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Appellate Division Rules that Medical Expenses that Exceed $15,000 PIP Limits are Recoverable in Personal Injury Action

By on June 9, 2017 in Awards with 0 Comments

In the published decision of Haines v. Taft, 2017 N.J. Super. LEXIS 64 (App. Div. June 1, 2017), the Appellate Division ruled that a plaintiff may recover medical expenses that exceed their $15,000 personal injury protection (PIP) limits in their automobile policy. At the trial court level, the trial judge had barred the admission of those expenses. However, that decision was reversed upon this appeal.

This issue was the subject of dispute due to conflicting decisions on the Law Division level. However, this published appellate decision resolved this dispute.

This case involved two plaintiffs (Joshua Haines and Tuwona Little) in automobile negligence actions in which both plaintiffs had minimum $15,000 PIP policies based upon a selection of this PIP option. However, they both incurred expenses in excess of that limit. Haines incurred $43,000 and she sought to introduce into evidence the $28,000 in uncompensated medical expenses. Little incurred $25,488 in medical expenses and sought to introduce into evidence $10,488 in medical bills not satisfied by PIP benefits.

The defendants argued to the trial court that all expenses between $15,000 and $250,000 should be inadmissible and barred at trial. The trial court accepted that argument and barred the introduction of medical bills that exceeded the plaintiffs’ limit in PIP benefits provided in each of their policies.

In deciding this issue, the Appellate Division reviewed the language in the pertinent statute, N.J.S.A. 39:6A-12, which makes inadmissible “evidence of the amounts collectible or paid under a standard automobile insurance policy … in a civil action for recovery of damages for bodily injury by such injured person.”  Defendants argued that this language makes inadmissible evidence of the first $250,000 in medical expenses an insured incurs, because $250,000 is the PIP limit in a “standard” policy, unless the insured elects a different option. Plaintiffs argued that this language makes inadmissible only evidence of those medical expenses that have been or are eligible to be paid under an insured’s policy per the PIP option selected.

The Court recognized that the automobile statute refers to PIP coverage of $250,000 as a standard policy. However, it also noted that automobile insurers must provide options of $150,000, $75,000, $50,000, or $15,000 per person per accident. If the insured does not select any of these options, then $250,000 is the default benefit.

In these two cases, the named insureds on the policies chose the $15,000 PIP option. The Court rejected the defendants’ argument that this selection made expenses incurred in excess of the $15,000 limit inadmissible into evidence. Essentially, the Appellate Division found that this interpretation would be reading this language too literally.

The Court noted that this statutory provision refers to $250,000 as the maximum PIP coverage available but also makes available options in lesser amounts. Thus, a “standard” policy is capable of providing one of five limits of PIP benefits. Accordingly, the Appellate Division rejected the premise that the language in N.J.S.A. 39:6A-12, referring to a “standard” policy, equates to a policy providing $250,000 in PIP benefits.

Instead, the Court found that this language refers to those PIP limits in a standard policy covering the subject insured, making inadmissible only those medical expenses up to and including the PIP limits in that insured’s policy. The amounts “collectible or paid” referred to in Section 12 of the statute depends on the limit of the insured’s PIP coverage. Because both policies selected $15,000 limits, the plaintiffs are barred from admitting evidence of medical expenses up to that amount but evidence of their medical expenses between $15,000 and $250,000 are admissible and recoverable against the tortfeasors.


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About the Author

About the Author:

Ms. Ramos is an Executive Committee Member and Co-Chair of the Litigation Department at Capehart Scatchard, P.A. located in Mount Laurel, New Jersey. She is an experienced litigator with over 30 years experience handling diverse matters. Practice areas include tort defense, business litigation, estate litigation, tort claims and civil rights defense, construction litigation, insurance coverage, employment litigation, shareholder disputes, and general litigation.

For the years 2020-2023, Ms. Ramos was selected for inclusion in The Best Lawyers in America© in the practice area of Litigation - Insurance. The attorneys on this list are selected based upon the consensus opinion of leading lawyers about the professional abilities of their colleagues within the same geographical area and legal practice area. A complete description of The Best Lawyers in America© methodology can be viewed via their website at: https://www.bestlawyers.com/methodology.

In 2021, Capehart Scatchard and Ms. Ramos received the “Best Law Firm” ranking in the area of Litigation – Insurance (Metro, Tier 3) published by U.S. News & World Report and Best Lawyers®. Law firms included on the list are recognized for professional excellence with consistently impressive ratings from clients and peers. To be eligible for a ranking, a firm must have at least one attorney who has been included in the current edition of Best Lawyers in America, which recognizes the top five percent of practicing lawyers in the United States. Betsy Ramos (Litigation – Insurance) was recognized for this prestigious award in the 2021 edition. For a description of the “Best Law Firm” selection methodology please visit: https://bestlawfirms.usnews.com/methodology.aspx.

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