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RECOVERY OF NEW JERSEY PIP AND MEDPAY BENEFIT …

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© Steven G. Kraus 2013 Steven G. Kraus, Esq., CSRP , LL.M. (Insurance Law) Law Offices of Steven G. Kraus 122 Mount Bethel Road Warren, NJ 07059 908-561-4240 / 908-561-2990 FAX [email protected] www.subrogationlawyer.com RECOVERY OF NEW JERSEY PIP AND MEDPAY BENEFIT PAYMENTS Revised February 2013
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Page 1: RECOVERY OF NEW JERSEY PIP AND MEDPAY BENEFIT …

© Steven G. Kraus 2013

Steven G. Kraus, Esq., CSRP, LL.M. (Insurance Law)Law Offices of Steven G. Kraus

122 Mount Bethel RoadWarren, NJ 07059

908-561-4240 / 908-561-2990 [email protected]

www.subrogationlawyer.com

RECOVERY OF NEW JERSEY PIP ANDMEDPAY BENEFIT PAYMENTS

Revised February 2013

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© Steven G. Kraus 2013 [email protected]

OBJECTIVES

1. MedPay Subrogation

2. Workers Compensation

3. Concurrent PIP Coverage and Contribution

4. No PIP Coverage for the Accident

5. PIP Reimbursement

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OVERVIEW

Through the use of the Application for PIP Benefits, police reports, statutes, administrative material, vehicle images, license plates and websites, we are going to analyze common motor vehicle accidents to illustrate when recovery is available.

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THE AUTOMOBILE PIP STATUTE

39:6A-4. Personal injury protection coverage, regardless of fault

Except as provided by section 45 of P.L.2003, c. 89 (C.39:6A-3.3) and section 4 of P.L.1998, c. 21 (C.39:6A-3.1), every standard automobile liability insurance policy issued or renewed on or after the effective date of P.L.1998, c. 21 (C.39:6A-1.1 et al.) shall contain personal injury protection benefits for the payment of benefits without regard to negligence, liability or fault of any kind, to the named insured and members of his family residing in his household who sustain bodily injury 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, and to other persons sustaining bodily injury while occupying, entering into, alighting from or using the automobile of the named insured, with permission of the named insured.

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N.J.S.A. 39:6A-7 EXCLUSIONS

a. Insurers may exclude a person from benefits under sections 4 and 10 of P.L.1972, c. 70 (C.39:6A-4 and 39:6A-10), medical expense benefits provided in section 4 of P.L.1998, c. 21 (C.39:6A-3. 1) and benefits provided in section 45 of P.L.2003, c. 89 (C.39:6A-3.3) if that person's conduct contributed to his personal injuries or death occurred in any of the following ways:

(1) while committing a high misdemeanor or felony or seeking to avoid lawful apprehension or arrest by a police officer; or

(2) while acting with specific intent of causing injury or damage to himself or others.

b. An insurer may also exclude from the benefits provided in sections 4 and 10 of P.L.1972, c. 70 (C.39:6A-4 and 39:6A-10) , the medical expense benefits provided in section 4 of P.L.1998, c. 21 (C.39:6A-3.1) and benefits provided in section 45 of P.L.2003, c. 89 (C.39:6A-3.3) any person having incurred injuries or death, who, at the time of the accident:

(1) was the owner or registrant of an automobile registered or principally garaged in this State that was being operated without personal injury protection coverage;

(2) was occupying or operating an automobile without the permission of the owner or other named insured

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N.J.S.A. 39:6A-7 EXCLUSIONS(CONT’D)

(3) Host-Passenger Exclusion:

was a person other than the named insured or a member of the named insured's family residing in his household, if that person is entitled to coverage under section 4 or section 10 of P.L.1972, c. 70 (C.39:6A-4 or 39:6A-10), or both, section 4 of P.L.1998, c. 21 (C.39:6A-3.1) or section 45 of P.L.2003, c. 89 (C.39:6A-3.3), as a named insured or member of the named insured's family residing in his household under the terms of another policy; or

(4) Follow the Family Exclusion:

was a member of the named insured's family residing in the named insured's household, if that person is entitled to coverage under section 4 or section 10 of P.L.1972, c. 70 (C.39:6A-4 or 39:6A-10), or both, section 4 of P.L.1998, c. 21 (C.39:6A-3.1) or section 45 of P.L.2003, c. 89 (C.39:6A-3.3) as a named insured under the terms of another policy.

