SUPERIOR COURT OF NEW JERSEY
APPELLATE DIVISION
A-5477-96T5
ESTATE OF CAREY LEEMAN,
Plaintiff-Respondent,
v.
EAGLE INSURANCE COMPANY,
Defendant-Appellant.
__________________________________________
Argued February 25, 1998 - Decided March 9, 1998
Before Judges Shebell, D'Annunzio and A.A. Rodríguez.
On appeal from the Superior Court of New Jersey,
Law Division, Morris County.
Maureen M. Johnston argued the cause for appellant (Law
Offices of Robert M. Sanderford, attorney; Ms.
Johnston, on the brief).
John S. Hoyt, III argued the cause for respondent (Hoyt
& Hoyt, P.C., attorneys; Mr. Hoyt, on the letter- brief).
The opinion of the court was delivered by
SHEBELL, P.J.A.D.
Plaintiff, Estate of Carey Leeman ("Estate"), filed for arbitration with the American Arbitration Association ("AAA"), seeking personal injury protection ("PIP") benefits under the automobile policy issued to decedent by defendant, Eagle Insurance Company ("Eagle"). Decedent's medical bills and other relevant discovery was exchanged in preparation for arbitration. On February 2, 1996, Eagle filed an action in the Law Division seeking to enjoin the arbitration proceedings. Eagle asserted
that the AAA did not have jurisdiction over the coverage issues
presented and sought a declaratory judgment that Eagle did not
cover the vehicle decedent was driving at the time of the
accident. The Estate took the position that the only issue was
whether decedent, at the time of his accident, was driving a
vehicle being used for personal, non-commercial purposes, and
that the arbitrator could decide this. Thereafter, Eagle
expressed a willingness to withdraw its complaint thereby
allowing the coverage issue to go before the arbitrator.
However, the Estate's counsel then decided to pursue the matter
as a PIP suit in Superior Court, rather than in arbitration.
On March 19, 1996, the Estate filed a Complaint for
Declaratory Judgment in the Law Division, seeking an order
"declaring [decedent] ... to be entitled to PIP benefits together
with any and all recoverable attorney's fees, interest and costs
of suit..." Eagle answered on or about May 23, 1996.
On November 13, 1996, Eagle moved for summary judgment.
Thereafter, the Estate cross-moved for summary judgment. The
judge denied both summary judgment motions without prejudice so
that the parties could conduct further discovery on the issue of
what policy form was applicable. Subsequently, both parties
renewed their summary judgment motions. On May 2, 1997, oral
argument was heard. The Estate stipulated that the policy
language that Eagle's counsel offered would control the court's
interpretation of coverage. The judge ultimately held that the
Estate was entitled to PIP benefits and entered an order to this
effect.
On or about May 14, 1997, the Estate submitted an Affidavit
of Services and Costs along with a proposed form of order under
the "Five Day Rule," Rule 4:42-1(c). The order provided for
$82,713.13 in medical expenses and interest, and attorney's fees
of $16,425.50, for a total of $99,138.63. Eagle objected to the
proposed order on the grounds that the only relief that the
Estate was entitled to was a declaratory judgment on the specific
PIP entitlement issue, and not an award of medical expenses.
Eagle's counsel argued that the medical bills had not been
subjected to the medical fees schedule as required by N.J.A.C.
11:3-29.4, that several of the benefits were incorrectly
computed, and that interest was incorrectly calculated because it
was based on an improper total outstanding amount. Eagle's
counsel also contended that the attorney's fees requested were
excessive. The judge signed the proposed order, reducing the
monetary award to $95,689.63, apparently adjusting for an
overstated funeral expense benefit assessment. Eagle appeals.
Decedent was involved in a single-vehicle accident on June
7, 1994, while driving a Ford Ranger XLT pick-up truck, owned by
his employer, Eastern States Property Management Service
("ESPMS"). Decedent suffered fatal injuries when, while on his
way home, the vehicle went out of control, left the roadway, and
flipped over.
Four days prior to his accident, on June 3, 1994, decedent
dropped off his personal car, a 1968 Chevrolet, at a repair shop.
