SUPERIOR COURT OF NEW JERSEY
APPELLATE DIVISION
A-4235-97T3
FREDERICK MONROE,
Plaintiff-Respondent,
v.
CITY OF PATERSON, THE CITY OF
PATERSON POLICE DEPARTMENT, and
VICTOR M. SANTIAGO,
Defendants-Appellants.
____________________________________________________________
Submitted January 19, 1999 - Decided March 1, 1999
Before Judges D'Annunzio, Cuff and Collester
On appeal from the Superior Court of New Jersey,
Law Division, Passaic County.
Dwyer, Connell & Lisbona, attorneys for appellants
(Albert C. Lisbona, on the brief).
Richard Mik, attorney for respondent (Mr. Mik,
on the brief).
The opinion of the court was delivered by
D'ANNUNZIO, J.A.D.
The issue is whether an uninsured motorist may recover
medical expenses and lost income from a tortfeasor in an
automobile negligence case.
Plaintiff, Frederick Monroe, a resident of Paterson, N.J.,
owned a 1976 Oldsmobile registered in New Jersey. In violation
of N.J.S.A. 39:6A-3 and 6B-1, Monroe had failed to insure his
vehicle. On August 7, 1993, Monroe was operating his uninsured
vehicle in Paterson when he collided with a vehicle owned by the
City of Paterson and operated by Victor M. Santiago, a City
employee.
Monroe sued for damages consisting of economic loss, medical
expenses and lost wages, and non-economic loss, such as pain and
suffering. Because Monroe's claim is against a public entity and
public employee, the New Jersey Tort Claims Act applies.
N.J.S.A. 59:1-1 et. seq. The claim, however, is based on the
alleged negligent operation of a motor vehicle and, therefore,
implicates the New Jersey Automobile Reparation Reform Act,
N.J.S.A. 39:6A-1 to -35, popularly known as the No-Fault Law.
The trial court granted partial summary judgment to
defendants regarding Monroe's claim for non-economic loss,
because Monroe had not established the injury threshold defined
in N.J.S.A. 59:9-2(d)See footnote 1 of the Tort Claims Act. That
determination is not an issue in this appeal.
Monroe pressed his claim for economic damages, and the
liability issue was tried without a jury. The court apportioned
responsibility for the collision ninety percent to Santiago and
ten percent to Monroe.
Thereafter, defendant moved for summary judgment on the
ground that Monroe was not entitled to recover economic damages
because he had failed to insure his vehicle. The court denied
defendants' motion and entered judgment in favor of Monroe for
$9,240.00 in lost wages and $7,077.50 in medical expenses, for a
total of $16,317.50. Judgement was entered for $14,685.75,
reflecting the ten percent reduction for Monroe's negligence.
There is nothing in the record to suggest that Santiago's
operation of the City's vehicle was cloaked with an immunity
under the Tort Claims Act. Consequently, this is a motor vehicle
negligence actionSee footnote 2, and Monroe's right to recover medical
expenses and lost wages is governed by the No-Fault Law. Brooks
v. Odom,
150 N.J. 395, 406-07 (1997) (holding that claimant could
not recover against a public entity, her "out-of-pocket expenses
for co-payments and deductibles under her [PIP] coverage.")
At the core of this case is the application of N.J.S.A.
39:6A-12 (section 12). It provides:
Except as may be required in an action
brought pursuant to section 20 of P.L. 1983,
c. 362 (C. 39:6A-9.1), evidence of the
amounts collectible or paid pursuant to
sections 4 and 10 of P.L. 1972, c. 70 (C.
39:6A-4 and 39:6A-10), to an injured person,
including the amounts of any deductibles,
copayments or exclusions, including
exclusions pursuant to subsection d. of
section 13 of P.L. 1983, c. 362 (C. 39:6A-4.3), otherwise compensated is inadmissible
in a civil action for recovery of damages for
bodily injury by such injured person.
The court shall instruct the jury that,
in arriving at a verdict as to the amount of
the damages for noneconomic loss to be
recovered by the injured person, the jury
shall not speculate as to the amount of the
medical expense benefits paid or payable by
an automobile insurer under personal injury
protection coverage to the injured person,
nor shall they speculate as to the amount of
benefits paid or payable by a health insurer,
health maintenance organization or
governmental agency under subsection d. of
section 13 of P.L. 1983, c. 362 (C. 39:6A-4.3).