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STRANGER PEDESTRIAN PIPNON-AUTOMOBILE MOTOR VEHICLES

17:28-1.3. Coverage for pedestrians

Every liability insurance policy issued in this State on a motor vehicle, exclusive of an automobile as defined in section 2 of P.L. 1972, c. 70 (C. 39:6A-2), but including a motorcycle, or on a motorized bicycle, insuring against loss resulting from liability imposed by law for bodily injury, death, and property damage sustained by any person arising out of the ownership, operation, maintenance, or use of a motor vehicle or motorized bicycle shall provide personal injury protection coverage benefits, in accordance with section 4 of P.L. 1972, c. 70 (C. 39:6A-4), to pedestrians who sustain bodily injury in the State caused by the named insured's motor vehicle or motorized bicycle or by being struck by an object propelled by or from the motor vehicle or motorized bicycle.

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Reference: Police Report 3

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STRANGER PEDESTRIAN PIP - PLIGA/UCJN.J.S.A. 39:86.1

When any person qualified to receive payments under the provisions of the "Unsatisfied Claim and Judgment Fund Law" suffers bodily injury or death as a pedestrian, as defined in section 2 of P.L. 1972, c. 70 (C. 39:6A-2), caused by a motor vehicle, including an automobile as defined in section 2 of P.L. 1972, c. 70 (C. 39:6A-2), and a motorcycle, or by an object propelled therefrom, or arising out of an accident while occupying, entering into, alighting from, or using an automobile, registered or principally garaged in this State for which personal injury protection benefits under the "New Jersey Automobile Reparation Reform Act," P.L.1972, c.70 (C.39:6A-1 et seq.), or section 19 of P.L. 1983, c. 362 (C. 17:28-1.3), would be payable to such person if personal injury protection coverage were in force and the damages resulting from such accident or death are not satisfied due to the personal injury protection coverage not being in effect with respect to such accident, or when a pedestrian suffers bodily injury as provided by section 35 of P.L. 2003, c. 89 (C. 39:6-86.7) then in such event the Unsatisfied Claim and Judgment Fund shall provide, under the following conditions, the following benefits:

N.J.S.A. 39:86.7

The Unsatisfied Claim and Judgment Fund created pursuant to P.L. 1952, c. 174 (C. 39:6-61 et seq.) shall provide personal injury protection benefits pursuant to section 7 of P.L. 1972, c. 198 (C. 39:6-86.1) to a pedestrian sustaining bodily injury in this State caused by an automobile, other than to a named insured or a member of the named insured's family residing in his household, if that pedestrian is entitled to personal injury protection coverage under an automobile insurance policy.

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Reference: Police Reports 4, 9

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THE BUS PIP STATUTE (MEB)

17:28-1.6. Owner or operator of motor bus required to maintain no-fault medical expense benefits for passengersa.Every owner, registered owner or operator of a motor bus registered or principally

garaged in this State shall maintain medical expense benefits coverage, under provisions approved by the commissioner, for the payment of benefits without regard to negligence, liability or fault of any kind, to any passenger who sustained bodily injury as a result of an accident while occupying, entering into or alighting from a motor bus.

b.Medical expense benefits coverage shall include the payment of reasonable medical expenses in an amount not to exceed $250,000 per person per accident. In event of death, payments shall be made to the estate of the decedent.

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EXTENDED MEDICAL EXPENSE BENEFITS COVERAGE - MEDPAY

N.J.A.C.  11:3-7.3 Personal injury protection policy forms or endorsements

(b) Each policy form or endorsement covering an automobile as defined at N.J.S.A. 39:6A-2 shall include excess medical payments coverage, corresponding to Section II, Extended Medical Expense Benefits Coverage of the personal automobile policy. Insurers must include a minimum coverage of $ 1,000 and may offer coverage of $ 10,000.

New Jersey Circular Letter Automobile 9 (February 22, 1973) Page 9

“Medical payments coverage with a minimum of $1,000 per person must be supplied and will be excess over other collectible insurance, including PIP benefits, and will be subrogable.

There are situations where an injured person might not be covered under PIP such as injured while riding in a truck, bus or a cab, for example.”

