PIP and med-pay rules in New Jersey

If you were hurt in a New Jersey crash, your own auto policy pays the first medical bills, no matter who caused the wreck. That coverage is Personal Injury Protection, or PIP, and New Jersey makes it mandatory under N.J.S.A. 39:6A-4.¹ One thing to clear up first, because it trips people up: New Jersey does not sell the small "med-pay" (medical payments) coverage that many tort states bolt onto a policy. Here, first-party medical coverage runs entirely through PIP. So when a New Jersey agent or adjuster mentions your "med-pay," they almost always mean PIP.

The general mechanics of no-fault insurance are covered on the national guide. This page sticks to the New Jersey numbers, deadlines, and exceptions.

How much PIP pays

The default medical-expense limit on a New Jersey Standard Policy is $250,000 per person, per accident.² If you never signed anything choosing a lower number, that is what you carry. You can trade the limit down to $150,000, $75,000, $50,000, or $15,000 to shave the premium, but that reduction has to be made in writing on your coverage selection form.²³ The stripped-down Basic Policy comes with $15,000 in PIP and no option to go higher.²

PIP is more than hospital bills. The statute also pays income continuation for lost wages (a standard benefit of $100 a week up to $5,200), reimbursement for essential services you can no longer perform yourself such as childcare or snow removal ($12 a day up to $4,380), a survivor death benefit, and up to $1,000 in funeral expenses.¹ On a Standard Policy these extras are packaged options you can raise; on a Basic Policy they are not included at all.

The $250,000 you keep no matter what

Here is the New Jersey rule people miss. Even if you chose the $15,000 PIP limit to save money, your policy still pays up to $250,000 for a short list of catastrophic injuries: a permanent or significant brain injury, a spinal cord injury, or permanent significant disfigurement.² That same $250,000 backstop also covers medically necessary treatment given at a trauma center or acute-care hospital right after the crash, until you are stable and no longer need critical care.² So a low limit only costs you on an ordinary injury. The worst-case treatment is covered either way.

The deductible and the 20 percent you owe

Every PIP claim starts with a deductible. The standard is $250, and you can raise it to $500, $1,000, $2,000, or $2,500 in exchange for a lower premium.²³ After the deductible, there is a 20 percent copayment on medical expenses between the deductible and $5,000.² In plain terms, on the first $5,000 of treatment you pay the deductible plus one-fifth of the rest, and PIP pays the other 80 percent, then covers the balance up to your limit. Choose the $2,500 deductible and you carry the first few thousand dollars yourself before PIP does much of anything, so match the deductible to what you could actually absorb.

Letting your health plan go first

New Jersey lets you name your health insurance as the primary payer for crash injuries, with PIP sitting behind it. This "Health Care Primary" option can cut the PIP premium, but it only works if your health plan actually covers auto-accident injuries, and it brings that plan's own copays and network limits along with it. Medicare and Medicaid cannot be used for it.²³ Read your plan before choosing this. Some self-funded ERISA plans decline to pay auto-crash bills, and that gap can leave you paying out of pocket.

Why your medical bills get reduced

Providers treating a PIP patient cannot charge whatever they want. New Jersey caps PIP medical reimbursement with a statutory fee schedule under N.J.S.A. 39:6A-4.6 and N.J.A.C. 11:3-29. The insurer's limit for a given service is the amount set in the schedule or the usual, customary, and reasonable fee, whichever is lower.⁴ That is why an explanation of benefits often shows a provider's charge knocked down to a smaller "allowed" amount. The balance above the schedule generally is not your debt.

Decision point review and the paper trail

For a set of common soft-tissue injuries, which the state groups into "Care Paths," your provider has to run treatment past the insurer before continuing. This is decision point review and precertification under N.J.A.C. 11:3-4, and it runs on a standard state document, the Uniform Attending Provider Treatment Plan Form.⁵ Skip the process and the insurer can cut reimbursement, often by half. If the insurer denies or trims care, your provider can file a pre-service appeal, generally within 30 days of the denial, and the insurer has to respond within about 14 days.⁵ Providers also have to notify the insurer of treatment within 21 days.⁵

