured that the insurer is prohibited by law from negotiating, adjusting or settling an automobile damage claim
with an unlicensed facility. The written notice shall be furnished at the time of acknowledgment of the claim as provided at
N.J.A.C. 11:2-17.6 or upon the furnishing of its written estimate, as specified at (c) above, whichever is sooner. The insurer
must make all reasonable efforts to obtain an agreed price with the facility selected by the insured. The insurer may
recommend, and if the insured requests, must recommend a qualified repair facility at a location reasonably convenient to the
insured motor vehicle who will repair the damaged motor vehicle at the insurer's estimated cost of repairs, but in either event
the provisions of (g) below apply.
(f) All estimates, including revisions and adjustments, prepared by any repair facility, estimator or appraiser must be
included in each claim file.
(g) If the insured's vehicle is repaired at a repair facility whose name is furnished by the insurer under (e) above for a sum
estimated by the insurer as the reasonable cost to repair the vehicle, the insurer:
1. Shall select a repair facility that issues written guarantees that any work performed in repairing damaged vehicles meets
generally accepted standards for safe and proper repairs;
2. Shall cause the damaged vehicle to be restored to the condition it was in prior to the loss, at no additional cost to the
insured and within a reasonable time, if the repair facility does not repair the damaged vehicle in accordance with generally
accepted standards for a safe and proper repair.
(h) Whenever an insurer elects to repair its insured's vehicle, that is, physically take the vehicle and have it repaired, the
election must be in writing addressed to the insured and contain a reasonable estimate of the time period within which the
vehicle will be repaired. The insurer shall guarantee, in writing, that the work performed meets generally accepted standards
for safe and proper repairs.
(i) Deductions for betterment and depreciation are permitted only for parts normally subject to repair and replacement during
the useful life of the insured motor vehicle. Deductions for betterment and depreciation shall be limited to the lesser of an
amount equal to the proportion that the expired life of the part to be repaired or replaced bears to the normal useful life of that
part, or the amount by which the resale value of the vehicle is increased by the repair or replacement. Calculations for
betterment, depreciation and normal useful life must be included in the insurer's claim file.
(j) Deductions for previous damage or prior condition of the vehicle must be measurable, discernible, itemized and specific
as to the dollar amount, and those deductions must be included in the insurer's claim file. The deductions shall be limited to
the amount by which the resale value of the motor vehicle is increased by the estimation of the previous damage or the
correction of the prior condition.
(k) The insurer must mail or hand deliver to the insured or the designated representative its proof of loss or payment within
five working days after the insured has accepted the insurer's offer.
(l) The insured shall have the right to receive the proceeds of any settlement. The insurer may not insist on making
settlement proceeds jointly payable to the insured and the repair facility, or payable to the repair facility only.
(m) The insured may elect to have the insurer pay the repair facility directly in order to expedite recovery of the motor
vehicle. The insured must make this election in writing.
11:3-10.4 Adjustment of total losses
(a) If the insurer elects to make a cash settlement, it must bear in mind at all times that the insured's position is that of a
retail consumer and the settlement value arrived at must be reasonable and fair for a person in that position. Written,
itemized valuations showing all options and deductions shall be included in the insurer's claim file and presented to the
insured no later than the date of payment. If the insurer elects to make a cash settlement, its offer, subject to applicable
additions or deductions, must be one of the following plus applicable sales tax:
1. The average of the retail values for substantially similar motor vehicles as listed in the editions current for the date of loss
of two valuation manuals approved by the Commissioner.
i. The average figure arrived at may be reduced or increased by considering all factors, including, but not limited to,
mileage tables and the presence or absence of extras.
ii. If the destroyed vehicle included an option which is listed in one manual but not in the other, the value of the option shall
not be averaged. The insured shall receive full value for the option by carrying over the amount listed to the other manual.
The option carryover shall apply only in those instances where the option has not been considered by the used vehicle guide
either as a separate item or included in the vehicle's base value.
iii. If a manual is submitted for approval by the Commissioner its accuracy must meet objective criteria for the values of
substantially similar vehicles of at least 85 percent of all makes and models for the last 15 years and shall include all major
options. A sufficient number of vehicles shall be used for each year, make and model to represent a cross-section sufficient
to determine fair market values. At the time of request for approval, the source of the manual's data must be revealed to the
Commissioner in a manner that can be verified by the Department. Manuals approved for use on or after January 1, 1976 are
"Automobile Red Book" and "Older Car/Truck Red Book" published by Maclean Hunter Market Reports, Inc. and the
"N.A.D.A. Official Used Car Guide" and "N.A.D.A. Official Older Car Guide" published by the National Automobile
Dealers Used Car Guide Company.
2. A quotation obtained by the insurer for a substantially similar motor vehicle from a dealer located within a reasonable
distance from the principal place of garagement of the insured vehicle. Unless otherwise agreed by the insured, a reasonable
distance shall not exceed 25 miles from the principal place of garagement. The vehicle must be available for purchase by the
insured and the insured must be able to purchase it for the insurer's cash offer plus applicable deductions. The insurer shall
maintain in its claim file proof of the vehicle's availability and the name and location of the dealer, stock number, vehicle
identification number and description of the substantially similar vehicle.
3. The fair market value of the insured vehicle, determined by using a source including a computerized database approved
by the Commissioner that meets all of the following minimum criteria:
i. The source must give primary consideration to the values of vehicles in the local market area, but if necessary to obtain a
reasonable cross-section of the market, may consider vehicles in the next closest area.
ii. The source shall produce fair market values of substantially similar vehicles for at least 85 percent of all makes and
models for the last 15 years and shall include all major options. A sufficient number of vehicles must be used for each year,
make, and model to represent a cross-section of the market sufficient to determine fair market value.
iii. If the database uses several price ranges for the same model vehicle depending on the condition of the vehicle, it must
clearly indicate what condition the vehicle is being valued at and define in detail the difference between such rating
categories. Documentation of the condition of the insured vehicle must be made a part of the written valuation.
iv. At the time of request for approval the source of the database shall be revealed to the Commissioner in a manner that can
be verified by the Department.
4. If it is not possible to value the insured vehicle by using the method set forth in (a)1, 2 and 3, the insurer shall determine
the retail value of the vehicle by using the best available method and shall fully explain in writing to the insured how its offer
was calculated.
(b) If the insurer is notified in writing within 30 calendar days of the receipt of the claim draft that the insured cannot
purchase a comparable vehicle at the market value established by the insurer, the insurer shall reopen its claim file and the
following procedures will apply:
1. The insurer may locate a substantially similar vehicle by the same manufacturer of the same year, make and model, with
similar options, mileage, and condition as the destroyed vehicle from a licensed dealer. Such vehicle must be within a
