PIP Claims

Pedestrian Personal Injury Protection (“PIP”) Claims

Pedestrians struck by a private passenger automobile, with no other available coverage, may be entitled to statutory PIP benefits from the Unsatisfied Claim and Judgment Fund, N.J.S.A. 39:6-60 et seq. Notice of the claim must be given within two years of the injury. A Notice of Intention to Make a Claim (“NOI”) form can be downloaded here.

Documents that need to be filed:

A Notice of Intention to Make a Claim (“NOI”) must be completed and submitted if you are filing a claim with the UCJF. An NOI form can be downloaded here. In addition to the NOI, the Association requires the following forms which can be downloaded from the Forms library on the Association’s website:

Hand putting coin into car bank
PIP APPLICATION: FORM LINK

Form made in support of a claim. Must be fully completed and submitted to the Association.

AFFIDAVIT IN SUPPORT OF UCJF ELIGIBILITYFORM LINK

Sworn statement made in support of a claim. Must be fully completed, notarized and submitted to the Association.

CERTIFICATE OF MEDICARE ELIGIBILITY: FORM LINK

Sworn statement made in support of a claimant’s Medicare beneficiary status. Must be fully completed and submitted to the Association.

HIPAA PRIVACY AUTHORIZATION: FORM LINK

Authorization for use or disclosure of protected health information pursuant to the Health Insurance Portability and Accountability Act.