Prohibits selection of health insurance coverage as primary under personal injury protection coverage.

S3142 TR

SENATE, No. 3142

STATE OF NEW JERSEY

222nd LEGISLATURE

�

PRE-FILED FOR INTRODUCTION IN THE 2026 SESSION

Sponsored by:

Senator NICHOLAS P. SCUTARI

District 22 (Somerset and Union)

Senator JON M. BRAMNICK

District 21 (Middlesex, Morris, Somerset and Union)

SYNOPSIS

���� Prohibits selection of health insurance coverage as
primary under personal injury protection coverage.

CURRENT VERSION OF TEXT

���� As reported by the Senate Commerce Committee with
technical review.

��

An Act
concerning personal injury protection and automobile
insurance and amending P.L.1983, c.362
and P.L.1972, c.70.

����
Be It
Enacted
by the Senate and General Assembly of
the State of New Jersey:

���� 1.��� Section 12 of P.L.1983,
c.362 (C.39:6A-4.2) is amended to read as follows:

���� Primacy of coverages.�
[
Except as
provided in subsection d. of section 13 of P.L.1983, c.362 (C.39:6A-4.3), the
]

The

personal injury protection coverage of the named insured shall be the primary
coverage for the named insured and any resident relative in the named insured's
household who is not a named insured under an automobile insurance policy of
his own.� No person shall recover personal injury protection benefits under
more than one automobile insurance policy for injuries sustained in any one
accident.�
No automobile insurer shall permit the selection of other health
insurance coverage or benefits as the primary coverage in regard to medical
expense benefits pursuant to section 4 of P.L.1972, c.70 (C.39:6A-4).

(cf: P.L.1990, c.8, s.5)

���� 2.��� Section 13 of P.L.1983,
c.362 (C.39:6A-4.3) is amended to read as follows:

���� 13.� Personal injury
protection coverage options. With respect to personal injury protection
coverage provided on an automobile in accordance with section 4 of P.L.1972,
c.70 (C.39:6A-4), the automobile insurer shall provide the following coverage
options:

���� a.��� Medical expense benefit
deductibles in amounts of $500.00, $1,000.00, $2,000.00 and $2,500.00 for any
one accident;

���� b.��� The option to exclude
all benefits offered under subsections b., c.,
[
d.,
]
and e. of section 4;

���� c.��� (Deleted by amendment,
P.L.1988, c.119.)

���� d.���
[
For policies
issued or renewed on or after January 1, 1991, the option that other health
insurance coverage or benefits of the insured, including health care services
provided by a health maintenance organization and any coverage or benefits
provided under any federal or State program, are the primary coverage in regard
to medical expense benefits pursuant to section 4 of P.L.1972, c.70
(C.39:6A-4).� If health insurance coverage or benefits are primary, an
automobile insurer providing medical expense benefits under personal injury
protection coverage shall be liable for reasonable medical expenses not covered
by the health insurance coverage or benefits up to the limit of the medical
expense benefits coverage.� The principles of coordination of benefits shall
apply to personal injury protection medical expense benefits coverage pursuant
to this subsection;
]

(Deleted by amendment, P.L.��� , c.��� ) (pending before the Legislation as
this bill)

���� e.��� Medical expense benefits
in amounts of $150,000, $75,000, $50,000 or $15,000 per person per accident;
except that, medical expense benefits shall be paid in an amount not to exceed
$250,000 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.� The coverage election form shall contain a statement, clearly
readable and in 12-point bold type, in a form approved by the commissioner,
that election of any of the aforesaid medical expense benefits options results
in less coverage than the $250,000 medical expense benefits coverage mandated
prior to the effective date of P.L.1998, c.21.

���� If none of the aforesaid
medical expense benefits options is affirmatively chosen in writing, the policy
shall provide $250,000 medical expense benefits coverage;

���� f.���� The insurer shall
provide an appropriate reduction from the territorial base rate for personal
injury protection coverage for those electing any of the options in subsections
a., b.,
[
d.
]
and e. of
this section.

