New Jersey § 39:6a-1

§ 39:6a-1.

a. This act shall be known and may be cited as the “Automobile Insurance Cost Reduction

Act.” b. The Legislature finds and declares: Whereas, While New Jersey's automobile insurance no-fault law, enacted twenty-six

years ago, has provided valuable benefits in the form of medical benefits and wage

replacement benefits, without regard to fault, to New Jersey residents who have been

injured in an automobile accident; and Whereas, Medical benefits paid by no-fault policies over those years amount to billions

of dollars, which would otherwise have been paid by health insurance, thus raising

the cost of health insurance for everyone; and Whereas, While medical benefits under no-fault insurance were unlimited under the

law enacted in 1972, the rapidly escalating cost of those benefits made it necessary

for the Legislature to reduce those benefits to a limit of $250,000 in 1990; and Whereas, Since the enactment of the verbal threshold in 1988, the substantial increase

in the cost of medical expense benefits indicates that the benefits are being overutilized

for the purpose of gaining standing to sue for pain and suffering, thus undermining

the limitations imposed by the threshold and necessitating the imposition of further

controls on the use of those benefits, including the establishment of a basis for

determining whether treatments or diagnostic tests are medically necessary; and Whereas, The present arbitration system has not sufficiently addressed the Legislature's

goal of eliminating payment for treatments and diagnostic tests which are not medically

necessary, leading to the belief that a revised dispute resolution mechanism needs

to be established which will accomplish this goal; and Whereas, The principle underlying the philosophical basis of the no-fault system is

that of a trade-off of one benefit for another; in this case, providing medical benefits

in return for a limitation on the right to sue for non-serious injuries; and Whereas, While the Legislature believes that it is good public policy to provide medical

benefits on a first party basis, without regard to fault, to persons injured in automobile

accidents, it recognizes that in order to keep premium costs down, the cost of the

benefit must be offset by a reduction in the cost of other coverages, most notably

a restriction on the right of persons who have non-permanent or non-serious injuries

to sue for pain and suffering; and Whereas, The high cost of automobile insurance in New Jersey has presented a significant

problem for many-lower income residents of the state, many of whom have been forced

to drop or lapse their coverage in violation of the State's mandatory motor vehicle

insurance laws, making it necessary to provide a lower-cost option to protect people

by providing coverage to pay their medical expenses if they are injured; and Whereas, To meet these goals, this legislation provides for the creation of two insurance

coverage options, a basic policy and a standard policy, provides for cost containment

of medical expense benefits through a revised dispute resolution proceeding, provides

for a revised lawsuit threshold for suits for pain and suffering which will eliminate

suits for injuries which are not serious or permanent, including those for soft tissue

injuries, would more precisely define the benefits available under the medical expense

benefits coverage, and establishes standard treatment and diagnostic procedures against

which the medical necessity of treatments reimbursable under medical expense benefits

coverage would be judged; and Whereas, It is generally recognized that fraud, whether in the form of inappropriate

medical treatments, inflated claims, staged accidents, falsification of records, or

in any other form, has increased premiums, and must be uncovered and vigorously prosecuted,

and while the pursuit of those who defraud the automobile insurance system has heretofore

been addressed by the State through various agencies, it has been without sufficient

coordination to aggressively combat fraud, leading to the conclusion that greater

consolidation of agencies which were created to combat fraud is necessary to accomplish

this purpose; and Whereas, With these many objectives, the Legislature nevertheless recognizes that

to provide a healthy and competitive automobile insurance market, insurers are entitled

to earn an adequate rate of return through the ratemaking process, which shall reflect

the impact of the cost-saving provisions of this act and other recent legislative

insurance reforms; and Whereas, The Legislature has thus addressed these and other issues in this comprehensive

legislation designed to preserve the no-fault system, while at the same time reducing

unnecessary costs which drive premiums higher.