That same day, decedent's employer, ESPMS, loaned him the pick-up
truck "because [decedent's]...vehicle was broken down." ESPMS
stated it was not common practice for it to loan vehicles to
employees; however, an exception was made and the vehicle was
loaned to decedent so he could get to and from work.
At the time of the accident, decedent's private passenger
vehicle was insured by Eagle. The policy included $250,000 in
PIP coverage. The Estate sought PIP benefits from Eagle on the
basis that decedent was driving a "temporary substitute vehicle"
at the time of his accident because his vehicle was inoperable.
Eagle responded that it was only required to pay under the
$10,000 extended medical expense benefit ("Med-Pay") portion of
decedent's policy. Eagle concluded that PIP benefits were not
payable because decedent was injured while driving a commercial
vehicle he did not own or regularly use.
Two provisions of decedent's policy are alleged to be
applicable to this issue. The first is the following definition
of "private passenger automobile," found in the "Personal Injury
Protection Endorsement" of decedent's policy:
a self-propelled vehicle designed for use
principally on public roads and which is one
of the following types:
(1) a private passenger or station wagon type
automobile,
(2) a van, a pick-up or panel truck or
delivery sedan, or
(3) a utility automobile designed for
personal use as a camper or motor home
or for family recreational purposes;
but
a private passenger automobile does not
include a motorcycle; an automobile used as a
public or livery conveyance for passengers; a
pick-up, panel truck, delivery sedan, van or
utility automobile customarily used for
business, occupational or professional
purposes; other than farming or ranching; or
a utility automobile customarily used for the
transportation of passengers other than
members of the user's family or other guests.
[Emphasis added.]
The second is the definition for "Your Covered Auto," as
found under the "Personal Auto Policy" portion of decedent's
policy to include:
1. Any vehicle shown in the Declarations.
2. Any of the following types of vehicles on the date
you become the owner:
a. a private passenger auto; or
b. a pickup or van that:
(1) has a Gross Vehicle Weight of less than 10,000
lbs.; and
(2) is not used for the delivery or transportation
of goods and materials unless such use is
(a) incidental to your "business" of
installing, maintaining or repairing
furnishings or equipment; or
(b) for farming or ranching.
...
3. Any "trailer" you own.
4. Any auto or "trailer" you do not own while used as a
temporary substitute for any other vehicle described
in this definition which is out of normal use
because of its:
a. breakdown; d. loss; or
b. repair; e. destruction.
c. servicing;
[Emphasis added.]
The motion judge, in granting the Estate's summary judgment motion, based her determination on the reasoning that "private passenger automobile" had a specifically defined meaning under the policy and was only a sub-part of one of the four categories
found under the definition of "your covered auto." The judge
found that if the policy writers had intended "auto" in category
4, relating to temporary substitute vehicles, to mean "private
passenger automobile," the precise language should have been
used. The judge also noted that the term "auto" was not
specifically defined anywhere in the policy and, thus, should be
construed broadly to provide and effectuate coverage. Thus, the
judge ruled that PIP benefits were provided because the vehicle
decedent was driving qualified for coverage under category 4 of
"your covered auto."
The judge did not specifically rule on whether the pick-up
met the definition of "automobile" under N.J.S.A. 39:6A-2. Under
N.J.S.A. 39:6A-2, "automobile" is defined as:
a private passenger automobile of a private
passenger or station wagon type that is owned
or hired and is neither used as a public or
livery conveyance for passengers nor rented
to others with a driver; and a motor vehicle
with a pickup body, a delivery sedan, a van,
or a panel truck or a camper type vehicle
used for recreational purposes owned by an
individual or by husband and wife who are
residents of the same household, not
customarily used in the occupation,
profession or business of the insured other
than farming or ranching. An automobile
owned by a farm family copartnership or
corporation, which is principally garaged on
a farm or ranch and otherwise meets the
definitions contained in this section, shall
be considered a private passenger automobile
owned by two or more relatives resident in
the same household.
[N.J.S.A. 39:6A-2(a) (emphasis added).]
