A Capehart Scatchard Blog

Plaintiff Permitted to “Board” Full Amount of Medical Expenses Not Covered by PIP

By on November 18, 2016 in Coverage with 0 Comments

Plaintiff Angel Viruet, Jr. was injured in an automobile accident and sued Defendant Fernando Maoine for his injuries. Plaintiff was insured by GEICO Insurance Company for his automobile insurance and had selected a limited PIP medical coverage benefits of $15,000. In Viruet v. Maoine, 2016 N.J. Super. Unpub. LEXIS 2426 (Law Div. Nov. 4, 2016), the court was asked to decide if the plaintiff’s medical bills in excess of $15,000 would be “boardable” at trial (admissible into evidence) and, if so, whether the full amount could be considered by the jury or would they be limited to the PIP Fee Schedule amounts.

The Plaintiff’s medical bills totaled $56,321 due to injuries suffered in the accident. The PIP carrier (GEICO) only paid $15,000 of those bills. The Defendant moved to have those bills in excess of the $15,000 limit subject to the PIP fee schedule amounts.

The trial court found that the Plaintiff’s medical expenses are clearly subject to the Fee Schedule to the extent they are within the $15,000 coverage limits. The court held that because the PIP carrier is not paying the medical bills in excess of the coverage limit, the Fee Schedule does not apply. The medical provider is not limited to the Fee Schedule and may bill the patient for the full amount. The patient is then personally responsible for the billed amount and, in turn, may seek recovery from the tortfeasor for his economic loss.

This court followed the decision of Wise v. Marienski, 425 N.J. Super. 110 (Law Div. 2011) in ruling that the medical expenses not paid by PIP are recoverable in a tort action. It decided that the full amount of those bills, without any reduction to the PIP Fee Schedule, were admissible into evidence at trial. Thus, they are fully “boardable” to the extent they were not paid by PIP.


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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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