A3911

An Act concerning certain personal injury protection claims, amending P.L.1985, c.520, P.L.1972, c.198, P.L.2003, c.89 and repealing section 19 of P.L.1983, c.362.

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

1. Section 18 of P.L.1985, c.520 (C.17:28-1.4) is amended to read as follows:

18. Any insurer authorized to transact or transacting automobile or motor vehicle insurance business in this State, or controlling or controlled by, or under common control by, or with, an insurer authorized to transact or transacting insurance business in this State, which sells a policy providing automobile or motor vehicle liability insurance coverage, or any similar coverage, in any other state or in any province of Canada, shall include in each policy coverage to satisfy at least the personal injury protection benefits coverage pursuant to section 4 of P.L.1972, c.70 (C.39:6A‑4) [or section 19 of P.L.1983, c.362 (C.17:28‑1.3) for any New Jersey resident who is not required to maintain personal injury protection coverage pursuant to section 4 of P.L.1972, c.70 (C.39:6A‑4) or section 4 of P.L.1998, c.21 (C.39:6A‑3.1) and who is not otherwise eligible for such benefits], whenever the automobile or motor vehicle insured under the policy is used or operated in this State. In addition, any insurer authorized to transact or transacting automobile or motor vehicle insurance business in this State, or controlling or controlled by, or under common control by, or with, an insurer authorized to transact or transacting automobile or motor vehicle insurance business in this State, which sells a policy providing automobile or motor vehicle liability insurance coverage, or any similar coverage, in any other state or in any province of Canada, shall include in each policy coverage to satisfy at least the liability insurance requirements of subsection a. of section 1 of P.L.1972, c.197 (C.39:6B‑1) or section 3 of P.L.1972, c.70 (C.39:6A‑3), the uninsured motorist insurance requirements of subsection a. of section 2 of P.L.1968, c.385 (C.17:28‑1.1), and personal injury protection benefits coverage pursuant to section 4 of P.L.1972, c.70 (C.39:6A‑4) [or of section 19 of P.L.1983, c.362 (C.17:28‑1.3)], whenever the automobile or motor vehicle insured under the policy is used or operated in this State.

Any liability insurance policy subject to this section shall be construed as providing the coverage required herein, and any named insured, and any immediate family member as defined in section 14.1 of P.L.1983, c.362 (C.39:6A‑8.1), under that policy, shall be subject to the tort option specified in subsection a. of section 8 of P.L.1972, c.70 (C.39:6A‑8).

Each insurer authorized to transact or transacting automobile or motor vehicle insurance business in this State and subject to the provisions of this section shall file and maintain with the Department of Banking and Insurance written certification of compliance with the provisions of this section.

"Automobile" means an automobile as defined in section 2 of P.L.1972, c.70 (C.39:6A‑2).

(cf: P.L.1998, c.21, s.72)

2. Section 7 of P.L.1972, c.198 (C.39:6-86.1) is amended to read as follows:

7. When any person qualified to receive payments under the provisions of the "Unsatisfied Claim and Judgment Fund Law" suffers bodily injury or death as a pedestrian, as defined in section 2 of P.L.1972, c.70 (C.39:6A-2), caused by a motor vehicle, including an automobile as defined in section 2 of P.L.1972, c.70 (C.39:6A-2), and a motorcycle or a motorized bicycle, or by an object propelled therefrom, or arising out of an accident while occupying, entering into, alighting from, or using an automobile, registered or principally garaged in this State for which personal injury protection benefits under the "New Jersey Automobile Reparation Reform Act," P.L.1972, c.70 (C.39:6A-1 et seq.)[, or section 19 of P.L.1983, c.362 (C.17:28-1.3),] would be payable to such person if personal injury protection coverage were in force and the damages resulting from such accident or death are not satisfied due to the personal injury protection coverage not being in effect with respect to such accident, or when a pedestrian suffers bodily injury as provided by section 35 of P.L.2003, c.89 (C.39:6-86.7) then in such event the Unsatisfied Claim and Judgment Fund shall provide, under the following conditions, the following benefits:

a. Medical expenses benefits. Payment of all medical expense benefits in accordance with a benefits plan, subject to the approval of the commissioner, for reasonable, necessary and appropriate treatment and provision of services in an amount not exceeding $250,000 per person per accident. In the event of death, payment shall be made to the estate of the decedent. The benefits plan shall set forth the benefits provided by the Unsatisfied Claim and Judgment Fund, including eligible medical treatments, diagnostic tests and services as well as such other benefits as the Unsatisfied Claim and Judgment Fund may provide.

