5 STAR RATING ACCIDENT LAWYER IN HACKENSACK 07601 | 201-646-3333

 DO YOU NEED A LAWYER BECAUSE OF AN ACCIDENT YOU WERE INVOLVED?

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 vehicle accidents.

We understand that each Car Accident Case is unique and must be treated with extreme precision. For this reason, the accident lawyer Rafael Gomez is specialized in traffic accidents and personal injury, and assists in the entire legal process.

Motor vehicle accidents 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.

MOTORCYCLE ACCIDENTS

Motorcycle accidents 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.

Motorcycle Accidents are a slightly nuanced version of Motor Vehicle Accidents. Although the same laws apply to both, motorcycles can be interpreted differently.

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.

ACCIDENT ATTORNEY IN NEW JERSEY 07601 - 201-646-3333

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.

HACKENSACK CAR ACCIDENT LAWYER 201-646-3333

INJURIES FROM CAR ACCIDENT - 5 STAR RATING ACCIDENT LAWYER 

IN HACKENSACK NJ 201-646-3333

Why do I need a car accident attorney

A Hackensack car accident attorney can completely take over your car accident claim. If a serious auto accident has affected you or someone close to you, a Hackensack accident attorney can give you peace of mind during the claim process.

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 car accident attorney Rafael Gomez in Hackensack to represent your interests during injury settlement negotiations and/or an injury trial in New Jersey. Trusting professionals with your car accident case can safeguard your future after a serious injury accident.

 

NEW JERSEY CAR ACCIDENT ATTORNEY - HACKENSACK 201-646-3333

 

Hackensack, a car accident and pedestrian accident attorney, Rafael Gomez, has helped hundreds of people over the years who have been injured and/or harmed as a result of car accidents in New Jersey. If you need help with a case related to this, please call immediately:

201-646-3333

HACKENSACK NJ ACCIDENT LAWYER - 201-646-3333

SUBCHAPTER 37. ORDER OF BENEFIT DETERMINATION  BETWEEN AUTOMOBILE PERSONAL INJURY PROTECTION AND HEALTH INSURANCE 

11:3-37.3 Health benefits providers

(a) Nothing in this subchapter shall be construed as requiring any health benefits provider to offer, provide, or continue coverage to or for any individual or group, except as may be set forth by other laws of this State, or of the Federal government.

(b) Nothing in this subchapter shall be construed as requiring any health benefits provider to provide coverage for any treatment or service not otherwise covered under the terms of the applicable health benefits plan.

I'm Michelle Williams, I just won my accident case with Mr Gomez and I recommend him to you, he'll help you win.

(c) No health benefits contract or policy delivered or issued for delivery in this State, or renewed, continued or converted on or after January 1, 1991, shall contain any provision, rider, waiver of endorsement or other instrument which restricts, limits or excludes coverage, directly or indirectly, of services or expenses otherwise eligible under the policy or contract on the grounds that such expenses or services would be covered under an automobile policy PIP provision for which the insured would be eligible had the named insured on the automobile policy not selected the PIP-as-secondary coverage option.

(d) No health benefits contract or policy delivered or issued for delivery in this State, or renewed, continued or converted on or after January 1, 1991, shall contain any provision, rider, waiver or endorsement, or other instrument which restricts, limits or excludes coverage, directly or indirectly, of services or expenses otherwise eligible under the policy or contract on the grounds that:

1. Such expenses arise from an automobile-related injury;

2. Such expenses are covered or paid by PIP; or 

3. Such expenses are covered or paid by OSAIC except for reductions in benefits when the health benefits contract provides secondary coverage as defined in and permitted by this rule.

(e) A health benefits contract or policy may provide that it is always primary to OSAIC, or may provide that it will determine its benefits as if it were secondary to any OSAIC. If the health benefits contract or policy provides that it will determine its benefits as if it were secondary to OSAIC and the OSAIC either contains a provision that it is always excess or secondary, or refuses to cooperate in determining the amount of benefits payable by the healthbenefits plan as secondary coverage provider, the health benefits plan shall provide primary coverage.

11:3-37.4 Application of the PIP-as-secondary coverage option

(a) When a named insured elects the PIP option, whereby the named insured intends that medical expenses incurred for treatment of an injury are to be covered by a health benefits provider or providers, as evidenced on the Coverage Selection Form, then the medical expense provisions of the PIP coverage shall be considered to be secondary coverage for the purposes of the order of benefit determination, and all health benefits plans of an insured subject to the PIP option elected shall be considered to be primary coverage.

(b) The election by the named insured to make PIP medical expense provisions secondary coverage shall apply to only the named insured and family members of the named insured who reside in the named insured's household and are not named insureds under other automobile policies.

(c) The election by the named insured to make PIP medical expense provisions secondary coverage shall continue in force as to subsequent renewal or replacement policies until the automobile policy insurer or its authorized representative receives a properly executed written request revoking the selection of this option.