reasonable distance not to exceed 25 miles from the insured's principal place of garaging;
2. The insurer shall either pay the difference between the market value before applicable deductions and the cost or the
market value as determined by (a)2 above of a substantially similar vehicle located by the insured or negotiate and effect
purchase of this vehicle for the insured;
3. The insurer may elect to offer a replacement vehicle in accordance with the provisions as in (e) below; or
4. The insurer or insured may conclude the loss settlement as provided for under the appraisal section of the insurance
contract in force at the time of loss. This appraisal shall be considered as binding against both parties, but shall not preclude
or waive any other rights either party has under the insurance contract or under law.
(c) The insurer shall advise the insured in writing of the rights of recourse at the time the settlement draft is issued and retain
a copy of the notice in its claim file.
(d) An insurer shall use the same source of settlement for all claims unless it is documented that the primary settlement
source is not available in the case of a particular vehicle. At the request of the Commissioner, the insurer shall provide the
Department with its primary source of valuation for vehicles.
(e) If the insurer elects to replace the vehicle, the replacement vehicle must be an immediately available, substantially similar
vehicle that is both furnished and paid for by the insurer, subject to the deductible, if any, and including applicable sales tax.
(f) If the insured vehicle is a private passenger automobile of the current model year, meaning that the vehicle has not been
superseded in the market place by an officially introduced succeeding model, the insurer shall utilize one of the following
methods in the settlement of the loss, unless the utilization of (a) or (b) above is more favorable to the consumer.
1. Either the insurer shall pay the insured an amount equal to the reasonable purchase price on the date of the loss of a new
identical vehicle, less any applicable deductible and an allowance for depreciation in accordance with the schedule below;
or
2. The insurer shall provide the insured with a new identical replacement vehicle charging the insured for any applicable
deductible and for depreciation in accordance with the schedule below:
Depreciation Schedule
Purchase Price Depreciation per mile
Up to $ 6,500 $0.10
$ 6,501-$ 8,000 0.12
8,001- 10,000 015
10,001- 12,000 0.18
12,001- 15,000 0.21
15,001- 20,000 0.25
More than $20,000 0.29
(g) In the event of a total loss, any parts of the insured vehicle included in its valuation which are removed by the insured or
the designated representative shall have their value deducted from the final settlement figure. This section shall not be
construed to grant a right of removal.
(h) The following provisions of N.J.A.C. 11:3-10.3 also shall apply to the adjustment of total losses, except that the insurer
shall have a total of 14 working days to comply with the requirements of subsections (a), (b), (c), (h), (i), (j) and (k) of
N.J.A.C. 11:3-10.3.
(i) This section does not prohibit an insurer from issuing a stated value policy insuring against physical damage where the
amount of damages to be paid in the event of a total loss is a specified dollar amount.
(j) If the vehicle is a total loss, the insurer may require that the insured transfer ownership of the vehicle to recoup salvage as
a condition of settlement.
11:3-10.5 Unreasonable delay
(a) Unless a clear justification exists, physical damage claims will have a maximum payment period of 30 calendar days. A
payment period is the period between the date of the receipt of the notice of loss by the insurer, and:
1. The date the settlement check is mailed; or
2. The date on which the damaged vehicle is returned to use when the insurer elects to repair or have repaired the insured
vehicle; or
3. The date on which the damaged vehicle is replaced by the insurer.
(b) If any element of a physical damage claim remains unresolved more than 30 calendar days from the date of receipt of
notice of loss by the insurer, the insurer shall provide the insured with a written explanation of the specific reasons for delay
in the claim settlement. An updated letter of explanation shall be sent again every 30 calendar days thereafter until all
elements of claim are either honored or rejected.
(c) Any letter of explanation, rejection or acceptance of any element of a claim shall contain in the upper right hand corner
the date of receipt of notice of loss by the insurer and be identified as such. The letter shall also contain the identity and
claim processing address of the insurer, and the insured's policy number and claim number.
11:3-10.6 Loss of use
In the event of the theft of the entire vehicle the insurer at the time of notification shall advise the insured of his or her right
under the policy to be reimbursed for transportation expenses. The notification must be confirmed in writing immediately
after receipt of notice of theft. All conditions and benefits related to this coverage as stated in the policy must be contained in
the notification to the insured.
11:3-10.7 Subrogation agreements
(a) If an insured has received payment under his or her physical damage coverage that is subject to a deductible, the insured
shall share, pro rata, with the insurer any net recovery received by the insurer from third parties.
(b) Net recovery shall be the total recovery less the insurer's allocated loss adjustment expenses attributable to such recovery.
The formula for computing net recovery and the insured's share of recovery of the deductible may be stated as follows:
1. Total recovery – Allocated loss adjustment expenses = Net recovery
(Deductible ÷ Total Loss) × Net recovery = Insured’s share of recovery.
2. Application of formula: Assume a loss of $500.00 subject to a $100.00 deductible with a $50.00 in allocated loss
adjustment expense:
i. If there is full recovery of $500.00; computation of net recovery: $500.00 - $50.00 = $450.00
Computation of insured’s share of recovery: ($100.00 ÷ $500.00) × $450.00 = $90.00
ii. If there is a partial recovery of $300.00: computation of new recovery: $300.00 - $50.00 = $90.00
Computation of insured’s share of recovery: ($100.00 ÷ $500.00) × $250.00 = $50.00
(c) Unless the insurer returns its insured's full deductible the insured shall attempt to effect full recovery in clear liability
cases and shall not enter into any intercompany agreements that provide for the acceptance of lesser amounts on a formula
basis.
(d) If an insurer has paid a physical damage claim that is subject to a deductible and it elects not to pursue its subrogation
claim where the probability of recovery exists, the insurer shall so notify its insured in writing within 60 calendar days after it
has paid the claim, except that the notification shall be given at least 30 days prior to the running of any applicable statute of
limitations or period required for notice of claim. If an insurer does not notify its insured within the time periods prescribed
above and the statute of limitations or period required for notice or claim has expired, the insurer shall forthwith remit to its
insured the full amount of the insured's deductible.
11:3-10.8 Repair estimates
If the insurer requires that its insured obtain more than one estimate of motor vehicle damage, the reasonable cost of such
additional estimates, if any, shall be borne by the insurer unless the estimator does the work.
11:3-10.9 Referral of insured to the at-fault party
There shall be no attempt to discourage an insured from filing a physical damage claim, nor shall an insurer encourage its
insured to assert a claim against a third party in lieu of filing a physical damage claim under the insured's policy.
11:3-10.10 Examinations by the New Jersey Department of Banking and Insurance
To ensure compliance with this rule, the Department of Banking and Insurance personnel will investigate the market
performance of insurers. To enable Department personnel to reconstruct an insurer's activities pursuant to the provisions of
this rule, each insurer must maintain a complete file on each claim settled pursuant to this rule. The claim file shall contain all
communications, transactions, notes and work papers relating to the claim. With respect to automobile damage claims, the
file also shall include the name, address, telephone number and license number of any auto body repair facility that has been
utilized by the insurer in the adjustment of the loss or repair of the automobile. All papers in the file must be accurately dated
by the insurer.
 