Medical expense benefit payments shall be subject to a deductible of $250.00 on account of injury in any one accident and a copayment of 20% of any benefits payable between $250.00 and $5,000.00.

b. Income continuation benefits. The payment of the loss of income of an income producer as a result of bodily injury disability, subject to a maximum weekly payment of $100.00. Such sums shall be payable during the life of the injured person and shall be subject to an amount or limit of $5,200.00, on account of injury to any one person in any one accident, except that in no case shall income continuation benefits exceed the net income normally earned during the period in which the benefits are payable.

c. Essential services benefits. Payment of essential services benefits to an injured person shall be made in reimbursement of necessary and reasonable expenses incurred for such substitute essential services ordinarily performed by the injured person for himself, his family and members of the family residing in the household, subject to an amount or limit of $12.00 per day. Such benefits shall be payable during the life of the injured person and shall be subject to an amount or limit of $4,380.00, on account of injury to any one person in any one accident.

d. Death benefits. In the event of the death of an income producer as a result of injuries sustained in an accident entitling such person to benefits under this section, the maximum amount of benefits which could have been paid to the income producer, but for his death, under subsection b. of this section shall be paid to the surviving spouse, or in the event there is no surviving spouse, then to the surviving children, and in the event there are no surviving spouse or surviving children, then to the estate of the income producer.

In the event of the death of one performing essential services as a result of injuries sustained in an accident entitling such person to benefits under subsection c. of this section, the maximum amount of benefits which could have been paid such person, under subsection c., shall be paid to the person incurring the expense of providing such essential services.

e. Funeral expenses benefits. All reasonable funeral, burial and cremation expenses, subject to a maximum benefit of $1,000.00, on account of the death to any one person in any one accident shall be payable to decedent's estate.

Provided, however, that no benefits shall be paid under this section unless the person applying for benefits has demonstrated that he is not disqualified by reason of the provisions of subsection (a), (c), (d) or (1) of section 10 of P.L.1952, c.174 (C.39:6-70), or any other provision of law.

(cf: P.L.2003, c.89, s.30)

3. Section 35 of P.L.2003, c.89 (C.39:6-86.7) is amended to read as follows:

35. The Unsatisfied Claim and Judgment Fund created pursuant to P.L.1952, c.174 (C.39:6-61 et seq.) shall provide personal injury protection benefits pursuant to section 7 of P.L.1972, c.198 (C.39:6-86.1) to a pedestrian sustaining bodily injury in this State caused by [an automobile] a motor vehicle, a motorcycle or a motorized bicycle, other than to a named insured or a member of the named insured's family residing in his household, if that pedestrian is entitled to personal injury protection coverage under an automobile insurance policy.

The New Jersey Property-Liability Insurance Guaranty Association shall be entitled to recover, on behalf of the Unsatisfied Claim and Judgment Fund, for all payments made by it to a pedestrian pursuant to this section, regardless of fault, from any person holding a certificate of self-insurance issued pursuant to section 30 of P.L.1952, c.173 (C.39:6-52) in whose name the motor vehicle, motorcycle or motorized bicycle involved in the accident was registered or leased.

(cf: P.L.2003, c.89, s.35)

4. Section 19 of P.L.1983, c.362 (C.17:28-1.3) is repealed.

5. This act shall take effect immediately and shall apply to all claims filed or pending after the effective date.

STATEMENT

This bill provides that the Unsatisfied Claim and Judgment Fund ("UCJF") shall insure all pedestrian personal injury protection (PIP) claims for injuries caused by motor vehicles, motorcycles, and motorized bicycles if the pedestrian is not otherwise covered under an automobile insurance policy. The bill also provides the UCJF with a mechanism to recover payments when a self-insured motor vehicle causes the injury to an uninsured pedestrian.

Previous automobile insurance reform legislation shifted responsibility for pedestrian PIP coverage from private passenger automobile insurance carriers to the UCJF. Although these revisions to the PIP coverage laws clearly indicate that the UCJF provides pedestrian PIP coverage for accidents involving automobiles, some uncertainty remains as to whether the UCJF is required to provide this coverage for accidents involving other vehicles.

In order to fulfill the Legislature's intent in passing the reform legislation and to clarify coverage as to these other vehicles, the bill provides that as to injuries to a pedestrian caused by a motor vehicle, a motorcycle or a motorized bicycle, the UCJF must provide personal injury protection (PIP) coverage if the pedestrian sustains bodily injury in the State and is not otherwise covered under an automobile insurance policy.

To further clarify that the UCJF provides this coverage, the bill repeals section 19 of P.L.1983, c.362 (C.17.28-1.3), which currently requires all liability insurance policies to provide pedestrian PIP coverage on motor vehicles that are not private passenger automobiles. The bill also makes certain technical changes that are consistent with the repeal of this section.

Finally, the bill provides that the New Jersey Property-Liability Insurance Guaranty Association shall be entitled to recover on behalf of the UCJF for all payments made by the UCJF to a pedestrian pursuant to pedestrian PIP coverage, regardless of fault, from any entity that self-insured the motor vehicle involved in the accident through a certificate of self-insurance. The bill allows this recovery by the UCJF from self-insurers because self-insurers are not presently required to contribute to the UCJF with respect to the pedestrian PIP coverage that the UCJF provides.