On appeal, Eagle argues that the judge erred in its decision because 1) N.J.S.A. 39:6A-2(a) clearly defines what constitutes
an automobile entitled to PIP benefits, and that the vehicle
driven by decedent at the time of his accident does not fall
under this definition; 2) the Med-Pay benefits satisfied Eagle's
duty to the Estate; 3) decedent's policy cannot be properly
interpreted to provide PIP coverage for an injured insured
driving a substitute commercial vehicle; and 4) the Estate was
not entitled to monetary relief or excessive and unreasonable
attorney's fees as part of their declaratory judgment action.
Under Rule 4:46, summary judgment must be granted if:
the pleadings, depositions, answers to
interrogatories and admissions on file,
together with the affidavits, if any, show
that there is no genuine issue as to any
material fact challenged and that the moving
party is entitled to a judgment or order as a
matter of law. An issue of fact is genuine
only if, considering the burden of persuasion
at trial, the evidence submitted by the
parties on the motion, together with all
legitimate inferences therefrom favoring the
non-moving party, would require submission of
the issue to the trier of fact.
[R. 4:46-2(c).]
In Brill v. Guardian Life Ins. Co.,
142 N.J. 520 (1995), the
Court articulated a new rule for determining whether there is a
genuine issue of material fact for trial. The standard requires
the motion judge to engage in an analytical process essentially
the same as that necessary to rule on a motion for a directed
verdict pursuant to either 4:37-2(b), 4:40-1, or 4:40-2. Brill,
supra, 142 N.J. at 536. The judge must decide whether
the competent evidential materials presented,
when viewed in the light most favorable to
the non-moving party, are sufficient to
permit a rational factfinder to resolve the
alleged disputed issue in favor of the non-moving party...If there exists a single
unavoidable resolution of the alleged
disputed issue of fact, that issue should be
considered insufficient to constitute a
"genuine" issue of material fact for purposes
of Rule 4:46-2.
[Id. at 540.]
Under the language of decedent's insurance policy, the pick-up driven by decedent at the time of his accident would fall under the definition of a private passenger automobile as long as it was not customarily used "for business, occupational or professional purposes; other than farming or ranching." This is different language than the definition of "automobile" under N.J.S.A. 39:6A-2(a). The policy language does not restrict the commercial vehicles exception to those used in the occupation, profession, or business of the insured, as the statute limits it. All insurance policies must conform with statutory mandates, and additional exclusions or eligibility requirements may not be imposed. Motor Club of America Ins. Co. v. Phillips, 66 N.J. 277, 286 (1974); Fellippello v. Allstate Ins. Co., 172 N.J. Super. 249, 261-62 (App. Div. 1979), certif. denied, 85 N.J. 481 (1980); Cynthia M. Craig & Daniel J. Pomeroy, New Jersey Auto Insurance Law, §6:1 at 73 (1998). The PIP statute controls when it conflicts with an insurance policy, even if the Insurance Commissioner approves the policy's language. CSC Ins. Services v. Graves, 293 N.J. Super. 244 (Law Div. 1996). The lower court properly found that policy language "has to be conformed or deemed to be conformed with the statute." Thus, the basic issue
on appeal is whether the pick-up truck, as used by decedent at
the time of the accident, is an automobile as defined under
N.J.S.A. 36:6A-2(a).
"`[T]he meaning of a statute must...be sought in the
language in which the act is framed, and if that is plain,...the
sole function of the courts is to enforce it according to its
terms.'" Sheeran v. Nationwide Mutual Insurance Co.,
80 N.J. 548, 556 (1979) (quoting Caminetti v. United States,
242 U.S. 470, 485,
37 S. Ct. 192, 194,
61 L.Ed. 442, 452 (1917)); accord
Bello v. Hurley Limousines, Inc.,
249 N.J. Super. 31, 36 (1991).
In any event, the No-Fault Insurance Act should be construed
liberally to effectuate its remedial purposes. N.J.S.A. 39:6A-16; Amiano v. Ohio Cas. Ins. Co.,
85 N.J. 85, 90 (1981); Gambino
v. Royal Globe Ins. Co.,
86 N.J. 100, 108 (1981); Fellippello,
supra, 172 N.J. Super. at 261-62.
