PA Training

Coverages

100

Another name for the medical expense limit 

First Party Benefits (FPB) 

200

This optional coverage will only pay once the first $100,000.00 of First Party Benefits have been exhausted

Extraordinary Medical Benefit (EMB)

300

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. 

400

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 

500

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 

Documents

100

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 

200

This non-automated letter is sent if we leave the claimant a voicemail on initial contact

Unable to Contact 

300

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 

400

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) 

500

This non-automated letter is sent if we are unable to obtain the social security number from the claimant

Medicare Eligibility Request Letter 

Systems

100

This system is used by Personal Lines and gives us a comprehensive view of the NJM policy 

Policy Center 

200

This system is used by the PIP department for precerts, medical bill questions, and lien documents 

Agile Point

300

This system is used for billing and provides a comprehensive view of all medical payments on a claim

Decision Point

400

This system is used to obtain prior claim history for a claimant or obtain the applicable social security number

Insurance Services Office (ISO) 

500

This system is used to create letters to send to claimants, medical providers, etc. 

Inspire 

Phone Etiquette

100

What is the proper NJM phone greeting?

Thank you for calling NJM this is _________, your PIP Claims Representative, on a recorded line. How can I help you? 

200

What are we required to ask at the end of every phone call?

Is there anything else I can assist you with today? 

300

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 

400

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 

500

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 

Miscellaneous

100

This is used to recover claimant payments from a responsible party (i.e. dram shop which is when someone who is intoxicated causes an accident)

Subrogation

200

How many days does NJM have to pay Pennsylvania bills before interest starts? 

30 days 

300

This is used to run reports for additional information such as a Carrier Discovery Report and a VIN Household Report

LexisNexis

400

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

500

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