(d) In the event that an insured is ineligible for health plan coverage of medical expenses, or is eligible for coverage under a dental expense or dental service plan only when an injury occurs, despite the selection of the PIP-as secondary coverage option by the named insured, benefits shall be provided to the insured through PIP coverage in accordance with N.J.A.C. 11:3-37.8

ACCIDENT ATTORNEY - HACKENSACK NEW JERSEY - (201) 646-3333

SUBCHAPTER 37. ORDER OF BENEFIT DETERMINATION BETWEEN AUTOMOBILE PERSONALINJURY PROTECTION AND HEALTH INSURANCE 

11:3-37.1 Purpose and scope 

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 automobile accident. 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 automobile insurer, 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: 

 1. Insurers, as defined at N.J.S.A. 17B:17-2; 

 2. Hospital service corporations, as defined at N.J.S.A. 17:48-1; 

 3. Medical service corporations, as defined at N.J.S.A. 17:48A-1; 

 4. Health service corporations, as defined at N.J.S.A. 17:48E-1; 

 5. Health maintenance organizations, as defined at N.J.S.A. 26:2J-2; 

 6. Dental service corporations, as defined at N.J.S.A. 17:48C-2; 

 7. Dental plan organizations, as defined at N.J.S.A. 17:48D-2; 

 8. Medicare; 

 9. Medicaid; 

 10. State Employees Health Benefits Plan; 

 11. CHAMPUS; 

 12. Self-insured programs; and 

 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 automobile insurance 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.

HACKENSACK ACCIDENT LAWYER - (201) 646-3333

THIS IS A SAMPLE OF HOW SOME AUTO 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

RONALD RAFANELLO VS. JORGE S. TAYLOR- ESQUIVEL, ET AL. (L-3488-15 AND L-1721-17, UNION COUNTY AND STATEWIDE)

In this multi-vehicle accident case involving a dump truck, the court concludes that New Jersey law requires a commercial motor carrier to provide a minimum insurance coverage amount of $750,000 when engaged in interstate or intrastate commerce, as prescribed by N.J.S.A. 39:5B-32 and N.J.A.C. 13:60-2.1. Here, the individual driving the dump truck was an employee of defendant trucking company and responsible for the accident but was not listed as a covered driver on the policy. However, he was a permissive user and therefore, the commercial insurance policy issued to the trucking company required a minimum coverage amount of $750,000 and the step-down provision in the insured's combined single limit policy is not triggered. The trial court's order granting summary judgment and capping the tortfeasor's exposure at $35,000 is reversed. 

Pedestrian mowed down by hit-and-run driver

 

RAW VIDEO: Pedestrian mowed down by hit-and-run driver in downtown LA | ABC7 - YouTube

Our law firm specializes in car accidents or pedestrian accidents. If you need help with something related to this, please call us:

201-646-3333

THIS IS A SAMPLE OF HOW SOME AUTO 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

BULLETIN NO. 05-25

TO: ALL INSURERS AUTHORIZED TO TRANSACT PRIVATE PASSENGERAUTOMOBILE INSURANCE IN NEW JERSEY, ALL INSURANCE COMPANIES, HEALTH MAINTENANCE ORGANIZATIONS, MEDICAL SERVICE CORPORATIONS, HOSPITAL SERVICE CORPORATIONS, AND HEALTH SERVICE CORPORATIONS AUTHORIZED TO TRANSACT HEALTH INSURANCE IN NEW JERSEY; ALL DENTAL SERVICE CORPORATIONS AND DENTAL PLAN ORGANIZATIONS AUTHORIZED TO TRANSACT BUSINESS IN NEW JERSEY

FROM: DONALD BRYAN, ACTING COMMISSIONER

RE: COORDINATION OF BENEFITS BETWEEN AUTOMOBILE PERSONAL INJURY PROTECTION AND HEALTH INSURANCE

N.J.S.A. 39:6A-4.3.d permits a named insured under a private passenger automobile insurance policy to elect to have his or personal injury protection (PIP) coverage become secondary coverage for the provision of benefits for medical expenses incurred due to injuries sustained in an automobile accident. N.J.A.C. 11:3-37 sets forth the requirements for the order of benefits determination between a plan of health insurance and PIP provided through an automobile policy when a named insured elects to have his or her PIP protection become secondary coverage, as well as when PIP is the primary coverage.

In an effort to facilitate the coordination of benefits between automobile insurers and health plans, the Department is encouraging compliance with the following in all cases where an insured submits a claim for PIP benefits, and the insured has elected to have his or her health plan provide primary coverage for PIP benefits pursuant to N.J.S.A. 39:6A-4.3:

• The claimant's private passenger automobile insurer should notify the insured, and any of the insured's health care providers known to the automobile insurer, that the insured or provider should first submit the claim to the appropriate health plan for coverage;

• The notice should clearly indicate in bold print that the insured has selected his or her health plan as the primary provider of PIP benefits;

• The time periods for the prompt payment of claims by health plans set forth at N.J.A.C. 11:22 should not begin until the health plan has received the claim directly from the insured or the provider.

