Righting the Ship with PIP

David Haislip • January 1, 2021

Understanding Personal Injury Protection

Now that it’s the start of a New Year it might be a good time to take stock of things on the auto insurance front to see how well covered we are moving into 2021. Particularly, if you have been involved in a motor vehicle accident in the State of New Jersey, it is very important that you understand what benefits your auto insurance policy can afford you insofar as your medical treatment is concerned. New Jersey is a “no-fault” state. That means that when you are injured in an accident, you are responsible for the costs of your own medical treatment. Often, many people injured in a motor vehicle accident do not understand this – “Why should I pay? He hit me!” is a common plea heard by many a personal injury attorney in no-fault states.

What is PIP?

Fortunately, however, your auto carrier provides a policy selection to help alleviate the personal financial burden of seeking treatment for your injuries – Personal Injury Protection (“PIP”). In New Jersey, insured drivers who have PIP coverage on their auto policy can utilize PIP coverage to pay for their medical treatment in very much the same way they would otherwise use their health insurance. PIP coverage limits in NJ ranges from between the minimum of $15,000 to the limit of $250,000, depending on your selection.

When seeking treatment for the injuries you have sustained in a motor vehicle accident, it is critical to ensure that you provide all of your treating providers – be they doctors, physical therapy, or radiology offices, for example – with your auto insurance information, in addition to your health insurance information. Every provider should be given the Insurance Company Name, Policy Number, Claim Number, and the name and contact information of the adjuster assigned to your claim. This is because, it is advisable in many cases that your treatment be billed through PIP first, and your health insurance secondarily. I will explain why momentarily.

When your provider bills through PIP, you will only be responsible for the deductible amount you selected, ranging from $250.00 to $2,500.00 and a co-pay amount of 20% of the first $5,000.00 in treatment. After the first $5,000.00 in medical bills, PIP picks up 100% of the medical bills, until exhaustion or cut off.

Why Treat through PIP First? The answer? – ERISA

The reason why, in many cases, you want the maximum extent of your medical treatment billed through PIP first is because some health insurance plans, particularly those provided by your employer, may be what is referred to as a “self-funded ERISA” plan. “ERISA” comes from the Employee Retirement Income Security Act of 1974, a federal law that governs retirement, health, life, and disability benefits for Americans. ERISA sets minimum standards for most voluntarily established pension and health plans in private industry to provide protection for employees in these plans. Among other things, ERISA requires plans to provide participants with important information about plan features and funding; provide fiduciary responsibilities for those who manage and control plan assets; require plans to establish a grievance and appeals process for participants to get benefits from their plans; and give participants the right to sue for benefits and breaches of fiduciary duty.

As ERISA relates to personal injury suits, providers of ERISA health insurance plans which are self-funded have a right to seek reimbursement (in a process called subrogation) for the treatment they paid for, out of the proceeds of a personal injury suit. In other words, if your health insurance plan is a self-funded ERISA plan, you treated through your health insurance, and you receive a financial recovery as a result of your personal injury claim, your health insurance can assert a lien against your recovery to be paid back for the monies they spent to cover the cost of your treatment.

Unfortunately, if you have sustained grave injuries requiring extensive medical treatment, and you have treated primarily through a self-funded ERISA plan (in other words, being “health primary”), you could see the bulk of your recovery go to your health insurance company to compensate them, instead of into your own pocket! Obviously, we don’t want that.

That is why, in most cases, it is best to have your treating providers bill through PIP first in order to minimize any residual cost which may be passed on to your health insurance provider to cover. Of course, which plan provides a cheaper co-pay and deductible is always a factor in making this determination, but provided you can swing these initial out-of-pocket costs, what you stand to save on the tail-end by treating through PIP as opposed to a self-funded ERISA heath plan can potentially lead to a significantly larger recovery at the end of your personal injury suit, not owing your health insurer reimbursement.

