NV PT Juris key terms

First-party no-fault coverage that pays medical, income continuation, essential services, and death benefits for injuries from a motor vehicle accident, regardless of who caused it.

An insurance framework in which each driver's own insurer pays certain economic losses after a crash, limiting the need to sue, in exchange for restricted tort recovery.

The baseline New Jersey automobile policy that includes PIP, liability coverage, uninsured/underinsured motorist coverage, and a default medical expense limit of $250,000 per person per accident.

A lower-cost New Jersey auto policy option providing $15,000 per person per accident of medical expense benefits and a $10,000 income continuation limit, with no liability coverage for pain and suffering.

The PIP component that reimburses reasonable and necessary treatment for accident-related injuries, including hospital, physician, diagnostic, surgical, and rehabilitative services, subject to policy limits and fee schedules.

The PIP component that replaces a portion of lost wages for an injured person who cannot work, typically subject to a weekly maximum and a percentage of gross earnings.

The PIP component that pays for reasonable and necessary household services the injured person can no longer perform, such as cleaning, cooking, and childcare, up to a stated daily or policy maximum.

The PIP component that pays a survivor benefit and, in some cases, funeral expenses when an accident-related injury causes death within the policy's stated time period.

A death benefit paid under PIP to the estate or surviving dependents of a person whose death resulted from a covered motor vehicle accident, subject to the policy limit.

The maximum dollar amount a policy will pay for PIP medical treatment per person per accident; New Jersey permits a range of selected limits, from the standard $250,000 down to much lower options.

The amount the insured must pay out of pocket for PIP medical expenses before the insurer begins paying benefits, chosen at purchase and applied per person per accident.

A fixed percentage or dollar share of each PIP medical bill that the insured pays, selected as a coverage option in exchange for lower premium, and applied in addition to any deductible.

The choices an insured makes at purchase that shape PIP protection, including medical expense limit, deductible, co-payment percentage, income continuation, essential services, and tort option.

A tort limitation that lets an injured person sue for non-economic damages only if the injury meets a statutory standard, such as death, disfigurement, or a permanent injury with a material loss of function.

The statutory restriction on when a person injured in an auto accident may bring a civil action for pain, suffering, and other non-economic losses, tied to the tort option selected.

The election made by an insured at purchase between a threshold that limits lawsuits for non-economic damages and a zero threshold that preserves the right to sue without meeting the injury standard.

A tort option, sometimes called the no-threshold option, that allows an injured person to sue for non-economic damages without proving a qualifying injury, usually at a higher premium.

A qualifying injury under the verbal threshold: a bodily injury that is permanent and causes a material loss of a body function, supported by objective medical evidence.

Findings such as imaging, tests, or observable clinical signs that a treating provider documents to support the existence and severity of an injury, as opposed to subjective complaints alone.

The insurer's process for receiving, investigating, evaluating, and paying or denying a PIP claim, including timelines for acknowledgment, benefit decisions, and payment.

The rules determining which of two or more health or auto coverages pays first, so that a provider is not paid twice for the same service and each plan pays its proper share.

The policy or plan that pays a claim first before any secondary coverage is considered, often determined by statute, policy language, or the order-of-benefit rules.

Payment to the insured or provider for covered expenses already incurred, or recovery by an insurer of amounts it paid that another party was responsible for.

The insurer's right to pursue recovery from a third party who caused the loss, after the insurer has paid benefits to its insured, to avoid shifting the ultimate cost.

A statement sent to the insured or provider showing services billed, amounts allowed, amounts paid, and any reduction or denial, with the reason for the determination.

The statutory and regulatory obligation to pay undisputed PIP benefits within set deadlines after receiving a complete claim, with penalties for unjustified delay.

A determination that a claimed PIP benefit is not payable because it is not covered, not reasonable or necessary, exceeds policy limits, or is barred by policy terms or law.

A formal request by the insured or provider asking the insurer to reconsider a denial or reduction of benefits, supported by additional records or argument.

A dispute resolution process in which an independent arbitrator decides contested PIP benefit claims, typically faster and less formal than court litigation.

The policies, controls, and reporting practices insurers and producers use to detect and deter false claims, staged accidents, and misrepresentation on applications.

Statutory and regulatory rules that prohibit insurance fraud, require insurers to maintain fraud plans, and authorize investigation, reporting, and civil or criminal penalties.

The obligation of insurers and producers to report suspected fraudulent insurance acts to the designated state authority within required timeframes, with supporting documentation.

The requirement that individuals and agencies selling or negotiating insurance hold a valid license for the lines they transact, obtained through application, examination, and continuing education.

Required periodic coursework or training that licensed producers must complete to maintain their license and stay current on statutes, products, and ethical obligations.

A regulatory review of an insurer's or producer's business practices, including sales, underwriting, claims, and complaint handling, to assess compliance with insurance law.

The obligation of a producer or insurer to act in the client's interest, handle premiums responsibly, and avoid self-dealing or misuse of funds entrusted to them.

Prohibited conduct such as unreasonable delay, failure to investigate, misrepresenting policy terms, or offering inadequate settlement, enforced through consumer protection and insurance regulation.

The duties owed by a licensed producer, including accurate application handling, timely submission, disclosure of coverage options, and compliance with marketing and recordkeeping rules.

The body of law and regulation safeguarding policyholders from deceptive sales, unfair claim handling, and improper denial of benefits, with complaint and enforcement mechanisms.