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Car accidents that lead to personal injury can be difficult and unfortunate, but recovery from them is not. Attorney Rafael Gomez helps you through the entire process of obtaining a truce from motor vehicleaccidents.
We understand that each Car Accident Case is unique and must be treated with extreme precision. For this reason, the accidentlawyer Rafael Gomez is specialized in traffic accidents and personal injury, and assists in the entire legal process.
Motor vehicleaccidents often have a number of overlapping factors that can be difficult to understand. Who was the culprit in the accident? Who must pay for damages? Does my insurance cover my injury? Our expert lawyer helps you understand the far-flung implications and guides you to the best possible outcome.
Motorcycleaccidents are the leading cause of traffic fatalities in the US. Cases range from minor injuries to serious damages, each of which requires a different legal resolution. Attorney Rafael Gomez is an expert in personal injury and years of experience help you get justice.
Claiming the insurance and obtaining the need for reimbursement are the sole responsibility of the claimant. Due to the many complexities of the law, these needs can last indefinitely. Attorney Rafael Gomez personally reviews the entire case to ensure that an adequate and timely appeal is presented to you.
THIS IS A SAMPLE OF HOW SOME ACCIDENT CASES ARE DECIDED BY THE NJ COURTS. OUR FIRM DID NOT PARTICIPATE AS COUNSEL IN THIS CASE. THIS IS MERELY A SAMPLE SUMMARY FOR INFORMATIONAL PURPOSES. PAST RESULTS DO NOT GUARANTEE FUTURE OUTCOME. THE SELECTION OF AN ATTORNEY IS IMPORTANT. GIVE THIS MATTER CAREFUL THOUGHT. SEE OUR ABOUT PAGE FOR LEGAL ADVERTISEMENT DISCLAIMER.
PALISADES INSURANCE COMPANY VS. HORIZON BLUE CROSS BLUE SHIELD OF NEW JERSEY (L-6136-19, MIDDLESEX COUNTY AND STATEWIDE)
Plaintiff Palisades Insurance Company appeals from a February 28, 2020 order granting defendant Horizon Blue Cross Blue Shield of New Jersey's motion for summary judgment and dismissing its complaint with prejudice. Plaintiff is an automobile insurance company that provides mandatory personal injury protection (PIP) benefits for medical expenses arising out of injuries sustained during car accidents. Pursuant to N.J.S.A. 39:6A-4.3(d), plaintiff allows its customers to designate their health insurer as primary for payment of car-accident-injury-related expenses, which election results in a premium reduction. The insureds named in plaintiff's complaint each elected to have defendant act as the primary payor. Despite the designation, plaintiff received and paid the claims, before they were properly submitted to defendant. On appeal, plaintiff asserts that it has a right to be reimbursed for the medical expenses it voluntarily paid under a theory of subrogation.
After reviewing the provisions of the New Jersey Automobile Reparations Reform Act (No-Fault Act), N.J.S.A. 39:6A-1 to -35, the Coordination of Benefits scheme (COB), N.J.A.C. 11:3-37.1 to -37.14, and case law, the court concluded that no cause of action for subrogation exists to allow a PIP carrier to pursue reimbursement from a health insurer for claims mistakenly paid out of turn. Plaintiff's remedies are to deny the claim upon receipt, recover payments from the medical providers, request that the insureds submit their claims to defendant and pursue an appeal if coverage is denied, or obtain an assignment of rights and pursue the appeals on the insureds' behalf. In addition, when a health carrier is exempt from providing benefits, the COB regulations allow the PIP carrier to recoup the amount of the reduced premium from its insured. None of these remedies were pursued by plaintiff in this case.
The court also concluded that further discovery would be futile, as the sought-after information is not capable of overcoming the legal obstacle faced by defendants: the absence of a legal right of subrogation to recoup payments mistakenly made out of turn.
Hiring an accident lawyer can result in greater compensation for your damages. Instead of settling for less than your case is worth or allowing an insurer to unfairly deny your claim, take a stand and protect your rights. Hire caraccidentattorney Rafael Gomez in Hackensack to represent your interests during injury settlement negotiations and/or an injury trial in New Jersey. Trusting professionals with your caraccident case can safeguard your future after a serious injuryaccident.