To determine whether your health insurance is a self-funded ERISA plan, your attorney will contact the insurer to ascertain this. In the meantime though, if you did not provide any of your treating medical providers with both your auto insurance’s PIP information and your health insurance information, you should reach out to their billing offices and apprise them of this information so as to avoid being billed unnecessarily. This most frequently happens for a hospital ER bill, as most people have not yet set up a PIP claim with their auto carrier and, therefore, can’t yet provide that information to the hospital.

What if I run out of PIP coverage?

As indicated earlier, PIP coverage begins at a minimum of $15,000 and caps at a limit of $250,000 in treatment. Obviously, the higher the amount of PIP coverage you select, the higher you can expect your monthly auto insurance premium to be. Unsurprisingly then, there are many people who choose the $15,000 minimum PIP coverage, thinking they will not be involved in an accident any time soon, and wanting to save money on their car insurance each month. Naturally, if you have minimal PIP coverage and you are still treating, you may wonder what happens if you exhaust it.

First and foremost, do not stop pursuing your medical treatment just because you have exhausted PIP. If you stop, your injuries could get worse and you may not recover as well as you would have if you had kept going to the doctor. If you do exhaust your PIP coverage though, logically, one of the first things you can do is contact your health insurance provider and find out if they will cover your medical treatment. While some of your treatment may be covered, you may still be responsible for copays, deductibles, and other out-of-pocket expenses. If so, make sure to keep track of these costs, as you may be able to include them in your personal injury claim filed against the other driver’s insurance. Bear in mind, however, as you would now be treating through your health insurance, the ERISA complications mentioned earlier could come into play.

Alternatively, if you have exhausted PIP and cannot utilize your health insurance for further treatment (perhaps because you have no health insurance, for example), another option is to discuss with your treating providers whether they would be willing to accept a Letter of Protection (“LOP”). A Letter of Protection is essentially a promissory letter sent by your personal injury attorney to your treating provider which, if accepted by the provider, allows the injured person to continue treating in exchange for an agreement to pay the bill out of proceeds of the personal injury claim. In other words, you have assigned a portion of your recovery to your doctor as payment. Unfortunately, if there is no recovery at the conclusion of the claim, the medical provider would still have the right to pursue collection efforts against the injured person, so LOPs should be entered into with care. Even so, they can be useful if an unpaid provider intends to send your unpaid bill into collections – a LOP may stop them from doing so.

Been involved in an accident?

To sum up, it is always important to have a firm understanding of the coverage to which you are entitled under your auto insurance policy, and if you have been involved in a motor vehicle accident and sustained injuries, understanding your personal injury protection benefits is particularly critical.

If you have been involved in a motor vehicle accident and have questions regarding your insurance coverage, contact the Lento Law Group today. We are committed to helping those who have sustained injuries through the carelessness of others. We will be happy to answer your questions and help you get the financial recovery you deserve!

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The Education Department is opening fewer sexual violence investigations as Trump dismantles it