NJ Defensive Driving Schools

School	Address	Contact	Telephone
AAA - Mid-Atlantic	1 River Place Wilmington, DE 19801	Kurt Gray, Director	1-800-374-9806
AAA - New Jersey Auto Club	1 Hanover Road Florham Park, NJ 07932		973-377-7200
AAA - North Jersey Auto Club	418 Hamburg Turnpike Wayne, NJ 07474	Regina Spizzari	973-956-2201
AAA - South Jersey	700 Laurel Oak Road P.O. Box 1953 Voorhees, NJ 08043-9053		856-783-4222
American Institute for Public Safety Improv Traffic School Sole provider of Improv's "Aware Driver"TM Laff 'n' Learn Program	475 Route 23 South Pompton Plains, NJ 07440		1-800-279-2038
A-1 Peck/Sears Driving School	366 Route 46 East Mine Hill, NJ 07803	David C. Peck	1-800-822-7640
AARP American Association of Retired Persons 55 Alive NJ	132 Main St Princeton, NJ 08540		1-888-227-7669
Drive Safe New Jersey	4 Meadows Run Drive Colts Neck, NJ 07722	John A Segreti, President	1-800-732-6242
Driving Dynamics	25 Bridge Ave Red Bank, NJ 07701		732-219-0404 1-800-225-3479
Driving School Association of NJ, Inc	2561 Yardville-Hamilton Square Road Hamilton, NJ 08690	Dan Gaskill, President	609-586-4944
DTA Program for Driver Improvement Driver Training Associates, Inc.	112 Prospect Ave Ridgewood, NJ 07470		1-800-276-8301
Garden State Safety Council	20 West Lafayette St Trenton, NJ 08625	William Bonds, Director	1-800-565-4699 609-396-2232
NTSI	201 Edward Curry Ave Staten Island, NY 10314	Rosemary DeFresco	718-720-6868
New Jersey Motorcycle Safety Program Division of Highway Traffic Safety Motorcycle only	P.O. Box 048 Trenton, NJ 08625	Richard Frost	1-800-422-3750
New Jersey Safety Program, Inc.	105 Idolstone Lane Aberdeen, NJ 07747		1-800-386-6562
New Jersey State Safety Council Note: Sole provider of National Safety Council (NSC) Defensive Driving course: "Certification of Completion."	6 Commerce Drive Cranford, NJ 07016	Jim Hughes	908-272-7712 1-800-228-3834
Top Driver	154 Tices Lane East Brunswick, NJ 08816	Karen Hampp	1-800-374-8373
USA Training Company, Inc.	196 West State St Trenton, NJ 08608	Gregg Silberman, State Coordinator	1-800-746-7690

 

 

NJ Auto Insurance Rating Territories



Territory 01 - Jersey City
 
• Territory comprises all that part of Hudson County east of the Hackensack River except the City of Bayonne
  Territory 02 - Newark
   
• Territory comprises the entire City of Newark in Essex County
  Territory 03 - Paterson
   
• Territory comprises all that portion of Passaic County south or east of Wayne Township including all territory and places lying within the area enclosed by the outside boundaries of the cities of Clifton, Passaic, and Paterson; and all territory and places lying within the area enclosed by the outside boundaries of the boroughs of East Paterson, Lodi, and Wallington and the City of Garfield in Bergen County
  Territory 04 - Elizabeth
   
