Coverages
Another name for the medical expense limit
First Party Benefits (FPB)
This letter is automatically sent once we update the PIP Exposure screen after the initial contact. This letter has policy coverages, requirements, and includes a PIP Application for Benefits
PA Explain Letter
This system is used by Personal Lines and gives us a comprehensive view of the NJM policy
Policy Center
Thank you for calling NJM this is _________, your PIP Claims Representative, on a recorded line. How can I help you?
Subrogation
This optional coverage will only pay once the first $100,000.00 of First Party Benefits have been exhausted
Extraordinary Medical Benefit (EMB)
This non-automated letter is sent if we leave the claimant a voicemail on initial contact
Unable to Contact
This system is used by the PIP department for precerts, medical bill questions, and lien documents
Agile Point
What are we required to ask at the end of every phone call?
Is there anything else I can assist you with today?
How many days does NJM have to pay Pennsylvania bills before interest starts?
30 days
Please explain what a Deemer Statute is and what type of coverage is provided to the claimant
A Deemer Statute is for a Pennsylvania resident who gets in a motor vehicle accident in New Jersey. Once the underlying Pennsylvania limit is exhausted, the claimant receives an additional limit with the total amount being $250,000.00. NJ regulations apply, meaning there would be a deductible, copay, and precert once PA is exhausted.
This automated letter is sent to the claimant 25 days after the creation of the claim if there has been no PIP Application received or the claim is under investigation
PA PIP Regulations Letter
This system is used for billing and provides a comprehensive view of all medical payments on a claim
Decision Point
A customer is upset about not being able to submit her medical bills to the other party's auto insurance since they caused the motor vehicle accident
Please provide her with an explanation as to why
No-fault laws
This is used to run reports for additional information such as a Carrier Discovery Report and a VIN Household Report
LexisNexis
This is a claimant who does not have their own auto insurance, does not live with someone who has auto insurance, and needs to come to the NJM policy for coverage
Affidavit of No Insurance (AONI) who receives the policy limit and must return the notarized affidavit paperwork
This automated letter is sent by changing 'Investigation' to 'Yes' on the PIP Exposure screen and lets the claimant know that eligibility for coverage is undetermined and may be denied at a later date
Reservation of Rights (ROR)
This system is used to obtain prior claim history for a claimant or obtain the applicable social security number
Insurance Services Office (ISO)
A customer is upset that she has to supply her social security number to NJM
Please provide her with an explanation
This is a federal regulation, not NJM's rules, since Medicare needs to updated with claim payments for Medicare claimants
She can fill it out on the PIP Application or just mark 'No' on the Medicare Eligibility Request Letter
This is used to notify Personal Lines of pertinent information that may affect the NJM auto policy (i.e. someone is not listed on the policy but resides in the house as a licensed driver)
Underwriting Report or AC66
What is the statute of limitations for non-combination policy, a combination policy, and a minor?
Non-combination policy: Four years from last medical payment
Combination policy: Three years from last medical payment
Minor Child: Four years from when they turn 18 years old
This non-automated letter is sent if we are unable to obtain the social security number from the claimant
Medicare Eligibility Request Letter
This system is used to create letters to send to claimants, medical providers, etc.
Inspire
You have just finished going through the initial contact questions
Please provide all advisements that you would give to the claimant before ending the call
No deductible, no copay, no precertification
Return PIP Application
Give attorney NJM information if applicable
Provide claim number and adjuster information to all medical providers
This is set up by the PA adjuster after months of treatment to help determine if further treatment is still medically necessary; An independent doctor reviews all medical records and potentially cuts off treatment from that medical provider
PRO review