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1、COMPULSORY LIABILITY INSURANCE - NO FAULT 39A:I-1. Definitions a. "Automobile" means a private passenger automobile of a private passenger or station wagon type that is owned or hired and is neither used as a public or livery conveyance for passengers nor rented to others with a driver; and a moto

2、r vehicle with a pickup body, a delivery sedan, a van, or a panel truck or a camper type vehicle used for recreational purposes owned by an individual or by spouses who are residents of the same household, not customarily used in the occupation, profession or business of the insured other than farmi

3、ng or ranching. An automobile owned by a farm family copartnership or corporation, which is principally garaged on a farm or ranch and otherwise meets the definitions contained in this section, shall be considered a private passenger automobile owned by two or more relatives resident in the same ho

4、usehold. b. "Basic automobile insurance policy" means an automobile insurance policy pursuant to 39:6A-3.1. c. "Economic loss" means uncompensated loss of income or property, or other uncompensated expenses, including, but not limited to, medical expenses. d. "Essential services" means those serv

5、ices performed not for income which are ordinarily performed by an individual for the care and maintenance of such individual's family or family household. e. "Health care provider" or "provider" means persons licensed or certified to perform health care treatment or services compensable as medical

6、 expenses and shall include: (1) a hospital or health care facility maintained by a state or any of its political subdivisions, (2) a hospital or health care facility licensed by the Department of Health and Senior Services, (3) other hospitals or health care facilities designated by the Department

7、of Health and Senior Services to provide health care services, or other facilities, including facilities for radiology and diagnostic testing, freestanding emergency clinics or offices, and private treatment centers, (4) a nonprofit voluntary visiting nurse organization providing health care service

8、s other than in a hospital, (5) hospitals or other health care facilities or treatment centers located in other states or nations, (6) physicians licensed to practice medicine and surgery, (7) licensed chiropractors, (8) licensed dentists, (9) licensed optometrists, (10) licensed pharmacists, (11) l

9、icensed podiatrists, (12) registered bio-analytical laboratories, (13) licensed psychologists, (14) licensed physical therapists, (16) certified nurse-midwives, (17) certified nurse-practitioners/clinical nurse-specialists, (18) licensed health maintenance organizations, (19) licensed orthotists and

10、 prosthetists, (20) licensed professional nurses, and (21) providers of other health care services or supplies, including durable medical goods. f. "Hospital expenses" means the cost of treatment and services, as provided in the policy approved by the commissioner, by a licensed and accredited acut

11、e care facility which engages primarily in providing diagnosis, treatment and care of sick and injured persons on an inpatient or outpatient basis; the cost of covered treatment and services provided by an extended care facility which provides room and board and skilled nursing care 24 hours a day a

12、nd which is recognized by the administrators of the federal Medicare program as an extended care facility; and the cost of covered services at an ambulatory surgical facility supervised by a physician licensed in this State or in another jurisdiction and recognized by the Commissioner of Health and

13、Senior Services, or any other facility licensed, certified or recognized by the Commissioner of Health and Senior Services or the Commissioner of Human Services or a nationally recognized system such as the Commission on Accreditation of Rehabilitation Facilities, or by another jurisdiction in which

14、 it is located. g. "Income" means salary, wages, tips, commissions, fees and other earnings derived from work or employment. h. "Income producer" means a person who, at the time of the accident causing personal injury or death, had an occupation earning or producing income. i. "Medical expenses

15、" means reasonable and necessary expenses for treatment or services as provided by the policy, including medical, surgical, rehabilitative and diagnostic services and hospital expenses, provided by a health care provider licensed or certified by the State or by another state or nation, and reasonabl

16、e and necessary expenses for ambulance services or other transportation, medication and other services as may be provided for, and subject to such limitations as provided for, in the policy, as approved by the Commissioner. "Medical expenses" also include any nonmedical remedial treatment rendered

17、in accordance with a recognized religious method of healing. j. "Medically necessary" means that the treatment is consistent with the symptoms or diagnosis, and treatment of the injury: (1) is not primarily for the convenience of the injured person or provider, (2) is the most appropriate standar

