Pain and suffering would be recovered exclusively on a first party basis. This change means that rather than suing other parties (even when they are negligent) for pain and suffering damages, TM insurers recover such damages from their own insurance carrier. The limit on recoveries for pain and suffering, therefore, is determined by the policy each individual purchases. Even in TM cases, however, when injuries are inflicted either intentionally or as the result of drug or alcohol abuse, the injured parties can sue the parties who inflicted the damages for pain and suffering, as well as economic, damages without limit. Thus, TM individuals can utilize existing state laws in order to recover all economic damages, and they can purchase pain and suffering coverages in amounts they themselves determine.

      Alternatively, individuals could opt out of the pain and suffering regime altogether by purchasing "personal injury protection" (PIP), which provides insurance coverage for economic damages only. PIP drivers recover from their own insurance carrier for economic damages up to the limit of their policy, without regard to whether they were negligently injured. At the same time, state negligence laws are retained under the PIP system, so that negligent PIP drivers can be sued for all economic damages that exceed their PIP coverage. However, because pain and suffering recoveries are made on a first party insurance basis only, PIP drivers cannot be sued (or for that matter, sue) for pain and suffering damages, with the important exception of injuries inflicted intentionally or as a result of drug or alcohol abuse.