Nothing in this section shall be construed to
limit the right of recovery, against the
tortfeasor, of uncompensated economic loss
sustained by the injured party.
[Emphasis added.]
The section 4 referred to in section 12 requires each automobile
liability insurance policy to provide personal injury protection
(PIP) coverage. N.J.S.A. 39:6A-4. PIP coverage includes medical
expense benefits, income continuation benefits, essential
services benefits, death benefits and funeral expense benefits.
Ibid. Section 10 authorizes additional PIP coverage. N.J.S.A.
39:6A-10. PIP coverage is first party coverage, i.e., the
insured collects the benefits from his or her carrier.
Defendants argue that Monroe's medical expenses and lost
wages would have been "collectible" under PIP coverage, if Monroe
had obeyed the law and insured his vehicle. Therefore, his
medical expenses and lost wages were inadmissible under section
12 and not recoverable.
Our Supreme Court addressed section 12 in Roig v. Kelsey,
135 N.J. 500 (1994). There, the injured person's PIP coverage
included a $250 medical expense deductible and a twenty-percent
copayment for medical expenses between the deductible and $5,000.
As a result, Kelsey, the injured person, had unpaid medical
expenses of $553.80. Writing for the Court, Justice Garibaldi
engaged in a comprehensive and thorough review of the legislative
history of the No-Fault Law relevant to the issue, especially
section 12. We need not relate the history of No-Fault
legislation, but we shall rely on certain basic principles which
emerged from Justice Garibaldi's analysis and we shall borrow
freely from her opinion.
One of those principles is that of consumer choice. A
consumer could elect certain automobile coverages which would
provide greater or lesser rights. The trade-off was in premiums
paid. Greater rights required higher premiums; lesser rights
generated lower premiums. Roig, supra, 135 N.J. at 506-07. In
the present case, Monroe achieved the ultimate in savings by
paying no premiums.
A second relevant principle is that "by mandating the $250
deductible and the twenty-percent copayment, the Legislature
guaranteed that in every automobile accident, some medical
expenses would not be paid under PIP. For those below-deductibles and copayments, the insured was responsible, either
through the insured's other insurance coverage, or, if the
insured had no other insurance coverage, . . . out of the
insured's own pocket." Id. at 509.
In addressing the inadmissibility of PIP benefits under
section 12, the Court stated:
In sum, courts have held that PIP benefits
are strictly excluded from a civil suit by
the injured party to serve a variety of
goals: easing court congestion, lowering
automobile-insurance premiums, and
prohibiting double recovery of PIP expenses.
Although Kelsey's case does not involve
double recovery, we conclude that under no-fault the parties have traded lower premiums
and prompt payment of medical expenses for a
restriction on their right to sue.
[Roig, supra, 135 N.J. at 513.]
Justice Garibaldi identified an unacceptable anomaly:
If an insured chooses a $1,000 or $2,500
deductible in exchange for a premium
reduction, the Legislature, clearly, did not
intend that that insured would be able to sue
the tortfeasor for the below-deductibles.
Under that logic, insureds choosing the
highest deductible would have the best deal:
the lowest premium and the right to recover
the excluded expenses in court against the
tortfeasor . . . To allow a claim for the
deductible and the copayment would be
antithetical to the entire No-Fault statutory
scheme. That kind of recovery could be
available only if the Legislature
reinstituted a fault-based system.
[Roig, supra, 135 N.J. at 514.]
Justice Garibaldi addressed and rejected Kelsey's argument
that section 12's exclusion of medical expense evidence applies
only to those expenses "otherwise compensated," noting that
"[s]uch an interpretation is contrary to the clear legislative
intent of the No-Fault Law." Id. at 515.
Finally, the Court stated:
We are satisfied that the Legislature never
intended to leave the door open for fault-based suits when enacting the No-Fault Law.
If we adopted Kelsey's reading of the
statute, courts would again feel the weight
of a new generation of congestion-causing
suits, and automobile-insurance premiums
would again rise. If the Legislature
disagrees with our interpretation of its
intent, it is, of course, empowered to enact
clarifying legislation.
[Roig, supra, 135 N.J. at 516.]
There was a legislative response. The Legislature amended
N.J.S.A. 39:6A-4.5a (section 4.5) in 1997. L. 1997, c.151, § 13.