THIS IS A SAMPLE OF HOW SOME ACCIDENT CASES ARE DECIDED BY THE NJ COURTS. OUR FIRM DID NOT PARTICIPATE AS COUNSEL IN THIS CASE. THIS IS MERELY A SAMPLE SUMMARY FOR INFORMATIONAL PURPOSES. PAST RESULTS DO NOT GUARANTEE FUTURE OUTCOME. THE SELECTION OF AN ATTORNEY IS IMPORTANT. GIVE THIS MATTER CAREFUL THOUGHT. SEE OUR ABOUT PAGE FOR LEGAL ADVERTISEMENT DISCLAIMER.
PATRICIA REIDER v. ALLSTATE NEW JERSEY INSURANCE COMPANY
On appeal from the Superior Court of New Jersey, Law Division, Camden County, Docket No. L-5772-05.
Stephen M. Tatonetti argued the cause for appellants (DuBois, Sheehan, Hamilton, Levin & Weissman, attorneys; Mr. Tatonetti, on the brief).
Francis X. Ryan argued the cause for respondent (Green, Lundgren & Ryan, P.C., attorneys; Mr. Ryan and Alexa J. Nasta, on the brief).
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PER CURIAM
Plaintiffs, Patricia Reider and Douglas Reider, appeal from a jury verdict of no cause for action in a damages-only automobile negligence trial. Because the tortfeasor was uninsured, plaintiffs instituted suit against their automobile insurance carrier, defendant Allstate New Jersey Insurance Company (Allstate). On appeal, plaintiffs raise eight claims of error, seven of which involve the trial judge's decision to admit or bar evidence, and the eighth concerns the denial of plaintiff Douglas Reider's motion for a directed verdict. We affirm.
I.
On October 10, 1999, plaintiffs, who are mother and son, were seated in Patricia's vehicle at an intersection waiting for the traffic light to turn green when a car came up behind them, crashed at a high rate of speed into the right rear portion of plaintiffs' vehicle, took off and crashed into a telephone pole. Patricia testified that she and her son were "too scared and nervous to go to the hospital" at the time, but two days later she and Douglas were evaluated by their family physician. Both complained of pain in their low back. Patricia produced evidence that she sustained lumbar sprain and strain, and a bulging disc at L5-S1. Although an orthopedic surgeon recommended surgery, Patricia was "afraid" and chose not to undergo the recommended surgery. According to Douglas's physician, he sustained a herniated lumbar disc.
On the day before jury selection commenced, Allstate moved in limine to bar plaintiffs from identifying defendant as Allstate Insurance Company, and to instead require them to refer to the actual tortfeasor, Matthew Thomas, as the defendant. In that same motion, Allstate also sought to bar plaintiffs from testifying that Thomas was operating a stolen vehicle and was being chased by police at the time of the collision. In support of its in limine motion, Allstate argued that because liability was stipulated, and Thomas's flight from police had no bearing on whether plaintiffs' injuries were permanent, plaintiffs should be precluded from testifying that Thomas fled the scene or was driving a stolen vehicle.
In opposition, plaintiffs argued that if the motion were to be granted, their credibility while testifying would be adversely affected. Plaintiffs asserted that an order prohibiting them from discussing the hit-and-run nature of the accident would require them "not to tell the entire truth to the jury" and would cause them to "seem more nervous on the stand" in an effort to avoid running afoul of the in limine order. Relying on Taddei v. State Farm Indemnity Co., 401 N.J. Super. 449, 464 (App. Div. 2008); Bardis v. First Trenton Insurance Co., 397 N.J. Super. 138, 152 (App. Div. 2007), certif. granted, 194 N.J. 444 (2008); and Wenz v. Allstate Insurance Co., 316 N.J. Super. 570, 573-74 (App. Div. 1998), Judge Blue rejected plaintiffs' arguments. The judge reasoned that plaintiffs' credibility would not be affected because they would be permitted to explain how fast the other vehicle was traveling at the time of the accident; the force of the impact; the number of police who responded to the scene; and that plaintiffs never spoke with Thomas, the tortfeasor. The judge emphasized that her in limine order was limited to the fact of the police chase and that Thomas fled the scene after the collision with plaintiffs' vehicle.
