New Jersey No-Fault Law: Who Covers My Medical Bills?
There are a lot of misconceptions about who is responsible to pay for medical bills after you
have been involved in an automobile accident. New Jersey’s No Fault Law covers payment of
medical bills. In New Jersey, each driver and passenger is generally responsible for the payment
of his or her own medical bills, regardless of fault in the accident. If an individual involved in
an accident has a policy of automobile insurance in their own name, is a named insured under a
policy, or resides with a blood relative who has a car insurance policy, his or her medical bills
are paid by that carrier. If an individual is not so covered then their medical bills are paid by the
insurance carrier covering the automobile that they were driving or were a passenger in.
Individuals can also elect in their automobile insurance policies to have their health insurance
provide primary coverage. In any event, payment of medical bills is governed by a strict payment
schedule and care for common injuries must be provided under a standard care plan adopted
by the New Jersey Department of Insurance. Pre-authorization is required for non-emergency
care. Your policy generally provides for an initial deductible and you are then responsible for
a 20% co-payment until your medical bills reach $5,000.00. By way of example, if you have
selected a $1,000.00 deductible on the first $5,000.00 of medical bills you would personally pay
$1,800.00 and all amounts after that would be covered 100%.
After you receive the Explanation of Benefits (EOB) form from your automobile insurance
carrier you can then submit it to your health insurance carrier which may cover all or part of the
$1,800.00. Please keep in mind that it is illegal for your health care providers to bill you for any
amounts in excess of the New Jersey Fee Schedule paid by your automobile insurance carrier.