Roig v. Kelsey

In Roig v. Kelsey, 135 N.J. 500, 505, 641 A.2d 248 (1994), Kelsey was a passenger in a motor vehicle driven by his sister when it was struck by Roig's motor vehicle. As a result, Kelsey incurred medical expenses of $ 1769. Kelsey was eligible for PIP benefits only under his sister's policy, which contained the basic $ 250 medical expense deductible and a 20% copayment for medical expenses between $ 250 and $ 5000; accordingly, $ 553.80 of Kelsey's expenses went unpaid. A declaratory judgment was filed which sought a determination of whether that part of Kelsey's expenses which remained uncompensated because of the deductible and copayment requirement was recoverable from Roig. The Court in Roig summarized the various changes to N.J.S.A. 39:6A- 12 which resulted in a prohibition on the admission of evidence of "the amounts of any deductibles, copayments or exclusions" in a civil action for the recovery of damages for bodily injury. The Court concluded from the statute's incremental changes, as well as the No Fault Law's goal of reducing litigation, that the deductible mandated by the No Fault Law constitutes an amount to be borne by the insured: By mandating the $ 250 deductible and the twenty-percent copayment, the Legislature guaranteed that in every automobile accident some medical expenses would not be paid under PIP. For those below-deductibles and copayments, the insured was responsible, either though the insured's other insurance coverage, or, if the insured had no other insurance, as in this case, out of the insured's own pocket. 135 N.J. at 509, 641 A.2d 248. Roig considered, and rejected, the idea that an injured party could seek recovery of expenses falling within a deductible against a tortfeasor.