Personal Auto Claims Forms
We’ve gathered all the forms and information you need if your vehicle is damaged or you’re injured in an auto accident.
Physical Damage Forms
Medical Services Forms
Application for Benefits must be completed by the injured party.
Employers must fill out a Wage and Salary Verification Form for an injured party to be reimbursed for lost wages.
Physical Damage Forms
Medical Services Forms
Application for Benefits must be completed by the injured party and returned to NJM no later than one year from the date of the accident.
Employers must fill out a Wage and Salary Verification Form for an injured party to be reimbursed for lost wages.
Physical Damage Forms
PIP: It's the Law
New Jersey law includes Decision Point Review, Precertification, and Notification Requirements for patients who are injured in auto accidents and their medical providers.
Learn about the Use of Telemedicine and Telehealth During the Coronavirus Pandemic.
Medical Services Forms
Application for Benefits must be completed by the injured party.
Employers must fill out a Wage and Salary Verification Form for an injured party to be reimbursed for lost wages.
Important No-Fault medical information for the insured.
Important requirements for the health care provider.
Health care providers must send their treatment plans to NJM in writing using the Attending Provider Treatment Plan (APTP) Form.
All requests for surgical procedures (CPTs 10000–69999) have to be submitted with the Surgery Precertification Request NJ No-Fault Claims Form.
All requests for pre-service appeal must include a fully completed New Jersey Pre-Service Appeal Form faxed to the appropriate NJM office below.
All requests for post-service appeal must include a fully completed New Jersey Post-Service Appeal Form faxed to NJM at 1-609-963-6075.
Precertification Mail
NJM Insurance Group
Attn: PIP Department
301 Sullivan Way
PO Box 928
West Trenton, NJ 08628-0278
Precertification Fax
1-609-493-1277 West Trenton
1-609-493-1565 Parsippany
1-609-493-1474 Hammonton
Physical Damage Forms
Medical Services Forms
Application for Benefits must be completed by the injured party.
Physical Damage Forms
Pennsylvania Claimant's Report
Medical Services Forms
Application for Benefits must be completed by the injured party.
Employers must fill out a Wage and Salary Verification Form for an injured party to be reimbursed for lost wages.