In opposition, plaintiffs argued that if the motion were to be granted, their credibility while testifying would be adversely affected. Plaintiffs asserted that an order prohibiting them from discussing the hit-and-run nature of the accident would require them "not to tell the entire truth to the jury" and would cause them to "seem more nervous on the stand" in an effort to avoid running afoul of the in limine order. Relying on Taddei v. State Farm Indemnity Co., 401 N.J. Super. 449, 464 (App. Div. 2008); Bardis v. First Trenton Insurance Co., 397 N.J. Super. 138, 152 (App. Div. 2007), certif. granted, 194 N.J. 444 (2008); and Wenz v. Allstate Insurance Co., 316 N.J. Super. 570, 573-74 (App. Div. 1998), Judge Blue rejected plaintiffs' arguments. The judge reasoned that plaintiffs' credibility would not be affected because they would be permitted to explain how fast the other vehicle was traveling at the time of the accident; the force of the impact; the number of police who responded to the scene; and that plaintiffs never spoke with Thomas, the tortfeasor. The judge emphasized that her in limine order was limited to the fact of the police chase and that Thomas fled the scene after the collision with plaintiffs' vehicle.
Here, we are satisfied that Judge Blue's decision to bar plaintiffs from describing the police chase or referring to Thomas's status as a hit-and-run driver was well within her discretion. Her reliance on Taddei, supra, Bardis, supra, and Wenz, supra, was correct. Moreover, any testimony by plaintiffs that Thomas stole the car and was fleeing from police would have been inadmissible hearsay in any event, because plaintiffs' knowledge on those subjects was derived solely from what police told them. As such, the testimony would have been inadmissible regardless of our decisions in Taddei, Bardis and Wenz, all of which held that the action should be maintained in the name of the uninsured tortfeasor, rather than the insurance carrier. The claims plaintiffs advance in Points I and II therefore lack merit. We thus affirm the judge's decision to designate Thomas, rather than Allstate, as defendant during the trial, and to bar reference to the hit-and-run nature of the accident.
II.
In Point IV, plaintiffs argue that even if the trial judge's rulings on those issues had been correct, Allstate "opened the door" to admission of the previously-barred hit-and-run testimony when, during its opening statement, it argued that plaintiffs sought an attorney prior to receiving medical attention. Plaintiffs argued before the trial judge that Allstate's reference to plaintiffs consulting a lawyer before seeking medical treatment "opened the door" to the true reason they sought legal advice before medical care--because they were victims of a hit-and-run crash. Although Judge Blue concluded that Allstate had not opened the door, she nonetheless permitted plaintiffs to testify that they consulted a lawyer because of police involvement at the scene. We find no abuse of discretion in her determination that the in limine order should not be disturbed. Her ruling was a balanced and fair resolution of this issue, and we have been presented with no meritorious basis upon which to disturb it.
III.
In Point III, plaintiffs argue that the judge erred when she permitted Allstate to introduce photographs of the damage to plaintiffs' vehicle without requiring Allstate to also introduce photographs of the vehicle Thomas was driving. Plaintiffs argue that "[t]o allow the photographs to be introduced without proper explanation about the happening of the accident was prejudicial and confused the jury." This argument lacks sufficient merit to warrant discussion in a written opinion. R. 2:11-3(e)(1)(E).
IV.
In Point V, Patricia argues that the judge committed reversible error when she barred Patricia from testifying that she became addicted to pain medication prescribed to her as a result of the accident. Significantly, Patricia was permitted to, and did, testify about the pain medication that her physician prescribed, and why she needed pain medication. The only issue she was not permitted to mention was her alleged addiction. Because plaintiff did not proffer any expert testimony to support her claim of addiction, Judge Blue correctly excluded it. See Kelly v. Berlin, 300 N.J. Super. 256, 267 (App. Div. 1997) (holding that if a subject is not within the common knowledge of a jury, expert opinion is required).
V.
In Point VI, Douglas argues that the judge erred when she denied his motion for a directed verdict. He contends that the herniated disc he suffered as a result of the accident qualifies as a permanent injury, thus entitling him to a directed verdict. In particular, he sought an instruction that if the jury found he sustained a herniated disc as a result of the accident, he had thereby demonstrated a permanent injury as a matter of law. In support of that argument, he relied on Pardo v. Dominguez, 382 N.J. Super. 489, 490-92 (App. Div. 2006), where we held that a herniated disc, demonstrated through an MRI, is sufficient to satisfy the verbal threshold.
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A motion for a directed verdict, filed pursuant to Rule 4:40-1, must be denied whenever a jury could, even if it accepted all of the evidence that supports the position of the moving party, nonetheless render verdict in favor of the party opposing the motion. Edwards v. Walsh, 397 N.J. Super. 567, 571 (App. Div. 2007). Such motion should be denied when questions of credibility must be resolved by a jury. Alves v. Rosenberg, 400 N.J. Super. 553, 566 (App. Div. 2008).