• Territory comprises the entire City of Elizabeth and all territory and places lying within the area enclosed by the outside boundaries of the following boroughs, cities, and townships in Union County:
  • Hillside
     
  • Kenilworth
     
  • Linden
     
  • Rahway
     
  • Roselle
     
  • Roselle Park
     
  • Union
     
  • Winfield
  
  Territory 05 - Bayonne
   
• Territory comprises the entire City of Bayonne in Hudson County
  Territory 06 - Trenton
   
• Territory comprises the entire City of Trenton and all territory and places lying within the area enclosed by the outside boundaries of the following townships in Mercer County:
  • Ewing
     
  • Hamilton
     
  • Lawrence
  
  Territory 07 - Camden
   
• Territory comprises the entire City of Camden and all territory and places lying within the area enclosed by the outside boundaries of the following cities or boroughs in Camden County; Gloucester and Brooklawn; also all territory and places lying within the area enclosed by the outside boundaries of that section of Haddon Township which is west of Black Horse Pike (which includes the villages of West Collingswood Heights and Northmont).
  Territory 08 - Perth Amboy
   
• Territory comprises all territory and places lying within the area enclosed by the outside boundaries of the following boroughs, city, township and places in Middlesex County:
   
  • Avenel
     
  • Carteret
  • Carteret Junction
     
  • Chrome
  • Colonia
     
  • East Rahway
  • Edgar
     
  • Fords
  • Genasco
     
  • Iselin
  • Keasbey
     
  • Maurer
  • Ostrander
     
  • Perth Amboy
  • Port Reading
     
  • Roosevelt
  • Sewaren
     
  • West Carteret
  • Woodbridge
  
  Territory 10 - Northern Bergen County
   
• Territory comprises all territory and places lying within the area enclosed by the outside boundaries of the following boroughs, townships and village in Bergen County:
   
  • Allendale
  • Norwood
     
  • Alpine
  • Oakland
     
  • Bergenfield
  • Old Tappen
     
  • Bogota
  • Oradell
     
  • Closter
  • Paramus
     
  • Cresskill
  • Park Ridge
     
  • Demarest
  • Ramsey
     
  • Dumont
  • Ridgewood (Village and Township)
     
  • Emerson
  • River Edge
     
  • Englewood
  • River Vale
     
  • Englewood Cliffs
  • Rockleigh
     
  • Fair Lawn
  • Saddle River
     
  • Franklin Lakes
  • Teaneck
     
  • Glen Rock
  • Tenafly
     
  • Harrington Park
  • Upper Saddle River
     
  • Haworth
  • Waldwick
     
  • Hillsdale
  • Washington
     
  • Hohokus
  • Westwood
     
  • Leonia
  • Woodcliff Lake
     
  • Mahwah
  • Wyckoff
     
  • Midland Park
     
  • Montvale
     
  • New Milford
     
  • Northvale
     
• and all territory and places lying within the area enclosed by the outside boundaries of the following borough and township in Passaic County:
   
  • Pompton Lakes
  • Wayne
     
  Territory 11 - Southern Bergen County
   
• Territory comprises all territory and places lying within the area enclosed by the outside boundaries of the following boroughs, city, townships and village in Bergen County:
   
  • Carlstadt
  • Cliffside Park
     
  • East Rutherford
  • Edgewater
     
  • Fairview
  • Fort Lee
     
  • Hackensack
  • Hasbrouck Heights
     
  • Little Ferry
  • Lyndhurst
     
  • Maywood
  • Moonachie
     
  • North Arlington
  • Palisades Park
     
  • Ridgefield
  • Ridgefield Park (Township and Village)
     
  • Rochelle Park
  • Rutherford
     
  • Saddle Brook
  • South Hackensack
     
  • Teterboro
  • Wood-Ridge
  
  Territory 12 - Camden Suburban
   
• Territory comprises all territory and places lying within the area enclosed by the outside boundaries of the following boroughs and townships in Camden County:
   
  • Audubon
  • Audubon Park
     
  • Barrington
  • Bellmawr
     
  • Cherry Hill
  • Collingswood
     
  • Haddon (that portion lying east of Black Horse Pike)
  • Haddonfield
     
  • Haddon Heights
  • Merchantville
     
  • Mount Ephraim
  • Oaklyn
     
  • Pennsauken
  • Tavistock
     
  • Wood-Lynne
  
  Territory 13 - Camden County (Balance)
   
• That portion of Camden County not included in Camden or Camden Suburban territory
  Territory 14 - Salem County (entire county) and Burlington County (Balance)
   
• That portion of Burlington County not included in Trenton Suburban territory
   
• Gloucester County (entire County)
  Territory 15 - Trenton Suburban
   
• Territory comprises all of Mercer County not included in Trenton territory and all territory and places lying within the area enclosed by the outside boundaries of the following city and townships in Burlington County:
   
  • Bordentown
  • Chesterfield
     
  • North Hanover
  
   
• all territory and places lying within the area enclosed by the outside boundaries of the following borough and townships in Middlesex County:
   
  • Cranbury
  • Jamesburg
     
  • Monroe
  • Plainsboro
  
   
• and all territories and places lying within the area enclosed by the outside boundaries of the following townships in Monmouth County:
   
  • Millstone
  • Upper Freehold
  
  Territory 16 - Long Branch
   
• Territory comprises the entire cities of Asbury Park and Long Branch and all territory and places lying within the area enclosed by the outside boundaries of the following boroughs and townships in Monmouth County:
   