18、d or level of service which is in accordance with standards of good practice and standard professional treatment protocols, as such protocols may be recognized or designated by the Commissioner of Banking and Insurance, in consultation with the Commissioner of Health and Senior Services or with a pr

19、ofessional licensing or certifying board in the Division of Consumer Affairs in the Department of Law and Public Safety, or by a nationally recognized professional organization, and (3) does not involve unnecessary diagnostic testing. k. "Motor vehicle" means a motor vehicle as defined in 39:1-1,

20、 exclusive of an automobile as defined in subsection (a). l. "Named insured" means the person(s) identified as the insured in the policy and, if an individual, the individual’s spouse, if the spouse is named as a resident of the same household. If the spouse ceases to be a resident of the househol

21、d of the named insured, coverage shall be extended to the spouse for the full term of any policy period in effect at the time of the cessation of residency. m. "Noneconomic loss" means pain, suffering and inconvenience. n. "Pedestrian" means a person who is not occupying, entering into, or alight

22、ing from a vehicle propelled by other than muscular power and designed primarily for use on highways, rails and tracks. o. "Standard automobile insurance policy" means an automobile insurance policy with at least the coverage required pursuant to 39:6A-3 and 39:6A-4. Source: 39:6A-2. COMMENT Th

23、is section is substantially identical to the original, but the defined terms have been listed in alphabetical order. 39A:I-2. Compulsory insurance coverage limits a. Except as provided by 39:6A-3.1, every owner of an automobile registered or principally garaged in this State shall maintain automo

24、bile liability insurance coverage, under provisions approved by the Commissioner of Banking and Insurance, insuring against loss resulting from liability imposed by law for bodily injury, death and property damage sustained by any person arising out of the ownership, maintenance, operation or use of

25、 an automobile. Such coverage shall be at least in an amount or limit: (1) Of $15,000, exclusive of interest and costs, on account of injury to, or death of, one person, in any one accident; (2) Subject to such limit for any one person so injured or killed, of $30,000, exclusive of interest and

26、costs, on account of injury to or death of, more than one person, in any one accident; and (3) Of $5,000, exclusive of interest and costs, for damage to property in any one accident. b. All automobile insurance policies issued or renewed shall include at least the coverage required pursuant to 39

27、:6A-3 and 39:6A-4 unless the named insured elects a basic automobile insurance policy pursuant to 39:6A-3.1 or a special automobile insurance policy pursuant to 39:6A-3.3. Election of a basic or special automobile insurance policy shall be in writing and signed by the named insured on the coverage

28、selection form required by 39:6A-23. The coverage selection form shall contain a statement, clearly readable and in 12-point bold type, in a form approved by the Commissioner, that: (1) Election of a basic automobile insurance policy will result in less coverage than the $250,000 medical expense

29、benefits coverage mandated prior to 39:6A-1.1 et al. or that election of a special automobile insurance policy will result in coverage only for emergency care; and (2) Election of a special automobile insurance policy, or a basic automobile insurance policy without the optional $10,000 liability c

30、overage provided for in 39:6A-3.1 may subject the named insured to a claim or judgment for noneconomic loss which is not covered by the insurance policy, and which may place the insured’s assets at risk, and in the event the insured is sued, the insurer shall not provide legal counsel. c. The insur

31、ance coverage provided for in 39:6A-3.1 shall be offered by every insurer which writes insurance coverage pursuant to 39:6A-3 and 39:6A-4 for a period of five years beginning May 19, 1998. The Commissioner shall require every company writing such insurance coverage to report annually during that fi

32、ve-year period as to the number of policies written pursuant to this subsection in the previous year, the number of policies with the coverage offered pursuant to 39:6A-4 converted to policies with the coverage offered pursuant to 39:6A-3.1 and any other information the Commissioner may require incl

33、uding the age of the policyholders and the territories in which the policyholders reside. The Commissioner shall report to the Governor and the Legislature regarding the acceptance of the basic automobile insurance policy by the automobile insurance consumers of this State annually for the first fo

