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Category Archives: insurance law


Insurance Policy Can Affect Your Personal Injury Claim

Your Auto Insurance Policy Can Affect Your Personal Injury Claim

Let’s look at how your auto insurance policy can affect your personal injury claim. If you have been injured in a car accident, your ability to recover monetary compensation for the injuries caused by this accident can depend on your automobile insurance policy.

If you live in New Jersey or are a non-resident injured in a car accident that occurred in New Jersey, you are subject to one of two thresholds: (1) “Zero/No Threshold,” or (2) “Limited Right to Sue/Verbal Threshold/Lawsuit Threshold.”

The first policy, the “Zero/No Threshold” policy, allows any person who is injured in a car accident to make a personal injury claim, no matter the extent of the injury. As the policy title implies, there is no threshold, meaning there is no minimum injury requirement in order to receive compensation for your injury. The only dispute will concern the value of your injury. Thus, the dispute with the insurance carrier will concern how much your injury is worth. In these cases, the defending insurance company will take the position, regardless of how injured you may be, that the injury has “little or no value.” Thereafter, the insurance company will make a monetary offer of settlement reflecting their devalued settlement price in hopes that you accept their offer. The attorneys at Puff & Cockerill will defend your injury and fight against the insurance company’s tactics to reach a fair and equitable settlement on your behalf.

The second policy, the “Limited Right to Sue/Verbal Threshold/Lawsuit Threshold” policy, acts as a potential bar to certain types of injuries. In other words, this threshold policy can prevent you (the injured party) from bringing a lawsuit in a personal injury claim, unless the car accident results in the following injuries:

  • Death;
  • Dismemberment;
  • Significant disfigurement or significant scarring;
  • Displaced fractures;
  • Loss of a fetus; or
  • Permanent injury within a reasonable degree of medical probability, other than scarring or disfigurement.

As a result, the defending insurance company will use the “thresholds” as a defense to your personal injury claim. The insurance company may take a “no-pay” position on the claims it believes do not surpass the above mentioned thresholds, which to no surprise is a vast majority of the claims for injuries. Consequently, the insurance company will not offer any compensation for those personal injury claims. Even when your injuries surpass the threshold, the insurance company will still argue that your injuries have little or no value and it will make a small monetary settlement offer reflecting its position in hope that you accept the offer.

During the past thirty plus years of handling automobile accidents, our attorney’s have observed that most residents in New Jersey are subject to the “Limited Right to Sue/Verbal Threshold/Lawsuit Threshold” policy, largely because the policy is cheaper. Unfortunately, this cheaper threshold policy may (and often does) affect your ability to recover for your injuries. Additionally, this policy may affect your ability to find an attorney willing to take your case.

South Jersey personal injury claim representation

Puff & Cockerill LLC is devoted to aggressively representing people in a personal injury claim, no matter what automobile insurance policy section you selected. We represent people who have been injured in car accidents, regardless of the choice of policy, so long as your case warrants moving forward.
If you have been injured in a car accident or would like to speak with an attorney regarding your car accident, please contact the experienced attorneys at Puff & Cockerill LLC. The attorneys at Puff & Cockerill LLC have handled hundreds of car accident cases and have obtained favorable results on behalf of our clients for their injuries through aggressive representation of our clients no matter what the policy selection is.

Injured on the Job in New Jersey

Injured on the Job in New Jersey?

If you are an employee and injured on the job in New Jersey, you have rights under the laws of the State of New Jersey. Your rights include compensation from your employer for past and future medical expenses, lost wages and pain and suffering. In order to promptly and properly receive compensation for your injury from your employer, there are several important initial steps that every injured employee should understand.

The important laws for work related injuries are found in the New Jersey Workers’ Compensation Act, N.J.S.A. 34:15-1 et seq. This Act provides the exclusive remedy available to an employee injured on the job. The Act is also, by operation of law, written into every employment contract in New Jersey.

As a starting point, the following is a quick summary of basic rights and information that you should be immediately aware of following any work related injury.

Injured on the Job in New Jersey? You are Entitled to Compensation from Employer
When personal injury is caused to an employee by accident arising out of and in the course of the employee’s employment, the employee is entitled to receive compensation from his employer. N.J.S.A. 34:15-1. In New Jersey, an injured employee may be compensated for that injury regardless of his or her fault. Intentional injuries by the employee, however, fall outside the scope of the Workers’ Compensation Act.
Your employer (not you) is required to provide the injured employee such medical, surgical and other treatment and hospital service as is necessary to cure and relieve the worker of the effects of the work related injury. N.J.S.A. 34:15-15.

Injured on the Job in New Jersey? You may be entitled to Temporary Disability Benefits
When an injured employee is unable to work for more than 7 days, he or she is eligible to receive temporary disability benefits. N.J.S.A. 34:15-14. Temporary disability benefits, in layman’s terms, are monetary payments made to the injured employee while that employee is unable to work due to the work related injury.
After all of the medical treatment has been provided to the injured employee and the injured employee has been discharged from medical care, the injured employee may be entitled to a monetary award for the injury that he or she sustained.

Injured on the Job in New Jersey? You may be entitled to Permanent Disability Benefits
When the workplace injury results in a permanent disability to the injured employee, benefits are payable to the employee based on a percentage of the employee’s permanent disability. The percentage of disability can range from 1% to 100%.

