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Recovery of Uncompensated Medical Expenses

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In Haines v. Taft, the Appellate Division addresses the frequently debated question of whether or not a plaintiff is entitled to reimbursement of medical expenses that are outside the scope of their PIP policy but within the standard PIP limit of $250k. The court concludes that these medical expenses are admissible and that an injured party has the right to seek recovery of such uncompensated economic loss.

Defendants make three main arguments, each of which the court found to be without merit. The court rejects defendant’s interpretation of NJSA 39:6A-4, that “standard automobile insurance policy” refers solely to the maximum PIP coverage. The PIP benefits under a standard policy, the court holds, is whichever of the four available options the insured chose. The court also disagrees with the argument that allowing recovery of minor expenses such as deductibles and copayments would be contrary to the legislative intent of the No-Fault Act. The court recognizes the legislative intent to bar the recovery of minor expenses in order to maintain lower premiums; however, the amount at issue in this case did not meet the minor expenses threshold. Lastly, the court disagrees with the argument that allowing an insured to choose a PIP policy with a lower deductible and then allowing the insured to sue to recover the deductible would result in a windfall. The court held that those who purchase PIP benefits that are less than $250k get what they pay for. Yes, they pay less for PIP premiums, but they give up the convenience of having medical expenses paid without having to prove fault or go through the arduous process of litigation against a tortfeasor who could be judgement-proof.

In conclusion, the court finds that unreimbursed medical expenses that go beyond the insured’s selected PIP limit, but are below the maximum PIP limit, are exactly the kind of uncompensated economic loss NJSA 39:6A-12 allows to be recovered.


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