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WASHINGTON (AP) — Before President Donald Trump’s administration started dismantling the Education Department, the agency served as a powerful enforcer in cases of sexual violence at schools and universities. It brought the weight of the government against schools that mishandled sexual assault complaints involving students. That work is quickly fading away. The department’s Office for Civil Rights was gutted in Trump’s mass layoffs last year, leaving half as many lawyers to investigate complaints of discrimination based on race, sex or disability in schools. Those who remain face a backlog of more than 25,000 cases. Investigations have dwindled. Before the layoffs last March, the office opened dozens of sexual violence investigations a year. Since then, it’s opened fewer than 10 nationwide, according to internal data obtained by The Associated Press. Yet Trump’s Republican administration has doubled down on sexual discrimination cases of another kind. Trump officials have used Title IX, a 1972 gender equality law, against schools that make accommodations for transgender students and athletes. The Office for Civil Rights has opened nearly 50 such investigations since Trump took office a year ago. Even before the layoffs, critics said the office was understaffed and moved too slowly. Now, many firms that handle Title IX cases have stopped filing complaints, calling it a dead end. “It almost feels like you’re up against the void,” said Katie McKay, a lawyer at the New York firm C.A. Goldberg. “It feels like a big question mark right now,” she said. “How are we supposed to hold a school accountable once it has messed up?” An Education Department spokesperson said the office is working through its caseload, blaming President Joe Biden’s Democratic administration for leaving a backlog and rewriting Title IX rules to protect LGBTQ+ students. 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In 2018, during Trump’s first term, there were 58. Since Trump took office again last year, there have been none. The dismantling of the Office for Civil Rights comes as a blow to Laura Dunn, a civil rights lawyer who was influential in getting President Barack Obama’s Democratic administration to make campus sexual assault a priority. As the issue gained public attention, the office started fielding hundreds of complaints a year. “All the progress survivors have made by sharing their story is being lost,” said Dunn, who’s now a Democratic candidate for Congress in New York. “We are literally losing civil rights progress in the United States, and it’s pushing us back more than 50 years.” ___ The Associated Press’ education coverage receives financial support from multiple private foundations. The AP is solely responsible for all content. Find the AP’s standards for working with philanthropies, a list of supporters and funded coverage areas at AP.org.

What the Next Artificial Intelligence Phase Means for School Discipline

By By: Joseph D. Lento September 8, 2025 • September 12, 2025

Artificial intelligence continues to make big changes on school campuses at all levels nationwide. Students have already learned how helpful AI tools can be for studies. Yet students have also experienced a frightening wave of school academic misconduct charges alleging misuse of those AI tools. LLG National Law Group’s premier attorneys have rallied to the defense of students accused of AI misuse, defending and defeating school misconduct charges for students at all levels nationwide. But the latest wave of AI chatbot tools threatens to once again transform the school misconduct landscape. Call 833.536.8652 now to retain the LLG National Law Group’s highly qualified attorneys if you face artificial intelligence issues with your school. Student Use of AI Tools in School To this point, students have used ChatGPT and other general artificial intelligence tools, and similar tools designed more specifically for education, to aid their studies. Students have used general AI tools to propose paper topics, suggest paper organization, flag spelling and grammar errors, and suggest improvements in writing. Students have also used general AI tools to correct problem answers, explain subjects more thoroughly, and for similar traditional study purposes. These uses of AI have made studies more efficient and productive, speeding learning. Chat Bots as the Next Phase of School AI Tools Artificial intelligence chatbots, though, are further accelerating the pace of technological change in schools. Students are now able to use platforms like Schoolhub.ai to create their own individual AI-powered chatbot as a personal study assistant, tailored to their specific needs and school program. Getting ready for school once meant buying notebooks and pencils. It later meant buying a laptop computer or tablet. Today, preparing for school may mean creating and training your own chatbot as a personal study assistant. The Discipline Risk of Chat Bots Teachers, professors, departments, and schools have all been slow in developing and publishing policies on student use of AI tools. That delay led to a first wave of student academic misconduct charges for misusing readily available, greatly helpful, and widely used AI tools. Our attorneys have been busy turning back that first wave of AI misuse charges. The new AI-powered chatbots, though, don’t just write assigned papers or answer exam problems, as specifically prohibited by many school policies. The AI chatbots are instead active student study partners, more like a human tutor than a computer program or other digital tool. Schools need to quickly modify their AI policies to help students take due advantage of these powerful new learning tools, rather than to punish students for getting the help they need. Premier Student AI Misconduct Defense Available Retain the LLG National Law Group’s premier attorneys if you are a student facing AI misconduct charges in a school disciplinary proceeding. Our attorneys are ready to help you defend your AI chatbot use or other use of AI tools. We help hundreds of students nationwide defend and defeat student code of conduct charges of all kinds. Call 833.536.8652 now for the representation you need for your best possible student discipline outcome.