  • Allenhurst
  • Atlantic Highlands
     
  • Avon-by-the-Sea
  • Belford
     
  • Belmar
  • Bradley Beach
     
  • Cliffwood
  • Deal
     
  • East Keansburg
  • Eatontown
     
  • Fair Haven
  • Fairview River Plaza
     
  • Green Grove
  • Hazlet
     
  • Highlands
  • Interlaken
     
  • Keansburg
  • Keyport
     
  • Leonardo
  • Little Silver
     
  • Matawan (Borough and Township)
  • Middletown
     
  • Monmouth Beach
  • Navesink
     
  • Neptune
  • Neptune City
     
  • New Shrewsbury
  • Oakhurst
     
  • Ocean
  • Oceanport
     
  • Port Monmouth
  • Raritan
     
  • Red Bank
  • Rumson
     
  • Sea Bright
  • Shrewsbury (Borough and Township)
     
  • Union Beach
  • Wanamassa
     
  • Wayside
  • West Long Branch
  
  Territory 17 - Monmouth County (Balance)
   
• That portion of Monmouth County not included in Long Branch or Trenton Suburban territories
  Territory 19 - Atlantic City
   
• Territory comprises the entire city of Atlantic City
  Territory 22 - Newark Semi-Suburban
   
• Territory comprises all territory and places lying within the area enclosed by the outside boundaries of the towns of Belleville and Irvington in Essex County
  Territory 23 - Hudson County (Balance)
   
• That portion of Hudson County not included in Bayonne and Jersey City territories
  Territory 24 - Essex County (Balance)
   
• That portions of Essex County not included in East Orange - Orange, Newark, Newark Semi-Suburban and Newark Suburban territories
  Territory 25
   
• Dover - Territory comprises all that part of Morris County not included in Morristown territory and all territory and places lying within the area enclosed by the outside boundaries of the following boroughs and township in Passaic County:
  • Bloomingdale
  • Ringwood
     
  • Wanaque
  • West Milford
  
  (Note: This includes all of Passaic County north and west of Pompton Lakes)
   
• Morristown - Territory comprises all territory and places lying within the area enclosed by the outside boundaries of the following boroughs, towns and townships in Morris County:
   
  • Boonton (Town and Township)
  • Mine Hill
     
  • Butler
  • Montville
     
  • Chatham (Borough and Twonship)
  • Morris
     
  • East Hanover
  • Morris Plains
     
  • Florham Park
  • Morristown
     
  • Hanover
  • Mountain Lakes
     
  • Harding
  • Parsippany-Troy Hills
     
  • Kinnelon
  • Passaic
     
  • Lincoln Park
  • Pequannock
     
  • Madison
  • Riverdale
     
  • and all territory and places lying within the area enclosed by the outside boundaries of the following borough, city and township in Union County:
     
  • Berkeley Heights
  • Summit
     
  • New Providence (Borough)
     
• Somerville - Territory comprises all the territory in Somerset County except the township of Green Brook (formerly North Plainfield) and the boroughs of North Plainfield and Watchung and except all territory and places lying within the area enclosed by the outside boundaries of Franklin Township.
  Territory 26
   
• Hunterdon County (entire County)
   
• Sussex County (entire County)
   
• Warren County (entire County)
  Territory 27 - Atlantic County (Balance)
   
• That portion of Atlantic County not included in the Atlantic City territory
   
• Cape May County (entire County)
   
• Cumberland County (entire County)
   
• Ocean County (entire County)
  Territory 31 - Newark Suburban
   
• Territory comprises all territory and places within the area enclosed by the outside boundaries of the following boroughs, cities, towns, townships and village in Essex County:
   
  • Bloomfield
  • Cedar Grove
     
  • Glen Ridge
  • Maplewood
     
  • Millburn
  • Montclair
     
  • Nutley
  • South Orange
     
  • Verona
  • West Orange
     
  Territory 38 - East Orange - Orange
   
• Territory comprises the entire cities of East Orange and Orange in Essex County
  Territory 39 - Plainfield
   
• Territory comprises the entire city of Plainfield and all territory and places lying within the area enclosed by the outside boundaries of the following boroughs, city, town and townships in Union County:
   
  • Clark
  • Cranford
     
  • Fanwood
  • Garwood
     
  • Mountainside
  • Plainfield
     
  • Scotch Plains
  • Springfield
     
  • Westfield
  
  and all territory and places lying within the area enclosed by the outside boundaries of the following boroughs and township in Somerset County:
   
  • Greenbrook
     
  • North Plainfield
     
  • Watchung
     
  Territory 40 - New Brunswick
   
• Territory comprises all territory and places lying within the area enclosed by the outside boundaries of the following boroughs, cities and townships in Middlesex County:
   
