N.J. Admin. Code § 11:3-14.3

Current through Register Vol. 56, No. 11, June 3, 2024

Section 11:3-14.3 - Optional medical expense benefits for standard policies

(a) With respect to personal injury protection under standard automobile insurance policies, issued pursuant to 39:6A-4, each insurer shall make available as an option, at appropriately reduced premiums, medical expense benefits in amounts of $ 150,000, $ 75,000, $ 50,000, and $ 15,000. If none of these options is affirmatively chosen in writing, the policy shall provide medical expense benefits in an amount not to exceed $ 250,000 per person per accident.

(b) Notwithstanding (a) above, if an optional medical expense benefit option is chosen, the policy shall provide that medical expense benefits shall be paid in an amount not to exceed $ 250,000, inclusive of any limit of medical expense benefits pursuant to (a) above, for all medically necessary treatment of permanent or significant brain injury, spinal cord injury or disfigurement or for medically necessary treatment of other permanent or significant injuries rendered at a trauma center or acute care hospital immediately following the accident and until the patient is stable, no longer requires critical care and can be safely discharged or transferred to another facility in the judgment of the attending physician.

(c) "Significant disfigurement" as used in (b) above means the result and/or manifestation of a serious traumatic injury that is observable as a permanent and substantial defect in the appearance and functional ability of the person injured. "Significant disfigurement" is a serious outward change that substantially detracts from the appearance and functional ability of the person injured.

N.J. Admin. Code § 11:3-14.3

As amended, R.1984 d.480, eff. 11/5/1984.
See: 16 New Jersey Register 1692(a), 16 New Jersey Register 3037(b).
Substantially amended (a)-(d).
Amended by R.1989 d.117, effective 2/21/1989.
See: 20 New Jersey Register 2984(a), 21 New Jersey Register 558(b).
Deleted (d); recodified (e)-(h) as (d)-(g) and substantially amended (d) and (f).
Amended by R.1996 d.58, effective 2/5/1996.
See: 27 New Jersey Register 3682(a), 28 New Jersey Register 855(a).
Repeal and New Rule, R.1998 d.591, effective 12/21/1998 (operative March 22, 1999).
See: 30 New Jersey Register 3202(a), 30 New Jersey Register 4390(b).
Section was "Optional medical expense benefit deductibles for personal injury protection coverage".
Amended by R.2000 d.454, effective 11/6/2000.
See: 31 New Jersey Register 4210(a), 32 New Jersey Register 4005(c).
Added (c).