Here, Judge Blue reasoned that the jury was faced with the task of deciding which expert was the more credible: Douglas's expert, Dr. Gleimer, who testified that Douglas's disc herniation was permanent and would adversely affect him indefinitely, or defendant's expert, Dr. Gerson, who opined that the herniation could as easily have been caused by a snowball thrown at Douglas's lower back years earlier as by the accident. Gerson also opined that many people who sustain a herniated disc are nonetheless able to function normally, and suffer no adverse sequelae as a result of the herniation. Under those circumstances, Judge Blue was correct when she found that the evidence was in such conflict that plaintiff's motion for a directed verdict should be denied. See Ibid.
THIS IS A SAMPLE OF HOW SOME ACCIDENT CASES ARE DECIDED BY THE NJ COURTS. OUR FIRM DID NOT PARTICIPATE AS COUNSEL IN THIS CASE. THIS IS MERELY A SAMPLE SUMMARY FOR INFORMATIONAL PURPOSES. PAST RESULTS DO NOT GUARANTEE FUTURE OUTCOME. THE SELECTION OF AN ATTORNEY IS IMPORTANT. GIVE THIS MATTER CAREFUL THOUGHT. SEE OUR ABOUT PAGE FOR LEGAL ADVERTISEMENT DISCLAIMER.
STATE OF NEW JERSEY VS. WILLIAM T. LIEPE (12-12-2766, ATLANTIC COUNTY AND STATEWIDE)(A-4431-14T4)
Defendant was sentenced to consecutive prison terms of twenty, seven, and five years, for first-degree aggravated manslaughter and two counts of second-degree aggravated assault, resulting from his having caused, while intoxicated, an auto accident that killed a nine-year old and seriously injured two others.
In State v. Carey, 168 N.J. 413, 429 (2001), a divided Court determined that in multiple-victim vehicular-homicide matters, sentencingjudges should "ordinarily" impose "at least two consecutive terms." The Court, however, also emphasized that it had not "adopt[ed] a per se rule" and the decision to impose consecutive terms remained in the discretion of sentencingjudges. Id. at 419. In considering Carey's influence here, the court remanded for resentencing because, among other things, the sentencingjudge appeared to have viewed Carey as imposing a presumption in favor of consecutive terms and because the judge did not fairly consider the real-time consequence of the aggregate thirty-two year sentence, all subject to an eighty-five percent period of parole ineligibility, imposed on an offender who was fifty-eight at the time of the incident and sixty-two at the time of sentencing.
Hackensack, Bergen County Accident Attorney Rafael Gomez, has helped recover damages for people who have been injured in traffic accidents or any type of accident that has caused any kind of bodily injury.
THIS IS A SAMPLE OF HOW SOME ACCIDENTCASES ARE DECIDED BY THE NJ COURTS. OUR FIRM DID NOT PARTICIPATE AS COUNSEL IN THIS CASE. THIS IS MERELY A SAMPLE SUMMARY FOR INFORMATIONAL PURPOSES
DIANE S. LAPSLEY VS. TOWNSHIP OF SPARTA, ET AL. (DIVISION OF WORKERS' COMPENSATION)
Petitioner Diane Lapsley appealed from an order of a judge of compensation concluding that injuries she sustained in a February 3, 2014 accident arose out of and in the course of her employment as a Sparta Township librarian pursuant to the Workers' Compensation Act (the Act), N.J.S.A. 34:15-1 to -146. After clocking out and exiting the library premises, petitioner was struck by a snowplow in an adjacent parking lot that happened to be owned by the township. The compensation judge concluded that petitioner'sinjuries were compensable pursuant to the premises rule, N.J.S.A. 34:15-36, which provides that "[e]mployment shall be deemed to commence when an employee arrives at the employer's place of employment to report for work and shall terminate when the employee leaves the employer's place of employment, excluding areas not under the control of the employer . . . ."
The court held that a mechanical application of the premises rule in the context of a public-entity employer deviates from well-settled principles applicable to private employers and invites an overbroad and unwarranted expansion of public-entity liability for workers' compensation claims. The court identified employer-directed control of an employee's use of a parking lot as a critical element in the application of the premises rule. See Novis v. Rosenbluth, 138 N.J. 92, 93 (1994). An injury will be compensable if it is sustained while the employee is using the lot where the manner of ingress or egress is dictated by the employer, or in an area where the employee parks at the employer's direction. Conversely, use of a shared parking lot that accommodates multiple tenants, without specific instruction from an employer, is not sufficient to satisfy to the premises rule.