The plain language of N.J.S.A. 39:6A-2(a) provides that
pick-up trucks may be considered "automobiles" unless they are
customarily used in the occupation, profession, or business of
the insured, other than for farming or ranching. In Cheatham v.
Unsatisfied Claim & Judg. Bd.,
178 N.J. Super. 437, 443 (App.
Div. 1981), we strictly construed the commercial/personal
distinction for pick-up trucks. In Cheatham, supra, plaintiff
sought PIP benefits from the Unsatisfied Claim and Judgment Fund
after he was struck and injured by a pick-up truck while riding a
bike. Id. at 439. Defendant used the pick-up truck for personal
transportation to and from work and to occasionally carry
supplies to and from job sites. Id. at 440. The issue presented
called for interpreting N.J.S.A. 39:6A-2(a)'s definition of
"automobile." We held that the pick-up was not customarily used
in defendant's occupation as it "was no more associated with
[defendant's]...occupation, profession or business than a bus,
had he availed himself of public transportation. There was no
direct relation between the use to which the pickup was put
and...[defendant's business]." Id. at 443.
The Ford Ranger is a "pick-up" truck and the only issue is
whether the truck was customarily used in decedent's occupation,
profession, or business. The decedent did not customarily use
the Ranger as part of his daily work routine. The record shows
that decedent's employer specifically allowed decedent to borrow
the car "because his vehicle was broken down" and because
decedent needed to get to and from work. Decedent used the
vehicle for this purpose for four days. His use of the vehicle
was no more associated with his occupation, profession, or
business than if he had simply availed himself of public
transportation. Id. at 443. There is no evidence that decedent
was using the vehicle in direct relation with his occupation,
profession or business. Cheatham, supra, 178 N.J. Super. at 433.
Thus, the pick-up truck used by decedent at the time of his
accident is an automobile as defined under N.J.S.A. 36:6A-2(a).
In light of our holding, we need not consider the Estate's
argument, adopted by the Law Division judge, that the term "auto"
under the temporary substitute vehicle provision of decedent's
policy encompasses the vehicle and its use at the time of the
accident.
The Law Division judge entered an order in favor of the
Estate for $95,689.63, covering both a monetary award for PIP
benefits and interest, as well as an award for attorney's fees
and costs. Eagle argues that the Estate was not entitled to a
judgment because it failed to specifically request such an order
as part of their complaint for declaratory relief. Eagle
maintains that the Estate only asked for a declaration that the
Estate was entitled to PIP benefits. Eagle also contends that
the lower court incorrectly computed the award. Finally, Eagle
contends that the attorney's fees and costs award was
unreasonable and excessive.
In its affidavit of services and proposed form of order
submitted under the "Five Day Rule," the Estate requested: 1)
medical expense benefits ($47,266.36); 2) funeral expense
benefits ($5,449.00); 3) lost wage benefits ($10,400.00); 4)
death benefits ($10,000.00); 5) essential services benefits
($8,760.00); 6) interest on the total of the previous five
amounts (10,625.77); 7) attorney's fees and costs ($16,425.50);
8) less the amount Eagle paid as Med-Pay ($9,788.00), for a total
of $99,138.63.
Eagle objected to the Estate's proposed form of order for
several reasons, including: 1) that Eagle had not yet had the
opportunity to review the medical fee schedule as set forth in
N.J.A.C. 11:3-29.4; 2) that the Med-Pay amount listed by the
Estate failed to take into account any co-pay or deductible that
would now be permissible based on the court's findings that PIP
payments were due; 3) that the funeral expense benefits should
only be $1,000, as authorized by N.J.S.A. 39:6A-4(e) and under
the policy; 4) that the lost wages benefits should only be $5,200
as authorized by N.J.S.A. 39:6A-4(b) and under the policy; 5)
that the essential services benefits should only be $4,380 as
authorized by N.J.S.A. 39:6A-4(c) and under the policy; 6) that
the statutory interest calculation was incorrect because it was
based on an improper total of the above-stated amounts; and 7)
that any award for attorney's fees and costs would be improper
under the circumstances of the case.