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Reference: Police Reports 6, 11, 12, 13

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CONTRIBUTION AMONGINSURERS

39:6A-11. Contribution among insurersIf two or more insurers are liable to pay benefits under sections 4 and 10 of P.L.1972, c. 70 (C.39:6A-4 and 39:6A-10) under a standard automobile insurance policy for the same bodily injury, or death, of any one person, the maximum amount payable shall be as specified in those sections 4 and 10 of P.L.1972, c. 70 (C.39:6A-4 and 39:6A-10) , section 4 of P.L.1998, c. 21 (C.39:6A-3.1) and section 45 of P.L.2003, c. 89 (C.39:6A-3.3), respectively, if additional first party coverage applies and any insurer paying the benefits shall be entitled to recover from each of the other insurers, only by inter-company arbitration or inter-company agreement, an equitable pro-rata share of the benefits paid.

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39:6A-6. Collateral source

The benefits provided in sections 4 and 10 of P.L.1972, c. 70 (C.39:6A-4 and 39:6A-10) , the medical expense benefits provided in section 4 of P.L.1998, c. 21 (C.39:6A-3.1) and the benefits provided in section 45 of P.L.2003, c. 89 (C.39:6A-3.3) shall be payable as loss accrues, upon written notice of such loss and without regard to collateral sources, except that benefits, collectible under workers' compensation insurance, employees' temporary disability benefit statutes, Medicare provided under federal law, and benefits, in fact collected, that are provided under federal law to active and retired military personnel shall be deducted from the benefits collectible under sections 4 and 10 of P.L.1972, c. 70 (C.39:6A-4 and 39:6A-10) , the medical expense benefits provided in section 4 of P.L.1998, c. 21 (C.39:6A-3.1) and the benefits provided in section 45 of P.L.2003, c. 89 (C.39:6A-3.3).

If an insurer has paid those benefits and the insured is entitled to, but has failed to apply for, workers' compensation benefits or employees' temporary disability benefits, the insurer may immediately apply to the provider of workers' compensation benefits or of employees' temporary disability benefits for a reimbursement of any benefits pursuant to sections 4 and 10 of P.L.1972, c. 70 (C.39:6A-4 and 39:6A-10) , medical expense benefits pursuant to section 4 of P.L.1998, c. 21 (C.39:6A-3.1) or benefits pursuant to section 45 of P.L.2003, c. 89 (C.39:6A-3.3) it has paid.

WORKERS COMP AND PIP

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Reference: Police Reports 7, 14

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PIP PAYMENTS MADE WHERETHERE IS NO PIP COVERAGE

Where PIP payments have been made but there was no PIP coverage for the accident under the policy, payments can be recovered by contribution from the insurance carrier that does provide the PIP coverage. Pratts v. Hulme, 2007 N.J. Super Unpub. LEXIS 665, 2007 WL 4441217 (App. Div. 2007).    

The most common situations are:

1. The injured person was a passenger in a taxi, truck, livery vehicle or bus*,

2. The person was injured as a pedestrian when the striking vehicle was a taxi, truck, livery cab or bus**,

3. When the Deemer Statute does not apply to convert an out of state policy to a New Jersey policy***.

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*Police Reports 5,6,11,12, 13 **Police Reports 4, 9 ***Police Reports 8, 15, 17

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PIP REIMBURSEMENT

There is a limited right for a PIP carrier to recover the amount of PIP payments, including claims expenses, from a tortfeasor or their insurance carrier which does not participate in the New Jersey PIP system because:

1. The tortfeasor is not a motor vehicle; commonly a tavern*,

2. The motor vehicle is not required to maintain New Jersey PIP benefits; a truck, taxi, livery vehicle, school bus, or out of state registered and garaged vehicle to which The Deemer Statute does not apply, or**

3. The tortfeasor is uninsured***.

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*Police Reports. 18, 19, 20, 21 **Police Reports. 1, 6, 11,12, 13, 15, 17, 22 ***Police Report 23

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THE PIP REIMBURSEMENTSTATUTE

39:6A-9.1. Recovery of personal injury protection benefits from tortfeasor

a) An insurer, health maintenance organization or governmental agency paying benefits pursuant to subsection a., b. or d. of section 13 of P.L.1983, c.362 (C.39:6A-4.3), personal injury protection benefits in accordance with section 4 or section 10 of P.L.1972, c.70 (C.39:6A-4 or 39:6A-10), medical expense benefits pursuant to section 4 of P.L.1998, c.21 (C.39:6A-3.1) or benefits pursuant to section 45 of P.L.2003, c.89 (C.39:6A-3.3), as a result of an accident occurring within this State, shall, within two years of the filing of the claim, have the right to recover the amount of payments from any tortfeasor who was not, at the time of the accident, required to maintain personal injury protection or medical expense benefits coverage, other than for pedestrians, under the laws of this State, including personal injury protection coverage required to be provided in accordance with section 18 of P.L.1985, c.520 (C.17:28-1.4), or although required did not maintain personal injury protection or medical expense benefits coverage at the time of the accident.