The stipulated facts of this case established that petitioner's employer exercised no control of its employee's use of the common-use parking lot. Petitioner was off-the-clock at the time of the accident and had exited the library premises. Library employees were not given any instructions about where in the subject lot to park or indeed whether to park in that particular lot, on the street, or anywhere else in town where parking may be available. Nor were library staff instructed on the manner of ingress or egress. The lot was shared with other municipal employees and members of the public alike.
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Under these facts, the court concluded that there was no reasoned basis to depart from the general rule that the library's "use" of the common-use parking lot for its employees' benefit was not sufficient to satisfy the premises rule. Accordingly, the court reversed the compensation judge's order finding the accident was compensable.
THIS IS A SAMPLE OF HOW SOME ACCIDENT CASES ARE DECIDED BY THE NJ COURTS. OUR FIRM DID NOT PARTICIPATE AS COUNSEL IN THIS CASE. THIS IS MERELY A SAMPLE SUMMARY FOR INFORMATIONAL PURPOSES
SHARAD YAGNIK, ET AL. VS. PREMIUM OUTLET PARTNERS, LP, ET AL. (L-2601-18, MERCER COUNTY AND STATEWIDE)
In this construction site accident case, the court addresses an unresolved question of New Jersey law: When is an Affidavit of Merit ("AOM") under N.J.S.A. 2A:53A-27, supporting claims against a licensed professional, due in situations where a plaintiff’s original complaint is later amended and additional answers or other pleadings are filed?
Plaintiffs served AOMs (one from an engineer and another from an architect) more than 120 days after the defendant engineering firm filed its answer to the original complaint, but before that firm answered an amended complaint naming another defendant.
Relying in part on several federal decisions interpreting New Jersey law, the motion judge ruled the deadline for an AOM "does not come into play until the pleadings are [all] settled." Based on that reasoning, the judge deemed timely the two AOMs tendered by plaintiffs more than a year after the engineering firm had filed its original answer and first amended answer.
Declining to adopt the federal approach, this court holds the AOM statute's text and legislative purposes require the affidavit to be served within 60 days (extendable for good cause to 120 days) from the date when the licensed professional files its answer, regardless of whether the pleadings are subsequently amended to name other defendants or assert additional claims. That deadline is subject, however, to the long established AOM exceptions for (1) substantial compliance or (2) extraordinary circumstances.
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The court concludes extraordinary circumstances to justify the delayed AOMs exist here, based on events stemming from the initial negotiated voluntary dismissal of plaintiffs’ claims against the engineering firm and the restoration of those claims the following year after discovery shed more light on the firm’s role in the project.
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THIS IS A SAMPLE OF HOW SOME AUTO ACCIDENTCASES ARE DECIDED BY THE NJ COURTS. OUR FIRM DID NOT PARTICIPATE AS COUNSEL IN THIS CASE. THIS IS MERELY A SAMPLE SUMMARY FOR INFORMATIONAL PURPOSES
CARLTON HOCUTT III VS. MINDA SUPPLY COMPANY (L-6537-17, BERGEN COUNTY AND STATEWIDE)
The New Jersey Workers Compensation Act (WCA), N.J.S.A. 34:15-1 to -146, generally prohibits employees from suing their employers for injuries sustained in workplace accidents. This case probes the boundaries of the ]"intentional wrong" exception to that general rule.
Plaintiff suffered serious injury while riding as a passenger on a forklift in defendant's warehouse. It was a common practice at the warehouse for workers to ride on the forklift while another worker drove the forklift. This practice violates workplace safety regulations promulgated by the U.S. Department of Labor Occupational Safety and Health Administration (OSHA).
The court first addressed plaintiff's contention that the WCA does not bar his lawsuit because he was not employed by defendant but rather by an employee leasing agency. The court applied the five-part test announced in Kelly v. Geriatric & Medical Services, Inc., 287 N.J. Super. 567, 571–72 (App. Div. 1996), and determined that plaintiff was a "special employee" of defendant and thus subject to the exclusive remedy of workers compensation.
The court turned next to plaintiff's contention that he is not barred from suing defendant because the company's practice of allowing, if not encouraging, workers to stand on moving forklifts was an intentional wrong, thereby exempting this case from the exclusive remedy of workers' compensation. Plaintiff argued defendant's misconduct constitutes intentional wrong because it occurred repeatedly. The court rejected the argument that violative conduct is an intentional wrong merely because it is an ongoing practice. The court interpreted Millison v. E.I. du Pont de Nemours & Co., 101 N.J. 161 (1985) as narrowing the circumstances when the intentional wrong exemption applies in recognition that reckless or negligent conduct often reflects a "deliberate" business decision by employers to promote speed and efficiency at the expense of workplace safety. The court concluded the intentional wrong exception would significantly erode the legislative preference for the workers' compensation remedy if all a plaintiff must show is that the negligent or reckless conduct was committed repeatedly.