The Estate, as part of their complaint for declaratory
judgment, demanded "declaratory judgment in the form of an Order
declaring [decedent]...to be entitled to PIP benefits together
with any and all recoverable attorney's fees, interest and costs
of suit..." We find it proper for the Law Division to provide
monetary relief, however, the computation must be accurate and
the award of attorney's fees and costs may not be unreasonable or
excessive. The record here is insufficient as to the basis for
the awards. We, therefore, must remand for a hearing and for
proper findings.
The Estate's calculation does not appear to consider the
medical fee schedule as authorized in N.J.A.C. 11:3-29.4. Eagle
objected to the fact that it was not given the opportunity to
have the medical bills adjusted to reflect the medical fee
schedule. Medical fee schedules are pertinent to the
determination of medical fees charged. Thermographic
Diagnostics, Inc. v. Allstate Ins. Co.,
125 N.J. 491, 516 (1991).
Thus, the judge should have allowed Eagle to adjust decedent's
medical bills to reflect the relevant fee schedule. On remand,
this is the course of action to be taken.
The hearing must also clarify the awards for funeral expense
benefits, lost wages benefits, and essential services benefits,
as there is conflict on these issues. See N.J.S.A. 39:6A-4(b),(c)&(e). The statutory interest award must be based on a
proper calculation of the total PIP award.
The Estate's argument that Eagle is estopped from
challenging the court's computation of PIP benefits because Eagle
failed to question or challenge the medical bills and expenses
during either the discovery phase of the aborted arbitration
proceeding or the discovery phase of the current litigation is
clearly without merit. R. 2:11-3(e)(1)(E).
Under N.J.S.A. 39:6A-5(c),See footnote 1 reasonable attorney's fees and
costs must be awarded to a successful claimant in arbitration.
There is no similar statutory provision for a PIP action brought
in Superior Court. However, Rule 4:42-9(a)(6), which allows for
attorney's fees "in an action upon a liability or indemnity
policy of insurance, in favor of a successful claimant," is
authority for permitting awards of attorney's fees and costs.
See Pressler, Current New Jersey Court Rules, Comment 2 on R.
4:42-9(a)(6); Maros v. Transamerica Ins. Co.,
76 N.J. 572, 579
(1978); Brewster v. Keystone Ins. Co.,
238 N.J. Super. 580, 586-87 (App. Div. 1990); Craig & Pomeroy, New Jersey Auto Insurance
Law, §10:5-2 at 150.
An award for attorney's fees and costs is at the court's
discretion. Zyck v. Hartford Ins. Group,
150 N.J. Super. 431,
435 (App. Div.), certif. denied,
75 N.J. 521 (1977). Except in
extraordinary circumstances, an award of attorney's fees will not
be disturbed on appeal. Herman v. Rutgers Cas. Ins. Co.,
221 N.J. Super. 162, 168-69 (App. Div. 1987).
There are seven basic factors that a court can utilize to
determine whether or not to award attorney's fees, including:
"(1) the insurer's good faith in refusing to pay the demands; (2)
excessiveness of plaintiff's demands; (3) bona fides of one or
both of the parties; (4) the insurer's justification in
litigating the issue; (5) the insured's conduct in contributing
substantially to the necessity for the litigation on the
policies; (6) the general conduct of the parties; and (7) the
totality of the circumstances." Enright v. Lubow,
215 N.J.
Super. 306, 313 (App. Div. 1987) (citations omitted), certif.
denied,
108 N.J. 193 (1987). Because of the lack of findings, on
remand, the judge shall reconsider this issue and enter a new
award in accordance with the appropriate authority.
The portion of the order declaring PIP coverage is affirmed.
The monetary portions of the order, including the award of
attorney's fees, is reversed and remanded.
Footnote: 1Now N.J.S.A. 39:6A-5(h), applicable only to accidents occurring after January 10, 1996 and, thus, not applicable to this case.