Prior to the amendment, section 4.5 provided that any injured
person who was required to carry medical expense benefits
coverage, but who failed to do so, was subject to the verbal
threshold, N.J.S.A. 39:6A-8, for the recovery of noneconomic
loss. The 1997 amendment of section 4.5 provides that such a
person "shall have no cause of action for recovery of economic or
noneconomic loss sustained as a result of an accident while
operating an uninsured automobile." The amendment, adopted
after Monroe's injury, does not control this case, but it informs
our analysis.
In Brooks v. Odom, supra, the Court held that a plaintiff
may not recover from a public entity and public employee "her
out-of-pocket expenses for co-payments and deductibles under her
Personal Injury Protection ("PIP") coverage." Brooks, supra, 150
N.J. at 406. The Court identified the "underlying policy
considerations" as preventing minor claims for reimbursement from
clogging the court system. Id. at 406-07. The Court expressly
left open "the question whether uninsured claimants who may not
recover for pain and suffering under N.J.S.A. 59:9-2(d) may
nonetheless recover the cost of their medical expenses." Id. at
407. As previously indicated, the Legislature, by amending
section 4.5, answered "no" to the reserved question.
The present case is not controlled by amended section 4.5;
it involves the issue the Court reserved in Brooks. Applying the
principles of Roig and Brooks, we conclude that Monroe may not
recover economic expenses that would have been collectible as PIP
benefits had he insured his vehicle. Permitting uninsured
vehicle owners to recover without contributing premiums to the
insurance pool would increase premiums for those motorists who
fulfill their statutory obligations by insuring their vehicles.
Precluding recovery also avoids the anomaly Justice Garibaldi
identified in Roig, placing an uninsured motorist in a better
position than an insured driver. If permitted to sue for
economic loss, the uninsured motorist would recover the
deductible and copayment amounts. Additionally, an uninsured who
satisfied the injury threshold and sued for pain and suffering
would enjoy a tactical advantage at trial if he could introduce
evidence of his out-of-pocket losses. Moreover, permitting
recovery would add to court congestion because a tort action
would be the only method of recovering economic loss.
The last sentence of section 12 permits the "recovery
against the tortfeasor, of uncompensated economic loss."
Assuming that this sentence permits recovery of a wage loss in
excess of PIP income continuation benefits, Monroe, arguably,
should be permitted to recover the difference between his wage
loss and basic income continuation benefits of $100 per week.
N.J.S.A. 39:6A-4b. Such a result, however, would require us to
speculate regarding the level of coverage Monroe would have
selected. Additional and substantial income continuation
benefits are available from insurers as authorized in N.J.S.A.
39:6A-10. If Monroe had purchased insurance, we would know his
benefit level. His failure to insure deprives us of that
information. It is not unreasonable, therefore, to burden him
with the consequences. Cf. Menichelli v. Mass. Gen. Life Ins.
Co.,
152 N.J. 194, 196 (1997) (holding that material
misrepresentation that decedent was not a cigarette smoker
required rescission rather than reformation to establish
beneficiary's liability for higher premiums; the remedy of
reformation would reward and promote dishonesty); Mass. Mutual
Life Ins. Co. v. Manzo,
122 N.J. 104, 115 (1991) (holding that
life insurer may rescind policy for material misrepresentation
though the truth would not have precluded issuance of policy;
dishonest applicant must not be placed in a better position than
honest applicant, and incentive for dishonesty must be avoided).
Moreover, this approach is consistent with the legislative policy
recently expressed in the amendment to section 4.5.
Finally, we address Monroe's argument that the provision of
section 4.5 in effect when Monroe was injured, imposed a limited
sanction for failure to carry insurance, to wit, that the injured
party had to satisfy the verbal threshold to pursue a claim for
noneconomic loss. Monroe contends, therefore, that section 4.5
implied that an uninsured injured party could pursue a claim for
economic damages.
We reject this argument. Former section 4.5 dealt only with
an injured party's right to recover damages for noneconomic
losses. It did not address economic damages, perhaps because
section 12 provided that amounts collectible through PIP coverage
were not admissible.
The judgment is reversed.
Footnote: 1 N.J.S.A. 59:9-2(d) authorizes damages for pain and
suffering only "in cases of permanent loss of a bodily function,
permanent disfigurement or dismemberment when the medical
expenses are in excess of $1,000.00."
Footnote: 2 N.J.S.A. 59:3-1 states that "[e]xcept as otherwise
provided by this act, a public employee is liable for injury
caused by his act or omission to the same extent as a private
person."
N.J.S.A. 59:2-2 provides that a public entity is liable when its public employee is liable acting within the scope of his employment.