Excess Medical Benefits ( EMB )
Excess Medical Benefits (EMB) provide a measure of relief to private passenger automobile insurers for medical benefits paid under Personal Injury Protection (PIP) coverage. This reimbursement spreads risk across the New Jersey private passenger automobile insurance system, sparing individual policyholders from disproportionately bearing the costs that expensive claims can impose on a single company. Insurers are reimburesed for medically necessary and appropriate PIP benefits that exceed $75,000 as follow:
Unlimited EMBs - for policies issued prior to January 1, 1991.
Limited EMBs - reimbursement up to $250,000 for policies issued between January 1, 1991 and December 31, 2003.
No EMB reimbursement for policies issued after January 1, 2004.
A claim is reportable to PLIGA when the potential exposure to the insurer exceeds $75,000 or when a total of $50,000 has been paid by the insurer. The insurer submits an itemized account with supporting documentation using applicable EMB forms that can be downloaded from our Forms Library. Subsequent submissions are provided on a quarterly basis.
An EMB claim is payable by PLIGA once insurers comply with the above and statutory and regulatory requirements.
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