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  1. Surcharge rules | Ask PIA

    Our insured was in an auto accident that was not his fault. However, he did have medical bills. Can the company surcharge him for submitting the medical claim?

    No. The company can surcharge only for “at-fault accidents,” as defined in N.J.A.C. 11:3-34.3.This definition includes accidents in which the insurer pays out at least $1,000 and for which the “driver is proportionately responsible based on the number of vehicles involved.”A driver is 50 percent responsible for an accident involving...

  2. Company vehicles—Broadened PIP | Ask PIA

    In New Jersey, PIP benefits follow the individual. The insured person under the New Jersey PIP form is the eligible injured person, which is defined as the named insured. The named insured under a commercial auto policy is typically a corporation; the corporation cannot sustain bodily injury. Are the executive...

    As defined in the New Jersey PIP (CA 22 30) endorsement, an “eligible injured person” includes the named insured or an insured person who sustains 'bodily injury' caused by an accident in a “private-passenger auto.” An executive officer would be covered while occupying a covered auto without adding the Named...

  3. NYSIF short-rate penalty | Ask PIA

    How can an employer avoid a short-rate penalty when replacing a New York State Insurance Fund policy at renewal?

    The Workers’ Compensation Law (see Section 94a below) requires 30 days’ advance written notice to the New York State Insurance Fund when an employer terminates its policy. The only exception (see Section 94b below) is when the employer no longer is subject to the Workers’ Compensation Law. To be eligible...

  4. Broadened PIP | Ask PIA

    If the broadened PIP endorsement is not necessary for benefits under the commercial auto form, what coverage does this form provide? Someone told me that this endorsement provides PIP coverage for vehicles that are not scheduled on the Commercial Auto Policy, to include a vehicle borrowed from a friend.

    The Named Individuals—Broadened PIP Coverage (CA 22 01) endorsement changes the coverage status of a designated person from that of “any other person” to a “named insured” under the definition of “eligible injured person.” The result is that such person is now covered while occupying any “private passenger auto,” not...

  5. Which state’s PIP applies? | Ask PIA

    In New York, the policy that pays personal injury protection benefits is determined by the vehicle the person occupies and, in New Jersey, the policy is determined by the named insured, or the person’s relationship to the named insured. If a New Jersey corporation furnishes a New Jersey-registered vehicle to...

    To resolve issues involving “conflict of laws,” one must navigate through a very complex branch of jurisprudence. The result may depend on which court has been petitioned, whether that court has jurisdiction, the criteria used by that court and the specific facts of the case. Since this vehicle is garaged...

  6. Rate filing | Ask PIA

    What is the process in Connecticut to obtain a carrier’s rate filing?

    The Connecticut Insurance Department has expanded public access to insurance company documents. The general public has access to regulatory filings free of charge through the department’s website at https://filingaccess.serff.com/sfa/home/CT. Click on begin search button at the top of the page, read the agreement and click accept to proceed. Select...

  7. NFIP sewer backup | Ask PIA

    How can we get better coverage for sewer backup? Is it covered under the flood policy?

    Loss from sewer backup is covered by the National Flood Insurance Program policy. See the following exclusion in the policy: 5. Water or water-borne material that: a. Backs up through sewers or drains; b. Discharges or overflows from a sump, sump pump or related equipment; or c. Seeps...

  8. Workers’ compensation offsets | Ask PIA

    If an employee is in an accident while working, he or she will file the medical claims under workers’ compensation coverage. If their workers’ compensation coverage is making indemnity payments, which are substantially lower than the insured’s salary, can the additional PIP coverage pay for the difference up to a...

    An insurer must pay the otherwise payable Added PIP income benefits, but offset by workers’ compensation benefits (which, by the way, is 70% of the gross weekly wage, not 66 2/3%). The excess PIP benefits over the Basic PIP benefits cannot exceed 75% of the insured’s weekly income. For example:...

  9. Livery (taxi, limo, bus, etc.) passengers | Ask PIA

    If there were individuals traveling as passengers in a bus or a limo, and they were injured in a car accident, who would pay for their medical expenses? I believe personal injury protection benefits would be excluded under the personal auto policy in New Jersey. Please confirm.

    You are correct. Personal injury protection benefits are limited to vehicles defined as an “automobile.” An “automobile” does not include a public or livery vehicle, such as a bus, taxi or limousine, which means that no PIP benefits would be payable from the personal auto policy. With regard to the...

  10. Company car | Ask PIA

    Our client is a person who lives in New York, but works in New Jersey driving a company car that is registered in New Jersey (although garaged at his home in New York). He does not have a personal auto policy. If he is in an accident in New Jersey,...

    The answer to your first question is the same as given in Ask PIA No. 290019. To resolve issues involving “conflict of laws,” one must navigate through a very complex branch of jurisprudence. The result may depend on which court has been petitioned, whether that court has jurisdiction, the...

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