N.J. Admin. Code § 11:3-7.2
Current through Register Vol. 56, No. 11, June 3, 2024
Section 11:3-7.2 - General requirements applicable to additional personal injury protection benefits(a) In addition to the personal injury protection benefits that insurers must provide pursuant to 39:6A-4 or 39:6A-3.1, insurers shall make available to the named insured, and, at his or her option, to any resident relatives in the name insured's household who are not named insureds on another standard or basic policy, additional income continuation benefits, essential services benefits, death benefits and funeral expense benefits pursuant to 39:6A-10 and this subchapter.(b) The additional benefit indicated in each option that an insurer may offer for income continuation benefits and essential services benefits represents the aggregate of the basic and additional personal injury protection benefits.(c) Any additional income continuation benefits that an insurer may offer shall be limited to 75 percent of the insured's weekly income.(d) The limits which are applicable to any additional personal injury protection benefits that an insurer may offer shall apply on a per person, per accident basis.(e) Each insurer shall make available as an option additional income continuation benefits for as long as the disability persists. 1. Each insurer shall furnish rates for such benefits upon the request of the insured.(f) Any additional death benefits which an insurer may offer shall be payable without regard to the period of time elapsing between the date of the accident and the date of death provided death occurs within two years of the accident and results from bodily injury from that accident. 1. The requirements of (f) above shall apply to any claim for additional death benefits where death occurs on or after April 21, 1986. i. With respect to any claim presented on or after the effective date of this subchapter, each insurer shall disclose the availability of additional death benefits in conformance with the applicable provisions of 11:2-17.1 et seq.ii. With respect to any claim initiated prior to the effective date of this subchapter, each insurer shall take appropriate steps to determine whether additional death benefits are payable, pursuant to (f) above. These steps shall include, but need not be limited to, review of claims closed on or after April 21, 1986 for the purpose of ascertaining the applicability of additional death benefits. Upon determining that such benefits are payable, each insurer shall provide written notice to eligible beneficiaries and process the claim in accord with 39:6A-5 and the applicable provisions of 11:2-17.1 et seq.(g) In addition to the minimum schedule of additional personal injury protection benefits set forth at 11:3-7.4(b), any insurer may provide other additional personal injury protection benefit options subject to review and approval of its filing by the Department of Banking and Insurance. Any additional options offered by the insurer must be in compliance with the standards and requirements set forth in this subchapter.(h) Insurers may also make available to named insureds covered under 39:6A-4, and at their option, to resident relatives in the household of the named insured or to other persons provided medical expense coverage pursuant to this statutory provision, or both, additional first party medical expense benefit coverage pursuant to 39:6A-10.N.J. Admin. Code § 11:3-7.2
Amended by R.1990 d.580, effective 11/19/1990 (operative January 1, 1991).
See: 22 New Jersey Register 1681(a), 22 New Jersey Register 3488(b).
New (h) added enabling insurers to make available additional first party medical expense benefit coverage in excess of $ 250,000 as per P.L. 1990 c.8.
Amended by 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).
In (a), deleted "basic" preceding "personal" and inserted "who are not named insureds on another standard or basic policy" following "household".
Amended by R.2001 d.44, effective 2/5/2001.
See: 32 New Jersey Register 3891(a), 33 New Jersey Register 573(a).
In (a), inserted an N.J.S.A. reference.