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Appellate Division Rules that Plaintiff May Recover Medical Expenses Beyond PIP Limits

The Appellate Division has ruled that a plaintiff may recover medical expenses in excess of the
PIP benefit limits contained in their automobile insurance policy. In the two cases before the court, the plaintiffs were covered by automobile policies which provided $15,000 in PIP benefits. As a result of motor vehicle accidents, the plaintiffs incurred medical expenses in excess of $15,000. Accordingly, at their respective trials the plaintiffs sought to recover medical expenses in excess of the $15,000 limit.

At the trial level, the plaintiffs argued that under the PIP statute, they were entitled to recover
medical expenses in excess of the PIP benefit limit of their respective policies. One plaintiff had
$28,000 in unpaid medical expenses, and the other had $10,000 in unpaid medical expenses. The
defendants argued that under the PIP statute, plaintiffs were only entitled to recover unpaid medical
expenses in excess of the standard PIP benefit limit. It was their position that the standard PIP benefit limit is $250,000. As such, the defendants maintained that persons injured in an automobile accident were not permitted to recover unpaid medical expenses unless they exceed the $250,000 standard PIP benefit limit. The trial court accepted the defendants’ position and dismissed the two cases.

On appeal, the Court was asked to examine whether a plaintiff’s claim for unpaid medical
expenses arises only after $250,000 in medical expenses are incurred, or whether such a claim arises when whatever PIP benefit limit in place is exhausted. The Court ultimately ruled that a plaintiff can seek reimbursement of unpaid medical expenses regardless of what PIP benefit limit they selected under their automobile policy. For example, if a plaintiff elects to reduce their PIP benefit coverage from the standard limit of $250,000 to $15,000, the plaintiff is permitted to seek recovery of any unpaid medical expenses in excess of $15,000. This ruling does not change the fact that medical expenses paid by PIP are not admissible. However, this decision does establish that in a case where a plaintiff’s injuries do not vault the verbal threshold, but they have medical expenses exceeding their PIP benefits, that individual may continue their lawsuit to recover those unpaid medical expenses.

It is likely that this matter will be appealed to the New Jersey Supreme Court.

The cases heard by the Court were Haines v. Taft, et. al, A-5503-13T4 and Little v. Nishimura,

Categories: Insurance Law


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