  • Dunellen
  • East Brunswick
     
  • Edison (formerly Raritan)
  • Helmetta
     
  • Highland Park
  • Madison
     
  • Metuchen
  • Middlesex
     
  • Milltown
  • New Brunswick
     
  • North Brunswick
  • Piscataway
     
  • Sayreville
  • South Amboy
     
  • South Brunswick
  • South Plainfield
     
  • Spotswood
  • South River
     
  and the township of Franklin in Somerset County

---


NJ Auto Insurance continued
SUBCHAPTER 37. ORDER OF BENEFIT DETERMINATION BETWEEN AUTOMOBILE PERSONAL
INJURY PROTECTION AND HEALTH INSURANCE
11:3-37.1 Purpose and scope
The purpose of this subchapter is to establish guidelines for the order of benefit determination between a
plan of health insurance and personal injury protection provided through an automobile policy pursuant to N.J.S.A.
39:6A-4, when a named insured elects to have his or her personal injury protection become secondary coverage for
the provision of benefits for medical expenses incurred due to injuries sustained in an automobile accident. This
subchapter also sets forth the requirements for the order of benefit determination between a plan of health insurance
and personal injury protection provided pursuant to N.J.S.A. 39:6A-4 or 39:6A-3.1, when personal injury protection
is primary coverage. The provisions of this subchapter shall apply to all automobile policies, as that term is defined
at N.J.S.A. 39:6A-2a, issued to New Jersey residents, or renewed on or after January 1, 1991, and to all health
benefits plans which have been or will be delivered or issued for delivery in this State.
11:3-37.2 Definitions
The following words and terms, when used in this subchapter, shall have the following meanings, unless the context
clearly indicates otherwise.
"Actual benefits" means those benefits determined to be payable for allowable expenses.
"Allowable expense" means a medically necessary, reasonable and customary item of expense covered by an
insured's health benefits plan(s) or PIP plan as an eligible expense, at least in part. When a plan provides benefits in
the form of services, the reasonable monetary value of each such service shall be considered as both an allowable
expense and a paid benefit.
"Benefits" means the provision of the following in consideration of payment of premiums or fees on a prepaid or
postpaid basis:
1. Services, including supplies;
2. Payment of expenses incurred;
3. A combination of 1 and 2 above; or
4. An indemnification.
"Eligible expense" means:
1. In the case of health benefits plans, that portion of the medical expenses incurred for treatment of
an injury which is covered under the terms and conditions of the plan, without application of the deductible(s) and
copayment(s), if any.
2. In the case of PIP plans, that portion of the medical expenses incurred for treatment of an injury
which, without considering any deductible and copayment, shall not exceed:
i. The percent or dollar amounts specified on the medical fee schedules, or the actual billed
expense, whichever is less; or
ii. The reasonable amount, as determined by the automobile insurer, considering the medical
fee schedules for similar services or equipment in the region where the service or equipment was provided, when an
incurred medical expense is not included on the medical fee schedules.
"Health benefits provider" means any person, whether subject to the regulation of the New Jersey Department of
Banking and Insurance, Department of Health and Senior Services, or both, or not otherwise subject to such
regulation, who contracts to provide health services, provide reimbursement for the cost of health services in whole
or in part, or to provide for indemnity in the event health services are used, in return for a prepaid or postpaid
premium or fee or other consideration, including, but not limited to:
1. Insurers, as defined at N.J.S.A. 17B:17-2;
2. Hospital service corporations, as defined at N.J.S.A. 17:48-1;
3. Medical service corporations, as defined at N.J.S.A. 17:48A-1;
4. Health service corporations, as defined at N.J.S.A. 17:48E-1;
5. Health maintenance organizations, as defined at N.J.S.A. 26:2J-2;
6. Dental service corporations, as defined at N.J.S.A. 17:48C-2;
7. Dental plan organizations, as defined at N.J.S.A. 17:48D-2;
8. Medicare;
9. Medicaid;
10. State Employees Health Benefits Plan;
11. CHAMPUS;
12. Self-insured programs; and
13. An entity organized under the laws of any other state or jurisdiction which delivers certificates to
residents of New Jersey evidencing coverage under a contract issued and delivered in a state or jurisdiction other
than New Jersey.
"Hospital expenses," when used by the automobile insurance PIP plan, means those expenses defined at N.J.S.A.
39:6A-2f.
"Injury" means bodily injury sustained by an insured as a result of an accident while occupying, entering into,
alighting from or using an automobile, or as a pedestrian, caused by an automobile or by an object propelled by or
from an automobile.
"Insured" means a person eligible for coverage, at least in part, for medical expenses incurred for treatment of
injuries, under an automobile policy PIP medical expense provision, and who meets the definition of a named
insured or family member.
1. Named insured means the person or persons identified as the insured in the automobile policy and
if an individual, that person's spouse, if the spouse is a resident of the same household, except that if the spouse
ceases to be a resident of the household of the named insured, coverage for that spouse shall continue until the
expiration of full term of any policy period in effect at the time of the cessation of residency.
2. Family member means any relative of the named insured or the named insured's spouse who:
i. Is related to the named insured or named insured's spouse by blood, marriage, adoption or
guardianship;
ii. Resides in the household of the named insured or spouse of the named insured; and
iii. Is not a named insured under another automobile policy.
"Medical expenses" is as defined in N.J.A.C. 11:3-4.2.
"Medical fee schedule" means that list of services, procedures and supplies to which have been assigned a
maximum fee or percentage of a fee payable by an automobile insurer for expenses incurred as a result of the
rendering to an insured any of those specific services, procedures or supplies for injuries, which list is set forth at
N.J.A.C. 11:3-29.
"Out-of-State automobile insurance coverage" or "OSAIC" means any coverage for medical expenses under an
automobile insurance policy other than PIP, as PIP is defined herein, including automobile insurance policies issued
in another state or jurisdiction.
"PIP" means personal injury protection coverage provided as part of an automobile insurance policy pursuant to
N.J.S.A. 39:6A-4 or 39:6A-3.1, issued in New Jersey, specifically those provisions for medical expenses coverage.
"Plan" means any policy, contract, certificate, booklet, evidence of enrollment, program, or other such term which
evidences the existence of a relationship between a health benefits provider or PIP carrier and an insured with
respect to the provisions of hospital, medical, surgical, dental and/or other health care related benefits, at least in
part.
"Primary coverage" means coverage by any plan which determines its actual benefits payable on allowable
expenses incurred by an insured for treatment of injuries without taking into consideration the existence of any
