S4847

An Act concerning evidence of future medical treatment expenses in automobile negligence actions and amending P.L.1972, c.70.

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

1. Section 12 of P.L.1972, c.70 (C.39:6A-12) is amended to read as follows:

12. Inadmissibility of evidence of losses collectible under personal injury protection coverage.

a. Except as may be required in an action brought pursuant to section 20 of P.L.1983, c.362 (C.39:6A-9.1), evidence of the amounts collectible or paid under a standard automobile insurance policy pursuant to sections 4 and 10 of P.L.1972, c.70 (C.39:6A-4 and 39:6A-10), amounts collectible or paid for medical expense benefits under a basic automobile insurance policy pursuant to section 4 of P.L.1998, c.21 (C.39:6A-3.1) and amounts collectible or paid for benefits under a special automobile insurance policy pursuant to section 45 of P.L.2003, c.89 (C.39:6A-3.3), to an injured person, including the amounts of any deductibles, copayments or exclusions, including exclusions pursuant to subsection d. of section 13 of P.L.1983, c.362 (C.39:6A-4.3), otherwise compensated is inadmissible in a civil action for recovery of damages for bodily injury by such injured person.

The court shall instruct the jury that, in arriving at a verdict as to the amount of the damages for noneconomic loss to be recovered by the injured person, the jury shall not speculate as to the amount of the medical expense benefits paid or payable by an automobile insurer under personal injury protection coverage payable under a standard automobile insurance policy pursuant to sections 4 and 10 of P.L.1972, c.70 (C.39:6A-4 and 39:6A-10), medical expense benefits under a basic automobile insurance policy pursuant to section 4 of P.L.1998, c.21 (C.39:6A-3.1) or benefits under a special automobile insurance policy pursuant to section 45 of P.L.2003, c.89 (C.39:6A-3.3) to the injured person, nor shall they speculate as to the amount of benefits paid or payable by a health insurer, health maintenance organization or governmental agency under subsection d. of section 13 of P.L.1983, c.362 (C.39:6A-4.3).

Nothing in this section shall be construed to limit the right of recovery, against the tortfeasor, of uncompensated economic loss as defined by subsection k. of section 2 of P.L.1972, c.70 (C.39:6A-2), including all unreimbursed medical expenses not covered by the personal injury protection limits applicable to the injured party and sustained by the injured party, including the value of any deductibles and copayments incurred through a driver's secondary insurance coverage and medical liens asserted by a health insurance company related to the treatment of injuries sustained in the accident. Medical expenses shall be subject to the current automobile medical fee schedules established pursuant to section 10 of P.L.1988, c.119 (C.39:6A-4.6). In any case in which the recovery is for medical expenses only, a prevailing claimant shall be entitled to reasonable and necessary attorneys' fees incurred by the prevailing claimant in the collection of such medical expenses.

b. For purposes of subsection a. of this section, an amount shall be deemed collectible only if the medical treatment, service, medication, procedure, diagnostic test, therapy, equipment, or other health care expense:

(1) has been rendered or provided to the injured person;

(2) has been billed or is billable in accordance with the applicable automobile insurance policy and any applicable medical fee schedule; and

(3) is payable or paid pursuant to the personal injury protection coverage available to the injured person.

c. An amount shall not be deemed collectible under subsection a. of this section solely because payment through personal injury protection coverage remains available under the applicable policy or because payment for the medical treatment, service, medication, procedure, diagnostic test, therapy, equipment, or other health care expense may be subject to personal injury protection coverage if rendered or provided in the future. Future medical treatment expenses, including the cost of care that has not yet been rendered, provided, billed, submitted, or determined payable pursuant to the applicable automobile insurance policy, shall not be excluded from evidence in a civil action for recovery of damages for bodily injury on the ground that the expenses are collectible under subsection a. of this section.

d. (1) Nothing in subsection b. or c. of this section shall permit a duplicate recovery for medical expenses that have been paid or are payable as personal injury protection benefits.

(2) To prevent duplicate recovery, a personal injury protection carrier may assert an offset or credit against a future application for personal injury protection benefits only to the extent the carrier establishes that the injured person has actually recovered, in a civil action, compensation for the same future medical treatment, service, medication, procedure, diagnostic test, therapy, equipment, or other health care expense for which personal injury protection benefits are later sought.

(cf: P.L.2019, c.245, s.2)

2. This act shall take effect immediately and shall apply to all civil actions pending on or filed after the effective date, except that it shall not apply to any action in which final judgment has been entered before the effective date.

STATEMENT

This bill clarifies the circumstances when future medical treatment expenses are “collectible” personal injury protection benefits in civil actions for recovery of damages for bodily injury.

Present law bars evidence of amounts “collectible or paid” under personal injury protection coverage in a civil action for bodily injury arising from an automobile accident. Concurrently, the law preserves recovery of uncompensated economic loss, including unreimbursed medical expenses not covered by applicable personal injury protection limits in certain automobile insurance policies.

This bill provides that future medical treatment expenses are not collectible merely because personal injury protection limits remain available or because the future treatment may become payable under personal injury protection coverage if the treatment is later rendered. Under the bill, an expense is collectible only when the treatment or service: (1) has been rendered or provided; (2) has been billed or is billable; and (3) is payable or paid under the applicable personal injury protection coverage. The bill is intended to prevent exclusion of future medical treatment expense evidence in bodily injury actions based solely on the theoretical future availability of personal injury protection benefits, while preserving the ability of the court and a personal injury protection carrier to prevent duplicate recovery for the same medical treatment expense.