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THE PIP REIMBURSEMENTSTATUTE (CONT’D)39:6A-9.1. Recovery of personal injury protection benefits from tortfeasor

b) In the case of an accident occurring in this State involving an insured tortfeasor, the determination as to whether an insurer, health maintenance organization or governmental agency is legally entitled to recover the amount of payments and the amount of recovery, including the costs of processing benefit claims and enforcing rights granted under this section, shall be made against the insurer of the tortfeasor, and shall be by agreement of the involved parties or, upon failing to agree, by arbitration. Any recovery by an insurer, health maintenance organization or governmental agency pursuant to this subsection shall be subject to any claim against the insured tortfeasor's insurer by the injured party and shall be paid only after satisfaction of that claim, up to the limits of the insured tortfeasor's motor vehicle or other liability insurance policy.

L. 1983, c. 362, § 20; amended 1985, c. 520, § 17; 1990, c. 8, § 10; 1998, c. 21, § 13; 2003, c. 89, § 53; 2011, c. 11, § 1, effective Jan. 28, 2011.

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VEHICLES REQUIRED TO MAINTAIN NJ PIP COVERAGE

1. Any “automobile” as defined by N.J.S.A. 39:6A-2(a). As a general matter, every motor vehicle that looks like a car or a station wagon, whether used for business or personal use, will initially meet the definition of "automobile" and be required to maintain PIP coverage.  Wagner v. Transamerica, 167 N.J. Super. 25 (App. Div. 1979), Favell v. Hernandez, 261 N.J. Super. 348 (Law Div. 1992).

2. Any “motor bus” as defined by N.J.S.A. 39:1-1, N.J.S.A 17:28-1.5 and N.J.S.A. 48:16-13.

3. New Jersey insurance requirements only apply to motor vehicles registered or principally garaged in New Jersey. N.J.S.A. 39:6A-3 and N.J.S.A. 39:6B-1.

4. Any out of state motor vehicle subject to The Deemer Statute, N.J.S.A. 17:28-1.4.

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DEFINITION OF AUTOMOBILE

39:6A-2a. “Automobile” means a private passenger automobile of a private passenger or station wagon type that is owned or hired and is neither used as a public or livery conveyance for passengers nor rented to others with a driver; and a motor vehicle with a pickup body, a delivery sedan, a van, or a panel truck or a camper type vehicle used for recreational purposes owned by an individual or by husband and wife who are residents of the same household, not customarily used in the occupation, profession or business of the insured other than farming or ranching. An automobile owned by a farm family copartnership or corporation, which is principally garaged on a farm or ranch and otherwise meets the definitions contained in this section, shall be considered a private passenger automobile owned by two or more relatives resident in the same household.

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• Meets the definition of an

“automobile”

• No cause of action for PIP

reimbursement

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FORD CROWN VICTORIA

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• No longer meets the definition of an “automobile”

because it is rented with a driver

• PIP reimbursement available

FORD CROWN VICTORIA

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FORD CROWN VICTORIATAXI CAB

• Does not meet the definition of “automobile”

because it is rented with a driver

• PIP reimbursement available

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• Meets the definition of an automobile. Immune from PIP reimbursement by Title 59 immunity

• Owned by a New Jersey public entity

FORD CROWN VICTORIA

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GMC TRUCK SAVANNAHCARGO CONFIGURATION

• As a commercial vehicle, an X plate, it does not meet the definition of an automobile

• However, if it has an X Farmer plate, the statute defines it as an “automobile”

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FORD F-350 PICKUP TRUCK

• A pickup truck owned by an individual used for personal use meets the definition of an automobile

• A pickup truck used for business use, other than farming or ranching, does not meet the definition of an automobile

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WHAT IS A “BUS”?N.J.S.A. 39:1-1

“Omnibus” includes all motor vehicles used for the transportation of passengers for hire, except commuter vans and vehicles used in ridesharing arrangements and school buses, if the same are not otherwise used in the transportation of passengers for hire.