The court surveyed a series of Supreme Courtcases that applied the Millison analytical framework and concluded that defendant's violative conduct was not sufficiently egregious to rise to the level of an intentional wrong. The court noted the cases following Millison that found intentional wrong involved violative conduct that was not just committed on multiple occasions but was repeated in the face of efforts by government regulators or others to put a stop to the practice. An employer's wrongful conduct is especially egregious when deception is used to conceal the repetition.
In this case, there were no prior forklift-related accidents or injuries, no prior OSHA citations pertaining to forklift operations, and no prior complaints from workers about unsafe forklift practices. Nor did defendant attempt to conceal its violative practice or otherwise deceive safety investigators. The court thus concluded that plaintiff failed to show his injury was substantially certain to occur and that the circumstances of its infliction were more than a fact of life of industrial employment.
The purpose of this subchapter is to establish guidelines for the order of benefit determination between a
plan of health insurance and personal injury protection provided through an automobile policy pursuant to N.J.S.A.
39:6A-4, when a named insured elects to have his or her personal injury protection become secondary coverage for
the provision of benefits for medical expenses incurred due to injuries sustained in an automobileaccident. This
subchapter also sets forth the requirements for the order of benefit determination between a plan of health insurance
and personal injury protection provided pursuant to N.J.S.A. 39:6A-4 or 39:6A-3.1, when personal injury protection
is primary coverage. The provisions of this subchapter shall apply to all automobile policies, as that term is defined
at N.J.S.A. 39:6A-2a, issued to New Jersey residents, or renewed on or after January 1, 1991, and to all health
benefits plans which have been or will be delivered or issued for delivery in this State.
11:3-37.2 Definitions
The following words and terms, when used in this subchapter, shall have the following meanings, unless the context
clearly indicates otherwise.
"Actual benefits" means those benefits determined to be payable for allowable expenses.
"Allowable expense" means a medically necessary, reasonable and customary item of expense covered by an
insured's health benefits plan(s) or PIP plan as an eligible expense, at least in part. When a plan provides benefits in
the form of services, the reasonable monetary value of each such service shall be considered as both an allowable
expense and a paid benefit.
"Benefits" means the provision of the following in consideration of payment of premiums or fees on a prepaid or
postpaid basis:
1. Services, including supplies;
2. Payment of expenses incurred;
3. A combination of 1 and 2 above; or
4. An indemnification.
"Eligible expense" means:
1. In the case of health benefits plans, that portion of the medical expenses incurred for treatment of
an injury which is covered under the terms and conditions of the plan, without application of the deductible(s) and
copayment(s), if any.
2. In the case of PIP plans, that portion of the medical expenses incurred for treatment of an injury
which, without considering any deductible and copayment, shall not exceed:
i. The percent or dollar amounts specified on the medical fee schedules, or the actual billed
expense, whichever is less; or
ii. The reasonable amount, as determined by the automobileinsurer, considering the medical
fee schedules for similar services or equipment in the region where the service or equipment was provided, when an
incurred medical expense is not included on the medical fee schedules.
"Health benefits provider" means any person, whether subject to the regulation of the New Jersey Department of
Banking and Insurance, Department of Health and Senior Services, or both, or not otherwise subject to suchregulation, who contracts to provide health services, provide reimbursement for the cost of health services in whole
or in part, or to provide for indemnity in the event health services are used, in return for a prepaid or postpaid
premium or fee or other consideration, including, but not limited to:
13. An entity organized under the laws of any other state or jurisdiction which delivers certificates to
residents of New Jersey evidencing coverage under a contract issued and delivered in a state or jurisdiction other
than New Jersey.
"Hospital expenses," when used by the automobileinsurance PIP plan, means those expenses defined at N.J.S.A.
39:6A-2f.
"Injury" means bodily injury sustained by an insured as a result of an accident while occupying, entering into,
alighting from or using an automobile, or as a pedestrian, caused by an automobile or by an object propelled by or
from an automobile.
"Insured" means a person eligible for coverage, at least in part, for medical expenses incurred for treatment of
injuries, under an automobile policy PIP medical expense provision, and who meets the definition of a named
insured or family member.