Deadlines that actually matter

Two clocks run at once. The insurer must pay a clean PIP claim within 60 days of getting written notice of the loss and its amount, under N.J.S.A. 39:6A-5.⁶ Separately, any lawsuit over the injuries has to be filed within two years of the crash under N.J.S.A. 2A:14-2.⁷ When the fight is about PIP benefits themselves, New Jersey does not send you straight to court. PIP disputes go to a dedicated arbitration forum administered by Forthright under N.J.A.C. 11:3-5.⁸

How PIP connects to your right to sue

Buying PIP and keeping your right to sue are two separate choices, and New Jersey links them on the same form. With a Standard Policy you elect either the Limitation on Lawsuit option or the No Limitation option under N.J.S.A. 39:6A-8.⁹ The limitation option is cheaper, but it blocks a claim for pain and suffering unless your injury fits one of six categories: death, dismemberment, significant disfigurement or scarring, a displaced fracture, loss of a fetus, or a permanent injury proven by objective medical evidence.⁹² The Basic Policy has the lawsuit limitation built in. Either way, your economic losses, like medical bills above your PIP limit and lost wages, are not affected by this choice. The threshold reaches only pain-and-suffering claims.

When PIP runs out

PIP is first-party coverage, so it pays quickly, but it has a ceiling and it never pays for pain and suffering. Once your medical costs pass your PIP limit, or you have a loss the no-fault system does not cover, you look to the at-fault driver's liability insurance. New Jersey's minimum liability limits rose to $35,000 per person, $70,000 per accident, and $25,000 in property damage for policies issued or renewed on or after January 1, 2026.¹⁰ If the other driver was uninsured or carried too little, your own uninsured/underinsured motorist coverage steps in. To press a claim against the other driver, it helps to have an attorney, a copy of your crash report, and, if your car lost resale value, a look at diminished value.

One more New Jersey option is worth knowing. Drivers eligible for federal Medicaid with hospitalization can buy the Special Automobile Insurance Policy (SAIP), a medical-coverage-only policy for about $365 a year that provides emergency PIP treatment instead of a full auto policy.²

This is general information about New Jersey law, not legal advice for your specific situation.

Sources

1. N.J.S.A. 39:6A-4, Personal Injury Protection Coverage (medical, income continuation, essential services, death and funeral benefits). https://law.justia.com/codes/new-jersey/title-39/section-39-6a-4/

2. New Jersey Department of Banking and Insurance, "Everything You Wanted to Know About Auto Insurance" (2026 consumer guide). https://www.nj.gov/dobi/division_consumers/pdf/everythingauto2026.pdf

3. N.J.S.A. 39:6A-4.3, Personal Injury Protection Coverage Options (limits, deductibles, health-primary election). https://law.justia.com/codes/new-jersey/title-39/section-39-6a-4-3/

4. N.J.S.A. 39:6A-4.6 and N.J.A.C. 11:3-29, Automobile Medical Fee Schedules (NJ DOBI rule text). https://www.nj.gov/dobi/pipinfo/feeschedruletext_130104.pdf

5. New Jersey Department of Banking and Insurance, PIP Decision Point Review, Care Paths, and 21-Day Notice (N.J.A.C. 11:3-4). https://www.nj.gov/dobi/pipinfo/aicrapg.htm

6. N.J.S.A. 39:6A-5, Payment of Personal Injury Protection Benefits (60-day payment period). https://law.justia.com/codes/new-jersey/title-39/section-39-6a-5/

7. New Jersey Courts, Statute of Limitations FAQ (N.J.S.A. 2A:14-2). https://www.njcourts.gov/faq/what-statute-of-limitations-claim-my-case

8. New Jersey Department of Banking and Insurance, Personal Injury Protection Dispute Resolution Rule (N.J.A.C. 11:3-5). https://www.nj.gov/dobi/pipinfo/njac11_3_5_effect130104.pdf

9. New Jersey Model Civil Jury Charge 5.33, Limitation on Lawsuit Option (N.J.S.A. 39:6A-8). https://www.njcourts.gov/sites/default/files/charges/5.33.pdf

10. New Jersey Department of Banking and Insurance, Bulletin No. 25-06 (minimum liability limits effective January 1, 2026). https://www.nj.gov/dobi/bulletins/blt25_06.pdf