34、ur years the basic policy is sold. On or before January 1, 2003, the Commissioner shall make a final, cumulative report to the Governor and the Legislature which includes recommendations as to the continuation of the basic policy. d. The insurance coverages provided for in 39:6A-3.3 shall be offer

35、ed or provided pursuant to subsection f. of that section for a period of five years after the effective date of 17:30A-2.1 et al. On or before January 1, 2008, the Commissioner shall make a final report which includes recommendations as to the continuation of the special policy to the Governor and

36、the Legislature. e. No licensed insurance carrier shall refuse to renew the required coverage stipulated by this act of an eligible person as defined in 17:33B-13 except in accordance with the provisions of 17:29C-7.1 or with the consent of the Commissioner of Banking and Insurance. Source: 39:6A-

37、3; 39:6A-3.2. COMMENT This section contains the substance of the original sections and consolidates them. In (c), the effective date of the statute referenced has been included instead of simply referring to the effective date. 39A:I-3. Automobile insurance for low income individuals a. To as

38、sist certain low income individuals in this State and encourage their greater compliance in satisfying the mandatory private passenger automobile insurance requirements, the Legislature has established a special automobile insurance policy. The special automobile insurance policy shall be offered on

39、ly to individuals who qualify for, and are actively covered by, designated government subsidized programs in the State. For the purpose of this section, "eligible low income individual" means an individual who meets the income criteria established by the commissioner by regulation. In setting the lo

40、w income criteria, the commissioner shall limit availability to those persons eligible and enrolled in the federal Medicaid program. b. As an additional option to the mandatory coverage provided in 39:6A-3 and 39:6A-4 or the alternative covered provided in 39:6A-3.1, an owner or registered owner o

41、f an automobile registered or principally garaged in this State, who is an eligible low income individual, may elect a special automobile insurance policy providing the following coverage: (1) Emergency personal injury protection coverage, for the payment of benefits without regard to negligence, l

42、iability or fault of any kind, only to the named insured and dependent members of the insured’s family, as defined by the federal Medicaid program, residing in the insured’s household, who sustain bodily injury as a result of an accident while occupying, entering into, alighting from or using an aut

43、omobile, or as a pedestrian, caused by an automobile or by an object propelled by or from an automobile, and to other persons sustaining bodily injury while occupying, entering into, alighting from or using the automobile of the named insured, with the permission of the named insured. In the event b

44、enefits paid by an insurer pursuant to this subsection are in excess of $75,000 on account of bodily injury to any one person in any one accident covered by a policy issued or renewed prior to January 1, 2004, that excess shall be paid by the insurer and shall be reimbursable to the insurer from the

45、 Unsatisfied Claim and Judgment Fund pursuant to 39:6-73.1. (A) "Emergency personal injury protection coverage" issued pursuant to this section means and includes only payment of treatment for emergency care in an amount not to exceed $250,000 per person per accident. "Emergency personal injury pro

46、tection coverage" shall also include all medically necessary treatment of permanent or significant brain injury, spinal cord injury or disfigurement after the patient is discharged from acute care. (B) "Emergency care" means all medically necessary treatment of a traumatic injury or a medical condi

47、tion manifesting itself by acute symptoms of sufficient severity such that absence of immediate attention could reasonably be expected to result in: death; serious impairment to bodily functions; or serious dysfunction of a bodily organ or part. Such emergency care shall include all medically necess

48、ary care immediately following an automobile accident, including, but not limited to, immediate pre-hospitalization care, transportation to a hospital or trauma center, emergency room care, surgery, critical and acute care. Emergency care extends during the period of initial hospitalization until th

49、e patient is discharged from acute care by the attending physician. Emergency care shall be presumed when medical care is initiated at a hospital within 120 hours of the accident. (2) Death benefit in the amount of $10,000; (3) The tort option provided in 39:6A-8(a) shall apply to every named ins

50、ured and any other person to whom the special automobile insurance policy applies. c. A special automobile insurance policy shall not provide liability, collision, comprehensive, uninsured or underinsured motorist coverage. d. The policy form for special automobile insurance policies shall be subj

