N.J.S. § 39:6A-5.1 Dispute Resolution Provided Regarding Recovery of Personal Injury Protection Benefits

• Library: New Jersey Permanent Statutes
• Edition: 2023
• Currency: Current through L. 2023, c. 194.
• Year: 2023
• Citation: N.J.S. § 39:6A-5.1

a. Any dispute regarding the recovery of medical expense benefits or other benefits provided under personal injury protection coverage pursuant to section 4 of P.L. 1972, c.70 (C.39:6A-4), section 4 of P.L. 1998, c. 21(C.39:6A-3.1) or section 45 of P.L. 2003, c. 89(C.39:6A-3.3) arising out of the operation, ownership, maintenance or use of an automobile may be submitted to dispute resolution on the initiative of any party to the dispute, as hereinafter provided.

b. The Commissioner of Banking and Insurance shall designate an organization, and for that purpose may, at his discretion, advertise for proposals, for the purpose of administering dispute resolution proceedings regarding medical expense benefits and other benefits provided under personal injury protection pursuant to section 4 of P.L. 1972, c.70 (C.39:6A-4), medical expense benefits coverage pursuant to section 4 of P.L. 1998, c. 21(C.39:6A-3.1) or emergency care medical expense bene...

c. Dispute resolution proceedings under this section 24 and section 25 of this amendatory and supplementary act shall include disputes arising regarding medical expense benefits provided under subsection a. of section 4 of P.L. 1972, c.70 (C.39:6A-4), section 4 of P.L. 1998, c. 21(C.39:6A-3.1) or section 45 of P.L. 2003, c. 89(C.39:6A-3.3), benefits provided pursuant to subsection b., c., d. or e. of section 4 of P.L. 1972, c.70 (C.39:6A-4), subsection b., c., d. or e. of section 7 of P.L. 1972, c.198 (C.39:6-86.1), and disputes as to additional first party coverage benefits required to be offered pursuant to section 10 of P.L. 1972, c.70 (C.39:6A-10). Disputes involving medical expense benefits may include, but not necessarily be limited to, matters concerning:

(1) interpretation of the insurance contract;

(2) whether the treatment or health care service which is the subject of the dispute resolution proceeding is in accordance with the provisions of section 4 of P.L. 1972, c.70 (C.39:6A-4), section 4 of P.L. 1998, c. 21(C.39:6A-3.1) or section 45 of P.L. 2003, c. 89(C.39:6A-3.3) or the terms of the policy;

(3) the eligibility of the treatment or service for compensation;

(4) the eligibility of the provider performing the treatment or service to be compensated under the terms of the policy or under regulations promulgated by the commissioner, including whether the person is licensed or certified to perform such treatment;

(5) whether the disputed medical treatment was actually performed;

(6) whether diagnostic tests performed in connection with the treatment are those recognized by the commissioner;