coverage for which the insured may be eligible provided secondary in accordance with this subchapter. There may
be more than one plan providing the insured primary coverage.
"Secondary coverage" means coverage by any plan which determines its actual benefits payable on all allowable
expenses incurred by an insured for treatment of injuries after all plans providing primary coverage have considered
expenses incurred and paid actual benefits.
11:3-37.3 Health benefits providers
(a) Nothing in this subchapter shall be construed as requiring any health benefits provider to offer, provide, or
continue coverage to or for any individual or group, except as may be set forth by other laws of this State, or of the
Federal government.
(b) Nothing in this subchapter shall be construed as requiring any health benefits provider to provide coverage for
any treatment or service not otherwise covered under the terms of the applicable health benefits plan.
(c) No health benefits contract or policy delivered or issued for delivery in this State, or renewed, continued or
converted on or after January 1, 1991, shall contain any provision, rider, waiver of endorsement or other instrument
which restricts, limits or excludes coverage, directly or indirectly, of services or expenses otherwise eligible under
the policy or contract on the grounds that such expenses or services would be covered under an automobile policy
PIP provision for which the insured would be eligible had the named insured on the automobile policy not selected
the PIP-as-secondary coverage option.
(d) No health benefits contract or policy delivered or issued for delivery in this State, or renewed, continued or
converted on or after January 1, 1991, shall contain any provision, rider, waiver or endorsement, or other instrument
which restricts, limits or excludes coverage, directly or indirectly, of services or expenses otherwise eligible under
the policy or contract on the grounds that:
1. Such expenses arise from an automobile-related injury;
2. Such expenses are covered or paid by PIP; or
3. Such expenses are covered or paid by OSAIC except for reductions in benefits when the health benefits
contract provides secondary coverage as defined in and permitted by this rule.
(e) A health benefits contract or policy may provide that it is always primary to OSAIC, or may provide that it will
determine its benefits as if it were secondary to any OSAIC. If the health benefits contract or policy provides that it
will determine its benefits as if it were secondary to OSAIC and the OSAIC either contains a provision that it is
always excess or secondary, or refuses to cooperate in determining the amount of benefits payable by the health
benefits plan as secondary coverage provider, the health benefits plan shall provide primary coverage.
11:3-37.4 Application of the PIP-as-secondary coverage option
(a) When a named insured elects the PIP option, whereby the named insured intends that medical expenses incurred
for treatment of an injury are to be covered by a health benefits provider or providers, as evidenced on the Coverage
Selection Form, then the medical expense provisions of the PIP coverage shall be considered to be secondary
coverage for the purposes of the order of benefit determination, and all health benefits plans of an insured subject to
the PIP option elected shall be considered to be primary coverage.
(b) The election by the named insured to make PIP medical expense provisions secondary coverage shall apply to
only the named insured and family members of the named insured who reside in the named insured's household and
are not named insureds under other automobile policies.
(c) The election by the named insured to make PIP medical expense provisions secondary coverage shall continue
in force as to subsequent renewal or replacement policies until the automobile policy insurer or its authorized
representative receives a properly executed written request revoking the selection of this option.
(d) In the event that an insured is ineligible for health plan coverage of medical expenses, or is eligible for coverage
under a dental expense or dental service plan only when an injury occurs, despite the selection of the PIP-assecondary
coverage option by the named insured, benefits shall be provided to the insured through PIP coverage in
accordance with N.J.A.C. 11:3-37.8.
11:3-37.5 Health benefit plan standards and the PIP premium reduction
(a) An automobile insurer may eliminate the premium reduction on the base rate applicable to the amount of
medical expense benefit chosen in conjunction with the PIP-as-secondary coverage option election if the automobile
insurer complies with (b) below, and verifies that the coverage specified by the named insured:
1. Excludes the provision of benefits for treatment of injuries of an eligible insured when expenses incurred
in relation to treatment of those injuries are eligible expenses under an automobile policy's PIP provisions; or
2. Provides that it is always secondary, or otherwise will not be a primary provider of benefits;
3. Provides benefits only for dental expenses or dental services; or
4. Provides benefits only for prescription drugs.
(b) An automobile carrier shall notify a named insured if the automobile insurer determines that the health benefits
plan(s) specified by the named insured contain exclusionary or restrictive coverage provisions as set forth in (a)
above, or if the automobile insurer determines that one or more of the insureds covered under the automobile
insurance policy is not provided coverage by at least one of the health benefit plan(s) specified by the named
insured, and, therefore, the named insured's premium reduction for PIP medical expense benefits will be eliminated.
1. The notice shall be in writing and shall specify the reasons why the automobile insurer believes the named
insured's health plan coverage is not in compliance with this subchapter.
2. The automobile insurer may include in the notice a demand for payment of the premium reduction difference
with an explanation that failure to pay the indicated premium reduction difference may result in early cancellation of
the automobile policy in accordance with (c) below.
3. The notice shall be sent no later than 30 days prior to the date of cancellation as calculated in accordance with
(c) below. A notice which is sent 30 days prior to the date of cancellation shall either contain a statement that it is a
notice of cancellation, or be attached to a notice of cancellation, setting forth the effective date of cancellation.
(c) The effective date of the cancellation of a policy for nonpayment of premium shall not be earlier than 10 days
prior to the last full day of which premium received by the company, prior to the date of preparation of the
cancellation notice, would pay for coverage on a pro rata basis. In calculating the effective date of the cancellation,
the premium applicable to the coverage provided by the policy and the premium received by the company at or prior
to the time the cancellation notice was prepared shall be the premium used for the calculation and determination of
such effective date.
1. No cancellation in accordance with (c) above shall be effective unless prior thereto, the automobile
insurer shall have notified the named insured that the premium reduction difference had to be paid to avoid
cancellation, as specified in (b)2 above.
2. No cancellation notice shall be mailed prior to 30 days in advance of its effective date.
