Personal Injury Protection, or PIP, is the engine of New Jersey’s no-fault system. It is the coverage on your own auto policy that pays your medical bills after a crash, regardless of who caused it. It is also the coverage most drivers know the least about until the first denial letter arrives.
At Ibrahim Personal Injury Law in East Brunswick, PIP disputes are part of nearly every car accident case we handle. This guide explains what PIP covers, where the limits are, and how to keep your carrier paying for the treatment you need.
What PIP is and where it comes from
PIP is mandated by N.J.S.A. 39:6A-4, part of New Jersey’s No-Fault Act. Every Standard and Basic auto policy in the state must include it. If you are unclear on how no-fault works overall, start with our guide to whether New Jersey is a no-fault state and what that means after a crash.
PIP covers you, resident relatives in your household, and passengers in your car. It also covers you as a pedestrian or cyclist struck by a vehicle. If you have no auto policy of your own, PIP comes from the vehicle that hit you, and if that vehicle was uninsured, from the state’s Unsatisfied Claim and Judgment Fund.
What PIP covers
Medical expense benefits
This is the core benefit: reasonable and necessary medical expenses arising from the crash, including emergency care, hospitalization, surgery, physical therapy, chiropractic, diagnostic imaging, prescription medication, and dental. Providers are paid according to the state’s medical fee schedule under N.J.A.C. 11:3-29, and they cannot balance-bill you for the difference.
Income continuation
Available on Standard policies only, as an optional add-on. It replaces a portion of lost wages when your injuries keep you from working. The base option is $100 per week for up to 52 weeks; higher limits can be purchased.
Essential services
Also Standard-only and optional. It pays for help with household tasks you can no longer perform, such as cleaning, cooking, or childcare, at $12 per day for up to 365 days.
Death and funeral benefits
Optional Standard-policy benefits that pay a lump sum to survivors and cover funeral costs up to $1,000.
PIP limits: Standard vs. Basic
The limits depend on which policy you carry. Our guide to the Basic vs. Standard policy in New Jersey covers the full comparison, but the PIP piece is this:
- Standard policy: medical expense coverage from $15,000 to $250,000 per person per accident. $250,000 is the default if no lower amount is selected.
- Basic policy: medical expense coverage capped at $15,000 per person per accident. No income continuation, essential services, or death benefit.
- Catastrophic injury override: both policy types extend to $250,000 for permanent or significant brain injury, spinal cord injury, or disfigurement, even when a lower limit was chosen.
Deductibles and co-pays
Under N.J.S.A. 39:6A-4.3, the default PIP deductible is $250, and you pay 20% of the next $4,750 in medical bills. Higher deductibles (up to $2,500) can be selected for a lower premium. Those amounts come out of your pocket, and under Roig v. Kelsey they generally cannot be recovered from the at-fault driver.
PIP vs. your health insurance
By default, PIP is primary: your auto carrier pays before your health insurer. You can elect the health-insurance-primary option under N.J.S.A. 39:6A-4.3 to reverse that order and reduce your premium, but only if your health plan actually covers auto injuries (Medicare and Medicaid do not qualify). Choosing health-primary when you are not eligible leaves you without coverage. Our post on who pays your medical bills after a NJ car accident walks through the interaction between PIP, health plans, and liens.
How to actually get PIP bills paid
- Report the crash to your own carrier immediately. PIP has notice requirements. Get a claim number before your first non-emergency appointment.
- Give every provider the PIP claim number, not your health insurance card. Bills sent to the wrong payer get bounced, delayed, or denied.
- Follow the decision point review and precertification rules. Every carrier has an approved plan that requires providers to request authorization for certain treatments (MRIs, injections, surgery, extended PT). Treatment outside the plan gets a penalty co-payment or is denied.
- Do not skip appointments. Gaps in treatment are used both to deny PIP and to attack your injury claim later under the verbal threshold.
- Appeal denials in writing, on time. Carriers must use an internal appeal process before a dispute goes to arbitration.
When PIP denies treatment
PIP denials are common: the carrier’s reviewing physician calls the treatment not medically necessary, or says the injury is degenerative rather than caused by the crash, or terminates benefits after an independent medical exam. Under N.J.S.A. 39:6A-5.1, these disputes go to mandatory PIP arbitration through the state-designated forum rather than to court. The process has strict deadlines and evidentiary requirements, and a denied provider is often the party who files.
If your carrier cuts off treatment, do not stop treating and do not pay out of pocket without talking to a lawyer first. Both decisions can be reversed, but the record you build in the meantime cannot.
How Ibrahim Personal Injury Law helps with PIP
We set up PIP claims correctly from day one, coordinate with your providers on precertification, handle appeals and arbitration when treatment is denied, and make sure the medical record built under PIP also supports your injury claim against the at-fault driver. If your PIP limits are exhausted, we pursue the remaining bills through the liability claim or your UM/UIM coverage.
Consultations are free and we work on contingency. Call (844) 315-4878 or contact us online.
Frequently asked questions
Does PIP cover me if I was at fault?
Yes. PIP pays regardless of fault. That is the entire point of no-fault coverage.
Does PIP cover passengers in my car?
Passengers are covered by their own PIP first if they have a policy; otherwise, by the PIP on the vehicle they were riding in.
What happens when my PIP limit runs out?
Remaining bills shift to your health insurance and, ultimately, to your claim against the at-fault driver. This is why a $15,000 limit is dangerous after a serious injury.
Can I sue the other driver for my PIP deductible?
Generally no. Medical expenses within your PIP coverage, including the deductible and co-pay, are not recoverable from the at-fault driver under Roig v. Kelsey.