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BUSES REQUIREDTO HAVE BUS PIP (MEB)

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WHAT BUSES DO NOT CARRYBUS PIP (MEB)?N.J.S.A. 17:28-1.5

“Motor bus” means an omnibus, as defined in R.S. 39:1-1, except that “motor bus” shall not include:a. Vehicles engaged in the transportation of passengers for hire in the manner and form commonly

called taxicab service unless such service becomes or is held out to be regular service between stated termini;

b.Hotel buses used exclusively for the transportation of hotel patrons to or from local railroad or other common carrier stations including local airports;

c. Buses operated for the transportation of enrolled children and adults only when serving as chaperones to or from a school, school connected activity, day camp, summer day camp, nursery school, child care center, pre-school center or other similar places of education, including “School Vehicle Type I” and “School Vehicle Type II” as defined in R.S. 39:1-1;

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WHAT BUSES DO NOT CARRYBUS PIP (MEB)?N.J.S.A. 17:28-1.5 (CONT’D)

“Motor bus” means an omnibus, as defined in R.S. 39:1-1, except that “motor bus” shall not include:d.Any autobus with a carrying capacity of not more than 13 passengers operated under municipal

consent upon a route established wholly within the limits of a single municipality or with a carrying capacity of not more than 20 passengers operated under municipal consent upon a route established wholly within the limits of not more than four contiguous municipalities within any county of the fifth or sixth class, which route in either case does not in whole or in part parallel upon the same street the line of any street railway or traction railway or any other autobus route;

e.Autocabs, limousines or livery services as defined in R.S. 48:16-13, unless such service becomes or is held out to be regular service between stated termini;

f. Any vehicle used in a “ridesharing” arrangement, as defined by the “New Jersey Ridesharing Act of 1981,” P.L.1981, c. 413 (C. 27:26-1 et al.);

g. Any motor bus owned and operated by the New Jersey Transit Corporation; orh.Any special paratransit vehicle as defined in R.S. 48:4-1.

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AUTOCAB: N.J.S.A. 48:16-13“Autocab” means a limousine. “Limousine” means and includes any automobile or motor car used in the business of carrying passengers for hire to provide prearranged passenger transportation at a premium fare on a dedicated, nonscheduled, charter basis that is not conducted on a regular route and with a seating capacity of no more than 14 passengers, not including the driver, provided, that such a vehicle is certified by the manufacturer of the original vehicle and the second-stage manufacturer, if applicable, to conform to all applicable Federal Motor Vehicle Safety Standards promulgated by the United States Department of Transportation pursuant to 49 CFR Part 571 (49 CFR 571.1 et seq.) and 49 CFR Part 567 (49 CFR 567.1 et seq.). In addition, a “Vehicle Emission Control Information” label, which contains the name and trademark of the manufacturer and an unconditional statement of compliance with the emission requirements of the Environmental Protection Agency, shall be present on the vehicle. Nothing in this article contained shall be construed to include taxicabs, hotel buses, buses employed solely in transporting school children or teachers, vehicles owned and operated directly or indirectly by businesses engaged in the practice of mortuary science when those vehicles are used exclusively for providing transportation related to the provision of funeral services, autobuses which are subject to the jurisdiction of the Department of Transportation, or interstate autobuses required by federal or State law or regulations of the Department of Transportation to carry insurance against loss from liability imposed by law on account of bodily injury or death.“Limousine or livery service” means and includes the business of carrying passengers for hire by limousines.

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BUSES THAT DO NOTHAVE TO HAVE BUS PIP (MEB)

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THE DEEMER STATUTEN.J.S.A. 17:28-1.4

Any insurer authorized to transact or transacting automobile or motor vehicle insurance business in this State, or controlling or controlled by, or under common control by, or with, an insurer authorized to transact or transacting insurance business in this State, which sells a policy providing automobile or motor vehicle liability insurance coverage, or any similar coverage, in any other state or in any province of Canada, shall include in each policy coverage to satisfy at least the personal injury protection benefits coverage pursuant to section 4 of P.L.1972, c. 70 (C.39:6A-4) or section 19 of P.L.1983, c. 362 (C.17:28-1.3) for any New Jersey resident who is not required to maintain personal injury protection coverage pursuant to section 4 of P.L.1972, c. 70 (C.39:6A-4) or section 4 of P.L.1998, c. 21(C. 39:6A-3.1) and who is not otherwise eligible for such benefits, whenever the automobile or motor vehicle insured under the policy is used or operated in this State.