����
[
Any named insured who chooses the
option provided by subsection d. of this section shall provide proof that he
and members of his family residing in his household are covered by health
insurance coverage or benefits in a manner and to an extent approved by the
commissioner. Nothing in this section shall be construed to require a health
insurer, health maintenance organization or governmental agency to cover
individuals or treatment which is not normally covered under the applicable
benefit contract or plan.� If it is determined that an insured who selected or
is otherwise covered by the option provided in subsection d. of this section
did not have such health coverage in effect at the time of an accident, medical
expense benefits shall be payable by the person's automobile insurer and shall
be subject to any deductible required by law or otherwise selected as an option
pursuant to subsection a. of this section, any copayment required by law and an
additional deductible in the amount of $750.
]

���� An option elected by the named
insured in accordance with this section shall apply only to the named insured
and any resident relative in the named insured's household who is not a named
insured under another automobile insurance policy, and not to any other person
eligible for personal injury protection benefits required to be provided in
accordance with section 4 of P.L.1972, c.70 (C.39:6A-4).

���� Medical expense benefits
payable in any amount between the deductible selected pursuant to subsection a.
of this section and $5,000.00 shall be subject to the copayment provided in the
policy, if any.

���� No insurer or health provider
providing benefits to an insured who has elected a deductible pursuant to
subsection a. of this section shall have a right of subrogation for the amount
of benefits paid pursuant to a deductible elected thereunder or any applicable
copayment.

���� The Commissioner of Banking
and Insurance shall adopt rules and regulations to effectuate the purposes of
this section and may promulgate standards applicable to the coordination of
personal injury protection medical expense benefits coverage.

(cf: P.L.1998, c.22, s.3)

���� 3.��� Section 12 of P.L.1972,
c.70 (C.39:6A-12) is amended to read as follows:

���� 12.� Inadmissibility of
evidence of losses collectible under personal injury protection coverage.�
Except as may be required in an action brought pursuant to section 20 of
P.L.1983, c.362 (C.39:6A-9.1), evidence of the amounts collectible or paid
under a standard automobile insurance policy pursuant to sections 4 and 10 of
P.L.1972, c.70 (C.39:6A-4 and 39:6A-10), amounts collectible or paid for
medical expense benefits under a basic automobile insurance policy pursuant to
section 4 of P.L.1998, c.21 (C.39:6A-3.1) and amounts collectible or paid for
benefits under a special automobile insurance policy pursuant to section 45 of
P.L.2003, c.89 (C.39:6A-3.3), to an injured person, including the amounts of
any deductibles, copayments or exclusions,
[
including
exclusions pursuant to subsection d. of section 13 of P.L.1983, c.362
(C.39:6A-4.3),
]

otherwise compensated is inadmissible in a civil action for recovery of damages
for bodily injury by such injured person.

���� The court shall instruct the
jury that, in arriving at a verdict as to the amount of the damages for
noneconomic loss to be recovered by the injured person, the jury shall not
speculate as to the amount of the medical expense benefits paid or payable by an
automobile insurer under personal injury protection coverage payable under a
standard automobile insurance policy pursuant to sections 4 and 10 of P.L.1972,
c.70 (C.39:6A-4 and 39:6A-10), medical expense benefits under a basic
automobile insurance policy pursuant to section 4 of P.L.1998, c.21
(C.39:6A-3.1) or benefits under a special automobile insurance policy pursuant
to section 45 of P.L.2003, c.89 (C.39:6A-3.3) to the injured person
[
, nor shall
they speculate as to the amount of benefits paid or payable by a health
insurer, health maintenance organization or governmental agency under
subsection d. of section 13 of P.L.1983, c.362 (C.39:6A-4.3)
]
.

���� Nothing in this section shall
be construed to limit the right of recovery, against the tortfeasor, of
uncompensated economic loss as defined by subsection k. of section 2 of
P.L.1972, c.70 (C.39:6A-2), including all unreimbursed medical expenses not
covered by the personal injury protection limits applicable to the injured
party and sustained by the injured party, including the value of any
deductibles and copayments incurred through a driver's secondary insurance
coverage and medical liens asserted by a health insurance company related to
the treatment of injuries sustained in the accident.� Medical expenses shall be
subject to the current automobile medical fee schedules established pursuant to
section 10 of P.L.1988, c.119 (C.39:6A-4.6).� In any case in which the recovery
is for medical expenses only, a prevailing claimant shall be entitled to
reasonable and necessary attorneys' fees incurred by the prevailing claimant in
the collection of such medical expenses.

(cf: P.L.2019, c.245, s.2)

���� 4.��� This act shall take
effect immediately and shall apply to all plans that are delivered, issued,
executed or renewed in this State, or approved for issuance or renewal in this
State by the Commissioner of Banking and Insurance, on or after the effective
date of this act.