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Supreme Court Rules that Plaintiffs Injured in Auto Accident are Barred from Recovering Medical Expenses Less Than $250,000 Statutory Amount Regardless of PIP Coverage Selected

By on March 29, 2019 in Claims with 1 Comment

In Haines v. Taft, 2019 N.J. LEXIS 441 (March 26, 2019), in a split decision, the New Jersey Supreme Court reversed the Appellate Division and found that plaintiffs, who elected a $15,000 PIP coverage, were barred from seeking to recover the amount of their outstanding medical expenses, incurred as a result of an automobile accident, that exceeded the $15,000 coverage. The defendant tortfeasors argued that the plaintiffs were precluded from recovering these bills based upon the application of N.J.S.A. 39:6A-12 which prohibits the admission of evidence of the amounts “collectible or paid” under personal injury protection coverage.

Both plaintiffs (Joshua Haines and Tuwona Little) had been involved in automobile accidents and had selected a PIP coverage lower than the statutory standard amount of $250,000. They selected the lower PIP coverage in the amount of $15,000 but incurred medical bills in excess of that amount ($28,000 and $10,000). While their noneconomic claim was barred because they did not meet the verbal threshold, they were pursuing the defendant tortfeasors (who caused the accident) to recover their uncompensated economic loss, i.e., their unpaid medical bills in excess of the $15,000 paid by their insurance carrier based upon their PIP coverage.

Under N.J.S.A. 39:6A-12, evidence of losses paid or collectible under PIP are inadmissible in a personal injury action. The issue here was whether the bills were recoverable as an uncompensated economic loss after considering the application of N.J.S.A. 39:6A-12. The trial court had ruled that the bills were not an uncompensated economic loss despite the selection of the lower PIP coverage and were barred. However, the Appellate Division disagreed and reversed the trial court’s decision, finding that plaintiffs could introduce evidence of their outstanding medical bills in excess of their selected PIP coverage.

The Supreme Court agreed with the trial court and reversed the Appellate Division. The Court found that it was not in accord with the legislative intent of the AICRA statute and, further, could produce the potentially absurd result whereby someone who chose a lower PIP option (at a lower cost) could receive a higher overall reimbursement than someone who chose the standard $250,000 option.

Hence, the bottom line of this case is, regardless of whether a plaintiff selects the standard $250,000 PIP option or a lower PIP option, any unreimbursed medical expenses less than $250,000 are not admissible at the time of trial and a plaintiff will not be able to pursue the tortfeasor for reimbursement of such expenses.

The Court did invite the Legislature to clarify the statutory language so we may see legislation in the future, effectively reinstating the Appellate Division decision.


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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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There is 1 Brilliant Comment

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  1. Mike says:

    Little do they state, the client did NOT have Health Insurance. If a client has 15,000 PIP it is required to have Health Insurance in order to pick up the left over amount.

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