In addition, any insurer authorized to transact or transacting automobile or motor vehicle insurance business in this State, or controlling or controlled by, or under common control by, or with, an insurer authorized to transact or transacting automobile or motor vehicle insurance business in this State, which sells a policy providing automobile or motor vehicle liability insurance coverage, or any similar coverage, in any other state or in any province of Canada, shall include in each policy coverage to satisfy at least the liability insurance requirements of subsection a. of section 1 of P.L.1972, c. 197 (C.39:6B-1) or section 3 of P.L.1972, c. 70 (C.39:6A-3), the uninsured motorist insurance requirements of subsection a. of section 2 of P.L.1968, c. 385 (C.17:28-1.1), and personal injury protection benefits coverage pursuant to section 4 of P.L.1972, c. 70 (C.39:6A-4) or of section 19 of P.L.1983, c. 362 (C.17:28-1.3), whenever the automobile or motor vehicle insured under the policy is used or operated in this State.

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PIP REIMBURSEMENT RECOVERY GUIDELINES – PART I

• The Statute of Limitations is 2 years from the date that the PIP claim is filed.

• Generally a claim is filed when the signed PIP Application is received. NJM v. Holger Trucking Corp., 417 N.J. Super. 393, 9 A.3d 1095 (App. Div. 2011)

• To avoid any issues as to the exact date the PIP claim is filed, the best practice is to use the date of loss as the date that begins the 2 year limitations period.

• For an insured defendant, the Statute of Limitations is tolled when a formal demand for arbitration is served on the liability insurance carrier. New Jersey Automobile Full Insurance Underwriting Association By and Through CSC v. Liberty Mutual Ins. Co., 270 N.J. Super. 49, 636 A.2d 550 (App. Div. 1994) or when the liability carrier agrees to pay the claim.

• If the liability carrier is not a member of Arbitration Forums, Inc., the best practice is to serve the Demand for Arbitration and file a Complaint within the 2 year time period.

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PIP REIMBURSEMENT RECOVERY GUIDELINES – PART II

• If the defendant is uninsured or self-insured, the Statute of Limitations is tolled when a Complaint is filed or the defendant agrees to pay the claim.

• Once the Statute of Limitations is tolled, the PIP carrier can make a claim for reimbursement of later PIP benefits at any time. Allstate Ins. Co. v. Universal Underwriters Ins. Co., 330 N.J. Super 628, 750 A.2d 223 (App. Div. 2000).

• The PIP reimbursement claim is paid from the bodily injury liability limit of the tortfeasor's insurance policy. IFA Insurance Company v. Waitt, 270 N.J. Super. 621 (App. Div.), cert. Den. 136 N.J. 295 (1994)

• The defendant does not have to be a motor vehicle. State Farm Mut. Auto. Ins. Co. v Licensed Beverage Ins. Exchange, 146 N.J. 1, 679 A.2d 620 (1996).

• For an insured defendant, the cause of action is only against the insurance carrier and excess carrier. Liberty Mutual Ins. Co. v. Selective Ins. Co., 271 N.J. Super. 569, 638 A.2d 1389 (Law 1993), aff ’d 271 N.J. Super 454, 638 A. 2d. 1330 (App. Div. 1994).

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PIP REIMBURSEMENT RECOVERY GUIDELINES – PART III• An insured defendant has no personal liability for a PIP reimbursement claim. The cause

of action is only against the liability insurance carrier. Sherman v. Garcia Const., Inc., 251 N.J. Super. 352, 598 A. 2.d 242 (App. Div. 1991).

• A defendant is only immune from a PIP reimbursement claim if the medical payments coverage provided by their policy is required by New Jersey law.  Drive New Jersey Ins. Co. v. Gisis, 420 N.J. Super. 295, 21 A.3d 216  (App. Div. 2011).

• For claims arising after January 28, 2011, any bodily injury claim has priority over any PIP reimbursement claim.   The PIP reimbursement claim can only be paid after “satisfaction” of any injured party’s claim.

• The insured cannot release the PIP reimbursement claim as a part of the settlement of the bodily injury claim. Buoni v. Browning-Ferris Industries, 219 N.J. Super. 96, 529 A.2d 1044 (Law. 1987).

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PIP REIMBURSEMENT RECOVERY GUIDELINES – PART IV• The elements of damages are PIP medical benefits, income continuation benefits,

essential service benefits, death benefits and funeral expense benefits payments and claims expenses such as IMEs and costs to defend PIP provider arbitrations to the extent that the defense is necessary and reasonable.

• The PIP reimbursement statute specifically provides that an element of damages is “the costs of processing benefits claims and enforcing rights granted under this section.”

• The attorney’s fee for the PIP reimbursement recovery is not an element of damages. David v. Government Employees Ins. Co., 360 N.J. Super. 127, 821 A.2d 564 (App. Div. 2003).

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