(d) If the insured provides payment of the full premium amount and subsequently provides proof that coverage is
not restricted in the manner set forth in accordance with (a) above, or that all insureds under the automobile policy
were provided coverage by a health benefits plan at the time notification of noncoverage was sent, and that such
coverage continues and is not restricted in the manner set forth in accordance with (a) above, the automobile insurer
shall refund the monies paid in excess of the full reduction, or shall credit any excess paid on the reduced premium
to the extent any premium payment is still unpaid on the policy.
11:3-37.6 Order of benefits determination when PIP is secondary coverage
(a) When the named insured of an automobile policy has selected the PIP-as- secondary coverage option, all health
benefits plans for which the insured is eligible shall provide coverage for the allowable expenses incurred by the
insured due to an automobile-related injury prior to any benefits for medical expenses being paid by a PIP plan.
(b) If the insured is eligible for coverage under more than one group health benefits plan, the group health benefits
plans shall coordinate benefits with one another in accordance with the rules set forth for such plans at N.J.A.C.
11:4-28.
(c) The PIP plan shall provide benefits for allowable expenses remaining uncovered after all health benefits plans
for which the insured is eligible have paid benefits towards those allowable expenses.
(d) The PIP plan shall continue to be liable for expenses related to the same occurrence as the expenses are
incurred, whether or not the health benefits plan(s) in force at the time of the accident terminate(s) coverage, or
benefits provided under the health benefits plan(s) are exhausted subsequent to the occurrence of the accident, up to
the maximum PIP benefits available to the insured under the terms of the automobile policy.
(e) Total benefits paid by an insured's health benefits and PIP plans shall not exceed the amount of total allowable
expenses.
11:3-37.7 Determination of PIP medical benefits payable when PIP is secondary coverage
(a) In calculating the actual benefits to be paid by the automobile insurer when the PIP-as-secondary coverage
option has been selected, the automobile insurer shall first determine the amount of eligible expenses which would
have been paid after application of the deductible and copayment limitations had the PIP-as-secondary coverage
option not been selected.
1. In the event the remaining allowable expenses are less than the benefits calculated pursuant to (a) above,
the automobile insurer shall pay actual benefits equal to the remaining allowable expenses, without reducing the
remaining allowable expenses by its deductible or copayments.
2. In the event the remaining allowable expenses are greater than the benefits calculated pursuant to (a)
above, the actual benefits paid by the automobile insurer shall be the benefits calculated pursuant to (a) above,
without reducing the remaining allowable expenses by its deductible or copayments.
(b) In paying actual benefits, the automobile insurer shall not:
1. Reduce its actual benefits payable on account of any deductibles or copayments of the health benefits
plans which have provided benefits ahead of the PIP plan due to the selection of the PIP-as-secondary coverage
option; or
2. Reduce its actual benefits payable for any allowable expense remaining uncovered which item of
expense otherwise would not be an eligible expense under the PIP plan, except as set forth by (c) below.
(c) In determining remaining uncovered allowable expenses, the automobile insurer shall not consider any amount
for items of expense which exceed the dollar or percent amounts recognized by the medical fee schedules
promulgated pursuant to N.J.S.A. 39:6A-4.6.
(d) The total amount of benefits to be provided through the PIP medical expense provisions for each insured per
accident or occurrence shall not exceed the maximum PIP benefits as provided for by the terms of the policy.
11:3-37.8 Health benefits plan coverage ineligibility
(a) When, subsequent to the selection of the PIP-as-secondary coverage option by a named insured, it is determined
that an insured did not have health coverage in effect at the time of an injury, or had health coverage in effect at the
time of any injury which is such that the PIP-as-secondary coverage option selection could have been invalidated by
the automobile insurer and elimination of the premium reduction amount effected in accordance with N.J.A.C. 11:3-
37.5(a), but was not, then the insured shall be provided benefits for incurred medical expenses through the PIP
medical expense provision.
1. Benefits payable shall be subject to a per accident deductible equalling the total of $750.00 plus the PIP
deductible selected by the named insured of the policy.
2. Benefits payable shall be subject to a 20 percent copayment for amounts less than $5,000 after the
deductible has been satisfied.
3. Determination of the amount of benefits payable shall be made in accordance with medical fee schedules
promulgated pursuant to N.J.S.A. 39:6A-4.6 and set forth at N.J.A.C. 11:3-29, or on a reasonable basis, as
determined by the automobile insurer, considering the medical fee schedules for similar services or equipment in the
region where the service or equipment was provided, when an item of expense is not included on the medical fee
schedules.
4. Total benefits paid for each insured eligible for benefits in any one accident shall not exceed the
maximum PIP benefits provided for by the terms of the policy.
(b) All items of medical expense incurred by the insured for treatment of an injury shall be eligible expense to the
extent the treatment or procedure from which the expenses arose is recognized on the medical fee schedules, or are
reasonable medical expenses in accordance with N.J.S.A. 39:6A-4.
(c) The automobile insurer shall be entitled to recover, for the contract period in which the automobile-related
injury occurred, the difference between the reduced premiums paid on the policy and the amount of premium which
would have been due on the policy had the named insured not selected the PIP-as- secondary coverage option, and
no premium reduction shall be provided on that policy for the PIP-as-secondary coverage option during the
remainder of that current contract period.
11:3-37.9 Determination of benefits when PIP is primary coverage
(a) When no election has been made by a named insured to make his or her health benefits plan(s) primary coverage
provider(s), so that the PIP plan will provide primary coverage for medical expenses incurred for treatment of
injuries, the PIP plan shall provide benefits to the insured without consideration of any benefits for which the
insured may be eligible under any health benefits plan.
(b) Actual benefits paid by the PIP plan shall be medical expenses, subject to the policy limits and the application of
any deductible and copayment provided for by the terms of the automobile policy, approved by the Commissioner
pursuant to N.J.S.A. 39:6A-4 or 39:6A-3.1, and any rules promulgated thereunder.
(c) Actual benefits payable by a health benefits plan, when the PIP plan is providing primary coverage for medical
expenses incurred for treatment of injuries, shall be the lesser of the remaining uncovered allowable expenses or the
actual benefits that would have been payable had the health benefits plan been providing