Medical Care After An Auto Accident in NJ

Medically Necessary PIP Benefits in New Jersey

Read­ing Time: < 1 minute

Eli­gi­ble $250,000 “Med­ical Expenses” 
“Med­ical expens­es” is defined as “rea­son­able and nec­es­sary expens­es for treat­ment or ser­vices as pro­vid­ed by the pol­i­cy, includ­ing med­ical, sur­gi­cal, reha­bil­i­ta­tive and diag­nos­tic ser­vices and hos­pi­tal expens­es, pro­vid­ed by a health care provider licensed or cer­ti­fied by the state or by anoth­er state or nation, and rea­son­able and nec­es­sary expens­es­for ambu­lance ser­vices or oth­er trans­porta­tion, med­ica­tion and oth­er ser­vices as may be pro­vid­ed for, …and also includ­ing any non-med­ical or reme­di­al treat­ment ren­dered in accor­dance with a rec­og­nized reli­gious method of healing.” 

To be payable by PIP, med­ical expens­es must be rea­son­able and “med­ical­ly necessary”
“Med­ical­ly nec­es­sary” is defined as “that the treat­ment is con­sis­tent with the symp­toms or diag­no­sis, and treat­ment of the injury (1) is not pri­mar­i­ly for the con­ve­nience of the injured per­son or provider, (2) is the most appro­pri­ate stan­dard or lev­el of ser­vice which is in accor­dance with stan­dards of good prac­tice and stan­dard pro­fes­sion­al treat­ment pro­to­cols…, and (3) does not involve unnec­es­sary diag­nos­tic testing.”