LAWYER FOR CAR ACCIDENTS IN HACKENSACK - BERGEN COUNTY - NEW JERSEY (201) 646-3333

THIS IS A SAMPLE OF HOW SOME AUTO 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

 N.J.S.A. 39:6A-5

 g. Personal injury protection coverage benefits pursuant to section 4 of P.L.1972, c. 70 (C.39:6A-4) and medical expense benefits pursuant to section 4 of P.L.1998, c.21 (C.39:6A-3.1) shall be overdue if not paid within 60 days after the insurer is furnished written notice of the fact of a covered loss and of the amount of same. If such written notice is not furnished to the insurer as to the entire claim, any partial amount supported by written notice is overdue if not paid within 60 days after such written notice is furnished to the insurer. Any part or all of the remainder of the claim that is subsequently supported by written notice is overdue if not paid within 60 days after such written notice is furnished to the insurer; provided, however, that any payment shall not be deemed overdue where, within 60 days of receipt of notice of the claim, the insurer notifies the claimant or his representative in writing of the denial of the claim or the need for additional time, not to exceed 45 days, to investigate the claim, and states the reasons therefor. The written notice stating the need for additional time to investigate the claim shall set forth the number of the insurance policy against which the claim is made, the claim number, the address of the office handling the claim and a telephone number, which is toll free or can be called collect, or is within the claimant's area code. Written notice to the organization administering dispute resolution pursuant to sections 24 and 25 of P.L.1998, c.21 (C.39:6A-5.1, 39:6A-5.2) shall satisfy the notice request for additional time to investigate a claim pursuant to this subsection. For the purpose of determining interest charges in the event the injured party prevails in a subsequent proceeding where an insurer has elected a 45-day extension pursuant to this subsection, payment shall be considered overdue at the expiration of the 45-day period or, if the injured person was required to provide additional information to the insurer, within 10 business days following receipt by the insurer of all the information requested by it, whichever is later. For the purpose of calculating the extent to which any benefits are overdue, payment shall be treated as being made on the date a draft or other valid instrument which is equivalent to payment was placed in the United States mail in a properly addressed, postpaid envelope, or, if not so posted, on the date of delivery. h. All overdue payments shall bear interest at the percentage of interest prescribed in the Rules Governing the Courts of the State of New Jersey for judgments, awards and orders for the payment of money. i. All automobile insurers and the Unsatisfied Claim and Judgment Fund shall provide any claimant with the option of submitting a dispute under this section to dispute resolution pursuant to sections 24 and 25 of P.L.1998, c.21 (C.39:6A-5.1, 39:6A-5.2).

IF YOU HAVE SUFFERED ANY CAR ACCIDENT AND NEED HELP, CONTACT US (201) 646-3333

CAR ACCIDENT LAWYER IN HACKENSACK - BERGEN COUNTY - NEW JERSEY (201) 646-3333 | (2021)

 

Hi my name is Regis. I worked with my attorney Rafael Gomez, he worked on my case today in court and it went great and I definitely recommend them. Give them five stars.

THIS IS A SAMPLE OF HOW SOME AUTO 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 JONATHAN JEFFREY VS. STATE OF NEW JERSEY, ET AL. (L-1007-18, UNION COUNTY AND STATEWIDE) Plaintiff was severely injured in a one-vehicle motorcycle accident and was diagnosed with quadriplegia. He claims the EMTs who responded to the accident scene caused or exacerbated his injuries by the way they picked him up from the ground and placed him in the ambulance. Plaintiff appeals from the order of Law Division that denied his motion for leave to file a late notice of claim under the Tort Claims Act. N.J.S.A. 59:8-8 requires a claimant to file a notice of claim within ninety days of its accrual. This court holds the Law Division mistakenly exercised its discretion by not giving proper consideration to the traumatic ramifications of the catastrophic, life-altering injuries plaintiff suffered in this accident. Under the standard established by the Supreme Court in S.E.W. Friel Co. v. New Jersey Turnpike Auth., 73 N.J. 107, 122 (1977), these facts are sufficient to constitute "extraordinary circumstances" pursuant to N.J.S.A. 59:8-9.

HACKENSACK CAR ACCIDENT LAWYER - NEW JERSEY (201) 646-3333 | (2021)

 

Hi my name is Jane D'antoni and I used Rafael Gomez as our lawyer, he made it so that there are no court charges pressed, we had a wonderful day in court and I'm ready to go home and I'm happy.

THIS IS A SAMPLE OF HOW SOME AUTO 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

JOSE CARBAJAL VS. NANCY V. PATEL, ET AL. (L-4317-17, MIDDLESEX COUNTY AND STATEWIDE) (A-1999-19) In this third-party automobile negligence action, this court determined that plaintiff was entitled, under the Comparative Negligence Act (CNA), N.J.S.A. 2A:15-5.1 to -5.8, to fully recover his damages from defendant after the jury found her sixty percent responsible for causing the accident, even though defendant was unable to obtain contribution under the Joint Tortfeasors Contribution Law, N.J.S.A. 2A:53A-1 to -5, directly from plaintiff's uninsured motorist (UM) carrier. From a practical standpoint, defendant receives an offset up to plaintiff's uninsured motorist policy limit, thereby foreclosing the possibility of plaintiff receiving double recovery. But her inability to recover directly from the UM carrier for any amount defendant paid above her pro rata share does not present an obstacle to plaintiff's full recovery under the CNA.