51、ect to the approval of the Commissioner of Banking and Insurance and shall clearly and conspicuously set forth the limitations on benefits provided under the policy. e. The commissioner shall approve the rating system to be used for a special automobile insurance policy, which shall be administered

52、 by the plan created pursuant to 17:29D-1, to provide a uniform Statewide rate to be utilized by all insurers providing coverage through a special automobile insurance policy. The rate established by the commissioner shall be sufficient to reimburse the insurer for the cost of writing the policy and

53、 an amount set by the commissioner to be forwarded to the Unsatisfied Claim and Judgment Fund to offset claims paid by the Unsatisfied Claim and Judgment Fund. The commissioner may adjust the rate annually. f. Special automobile insurance policies shall be assigned to insurers pursuant to the appor

54、tionment methodology of the plan created pursuant to 17:29D-1. The number of policies assigned pursuant to this subsection shall not be included in the determination of a competitive market pursuant to 17:33B-15(d). Source: 39:6A-3.3. COMMENT This section is substantially identical to the origi

55、nal. 39A:I-4. Personal injury protection coverage Except as provided by 39:6A-3.3 and 39:6A-3.1, every standard automobile liability insurance policy issued or renewed on or after May 19, 1998 shall contain personal injury protection benefits for the payment of benefits without regard to negligen

56、ce, liability or fault of any kind, to the named insured and members of the insured’s family residing in the insured’s household who sustain bodily injury as a result of an accident while occupying, entering into, alighting from or using an automobile, or as a pedestrian, caused by an automobile or

57、by an object propelled by or from an automobile, and to other persons sustaining bodily injury while occupying, entering into, alighting from or using the automobile of the named insured, with permission of the named insured. No insurer or health provider providing benefits to an insured shall have

58、 a right of subrogation for the amount of benefits paid pursuant to any deductible or copayment under this section. "Personal injury protection coverage" includes: a. Medical expense benefits. Payment of medical expense benefits in accordance with a benefit plan provided in the policy and approved

59、 by the commissioner, for reasonable, necessary, and appropriate treatment and provision of services to persons sustaining bodily injury, in an amount not to exceed $250,000 per person per accident. In the event benefits paid by an insurer pursuant to this subsection are in excess of $75,000 on acc

60、ount of bodily injury to any one person in any one accident, that excess shall be paid by the insurer and shall be reimbursable to the insurer from the Unsatisfied Claim and Judgment Fund pursuant to 39:6-73.1. (1) The policy form, which shall be subject to the approval of the commissioner, shall

61、set forth the benefits provided under the policy, including eligible medical treatments, diagnostic tests and services as well as such other benefits as the policy may provide. The commissioner shall set forth by regulation a statement of the basic benefits which shall be included in the policy. (

62、2) Medical treatments, diagnostic tests, and services provided by the policy shall be rendered in accordance with commonly accepted protocols and professional standards and practices which are commonly accepted as being beneficial for the treatment of the covered injury. Protocols and professional s

63、tandards and practices and lists of valid diagnostic tests which are deemed to be commonly accepted pursuant to this section shall be those recognized by national standard setting organizations, national or state professional organizations of the same discipline as the treating provider, or those de

64、signated or approved by the commissioner in consultation with the professional licensing boards in the Division of Consumer Affairs in the Department of Law and Public Safety. The commissioner, in consultation with the Commissioner of the Department of Health and Senior Services and the applicable l

65、icensing boards, may reject the use of protocols, standards and practices or lists of diagnostic tests set by any organization deemed not to have standing or general recognition by the provider community or the applicable licensing boards. Protocols shall be deemed to establish guidelines as to stan

66、dard appropriate treatment and diagnostic tests for injuries sustained in automobile accidents, but the establishment of standard treatment protocols or protocols for the administration of diagnostic tests shall not be interpreted in such a manner as to preclude variance from the standard when warranted by reason of medical necessity. (3) The policy form may provide for the precertification of certain procedures, treatments, diagnostic tests, or other services or for the purchase of durable me