Injured on the Job in New Jersey? Your Homeowners’ Insurance Policy and Workers’ Compensation Claims
Unknown to most of the public is the fact that your homeowners’ insurance policy may under certain circumstances provide coverage should someone working at your home have such a workplace injury. For further information, please contact the attorneys at Puff & Cockerill.

Injured on the Job in New Jersey? You Deserve Legal Advice to Pursue Your Recovery
If you are injured on the job in New Jersey, you deserve to know your rights and receive proper medical attention. There are many different sections of the New Jersey Workers’ Compensation Statute. Some sections may apply to your case, while others may not.

If you have any questions or would like to speak to an attorney regarding an injury sustained on the job, please contact the experienced workers’ compensation attorneys at Puff & Cockerill LLC. The attorneys at Puff & Cockerill LLC have handled hundreds of workers’ compensation cases and obtained compensation for past and future medical expenses, lost wages, and compensation for pain and suffering, in addition to receiving favorable settlements on behalf of our clients.

medical expense benefits

NJ Drivers Should Know Their Medical Expense Benefits

New Jersey drivers should know what their medical expense benefits are before they are involved in an automobile accident, because by then it is too late. Our firm and this author have represented hundreds of clients who were injured in car accidents. Unfortunately for the majority of our clients, the only time they viewed their automobile insurance policy was after the accident, while in this office. When reviewing the insurance policy together, most clients are surprised to discover what their policies will and will not cover.

This article is dedicated to informing New Jersey drivers that being proactive with their automobile insurance policy will help drivers plan and prepare for the unexpected. In staying proactive, consumers must understand their “Medical Expense Benefits Limits,” which fall under Personal Injury Protection Benefits (“PIP benefits”).

Medical Expense Benefits Limits, in everyday terms, refers to the payment of medical bills, including surgical, rehabilitative and diagnostic services and hospital expenses, for the medical treatment of injuries sustained in an automobile accident. For the statutorily defined definition of “medical expenses” see N.J.S.A. 39:6A-2(e).

A client needs to be aware of his/her medical expense benefits limits because as a consumer you want to ensure that you have adequate coverage to pay the medical bills no matter how severe the injuries are.

The following is a brief synopsis of medical expense benefits limits found in typical automobile insurance policy:

Under a Standard policy of insurance, medical expenses up to a $250,000.00 limit will be paid by your automobile insurance carrier for medical treatment (reasonable, necessary and appropriate medical treatment) that is rendered in connection with injuries sustained in a car accident. N.J.S.A. 39:6A-4(a). Limits under N.J.S.A. 39:6A-4(a) can also be lowered to $15,000, $50,000, $75,000 or $150,000. By reducing you limits, you save money, but you expose yourself to payment for medical expenses should those medical expenses exceed your chosen policy limits. If you exceed those policy limits and have health insurance, the medical bills, over and above those limits, can be submitted to health insurance.

Under a Basic policy of insurance medical expense benefits are limited to $15,000.00 per person, per accident. An exception exists for additional medical expense benefits up to $250,000.00 for (1) all medically necessary treatment of permanent or significant brain injury, spinal cord injury or disfigurement or (2) for medically necessary treatment of other permanent or significant injuries rendered at a trauma center or acute care hospital immediately following the accident. N.J.S.A. 39:6A-3.1. Choosing a basic policy may save you some money on your premiums, but it can expose you to payment for medical expenses above the $15,000.00 limit, unless the injury was a category 1 or 2 injury. Additionally, if you have health insurance, the medical bills not covered under a basic policy of insurance can be submitted to health insurance for payment.

Under a Special policy of insurance medical expense benefits are limited to an amount not to exceed $250,000.00 for “emergency care.” Emergency care refers to all medically necessary treatment of a traumatic injury or a medical condition. Such emergency care shall include all medically necessary care immediately following an automobile accident. Emergency care extends during the period of initial hospitalization until the patient is discharged for acute care by the attending physician. Emergency care shall be presumed when medical care is initiated at a hospital within 120 hours of the accident. Emergency PIP coverage shall also include all medically necessary treatment of permanent or significant brain injury, spinal cord injury or disfigurement after the patient is discharged from acute care. N.J.S.A. 39:6(A)-3.3. This is the cheapest possible insurance coverage available. Emergency care is covered; non-emergency care is not. Choosing a special policy may save you more money on your premiums, but it can expose you to payment of all non-emergency medical expenses, if you have no health insurance.

An insured may also select their own health insurance coverage as primary coverage for medical expense benefits. In that case, the automobile insurance carrier providing medical expense benefits under PIP coverage would make payments on reasonable medical expenses not covered by health insurance or benefits up to the limit of the medical expense benefit coverage.

In this author’s opinion, I normally recommend that clients carry the standard policy of insurance with medical expenses up to the $250,000.00 limit pursuant to N.J.S.A. 39:6A-4(a), because it ensures a significant amount of coverage in the event of an injury. There are no guarantees that a person will not be in a car accident, but if you are, you want to make sure that there is enough coverage to pay the bills no matter how severe the injuries sustained. If you are wealthy, you may choose a higher limit.

All New Jersey drivers are encouraged to review their automobile insurance policies with their attorney to ensure their medical expense benefits limits are adequate and acceptable to their financial and personal wishes.

This advice is general in nature and everyone has their own special circumstances in life. So be prudent, careful and responsible to protect yourself. If you have a question, please contact your attorney.