SUPERIOR COURT OF NEW JERSEY
APPELLATE DIVISION
A-5988-95T2
KAREN METAKES PARISI,
Plaintiff-Respondent,
v.
AETNA CASUALTY AND SURETY COMPANY,
as servicing carrier for the NEW
JERSEY FULL INSURANCE UNDERWRITERS
ASSOCIATION; and AETNA CASUALTY
AND SURETY COMPANY,
Defendant-Appellant.
_________________________________________________________________
Argued December 10, 1996 - Decided January 6, 1997
Before Judges Pressler, Stern and Wecker.
On appeal from the Superior Court of New Jersey,
Law Division, Hudson County.
John V. Petrycki, Jr. argued the cause for appellant
(Fitzpatrick, Reilly, Supple & Gaul, attorneys;
John V. Petrycki, Jr., on the brief).
Theodore F. Kerin argued the cause for respondent
(Sullivan & Liapakis, attorneys; Mr. Kerin, on
the letter brief).
The opinion of the court was delivered by
PRESSLER, P.J.A.D.
Defendant Aetna Casualty and Surety Company appeals from a summary judgment adjudicating its liability, by way of declaratory judgment, to pay personal injury protection (PIP) benefits to plaintiff Karen Metakes Parisi. We conclude that the trial judge
was correct in rejecting Aetna's statute of limitations defense,
and, accordingly, we affirm.
The novel issue before us requires us to determine when the
cause of action accrues against a PIP carrier that is not primarily
liable. Analogizing to excess insurance, we are satisfied that the
cause does not accrue until the injured person entitled to benefits
knows or is chargeable with knowing that the primary coverage will
be inadequate. N.J.S.A. 39:6A-13.1 requires the action for PIP
benefits to be brought within two years, extendable to four in
specified circumstances, "after the injured person ... suffers a
loss or incurs an expense...." In our view, if the injured person
is required to exhaust primary coverage before recourse to "excess"
coverage, the loss vis-a-vis the excess coverage has not been
suffered until the exhaustion occurs.
The facts giving rise to this controversy are not in dispute.
In September 1989, plaintiff, a pedestrian, was struck by a vehicle
registered in New Jersey owned by Chimanbha G. Patel, driven by his
wife, Rashmika Nancy Patel, and insured by defendant Aetna.
Plaintiff, not a New Jersey resident, had an automobile policy
issued to her in New York by The Travelers whose total combined no-fault benefits were statutorily limited to $50,000. N.Y. Ins. Law
§ 5102(a) (McKinney 1996).See footnote 1 Plaintiff's medical and hospital bills
were submitted to The Travelers, which had assumed its PIP
responsibilities from the outset. It appears from the
certifications filed in the trial court that plaintiff's injuries
included shoulder and knee injuries as well as a variety of soft-tissue injuries. Her initial treatment was conservative in an
attempt to avoid surgery, and in the first several years following
the accident, her total medical bills amounted to about $20,000.
As time went on, however, more aggressive intervention became
necessary, and plaintiff underwent lateral release surgery to
repair her knee injury and, in 1994, complex reconstructive surgery
of her left shoulder, an eventuality that had not been foreseen
early on.
It appears that when the shoulder surgery was scheduled,
plaintiff was concerned about the adequacy of her remaining
Traveler's benefits. In early January 1994, she determined that
about $35,000 had already been spent for her care. At that time,
her attorney wrote to Aetna, advising it that there were probably
insufficient benefits left on the Traveler's policy to cover
plaintiff's future expenses. Pointing out that "Aetna would
already have a substantial file in this matter concerning the
liability claim against your driver, and that file should contain
the medical reports," plaintiff's attorney demanded that Aetna
prepare to pay medical expenses in excess of $50,000 should that
amount be reached and that it "set up a `no-fault' file in this
matter for future bills." On February 24, 1994, Aetna responded to
counsel by form letter, disclaiming coverage on the ground of the
statute of limitations, N.J.S.A. 39:6A-13.1; the anti-stacking
provision of the statute, N.J.S.A. 39:6A-4.2; and, because
plaintiff was a pedestrian, the inapplicability of the so-called
"deemer" statute, N.J.S.A. 17:28-1.4. This action was commenced in
April 1994.
Defendant moved for summary judgment dismissing the complaint.
Abandoning its anti-stacking and deemer arguments, it relied
exclusively on N.J.S.A. 39:6A-13.1. The trial judge, concluding
that the suit was not thereunder barred, granted plaintiff's cross-motion for summary judgment, adjudicating Aetna's liability for PIP
payments in excess of $50,000. Aetna appeals.
At the outset, we assume that Aetna's abandonment of its anti-stacking argument was based on Judge King's analysis in Martin v.
Prudential Ins. Co.,
255 N.J. Super. 524 (App. Div. 1992), of the
import of N.J.S.A. 39:6A-4.2. That provision, enacted in 1983, has
a two-pronged significance. First, it renders the named insured's
personal injury protection the primary coverage as well as the
primary coverage of resident relatives of the insured's household
not having their own insurance. Second, it has an anti-stacking
provision preventing recovery of PIP benefits under more than one
automobile policy for injuries sustained in a single accident.
Martin construed the anti-stacking provision in the context of a
Pennsylvania resident who had her own Pennsylvania family
automobile policy and who was injured in New Jersey while a
passenger in a New Jersey-registered automobile. The Pennsylvania
policy afforded medical benefits of $10,000. Martin obtained and
exhausted those benefits under that policy. She then sought PIP
benefits from her host driver's New Jersey policy issued by
Prudential Insurance Company. Prudential argued that by having
accepted the medical pay limits on her own policy, Martin was
precluded by N.J.S.A. 39:6A-4.2 from recourse against its policy.
In rejecting that argument, this court held that the anti-stacking
provision, intended to prevent double recovery, did not apply.
Judge King reasoned as follows:
While the language of N.J.S.A. 39:6A-4.2
may arguably support more than one
interpretation, including that advanced here
by Prudential, we conclude that the
construction urged by appellant Martin is the
correct one.
Discerning the will of the legislature in this
case is neither difficult nor a matter of
first impression. Our courts have
consistently held that the language under
consideration here...."[n]o person shall recover
personal injury protection benefits under more
than one automobile insurance policy for
injuries sustained in any one accident"....is a
prohibition against double PIP recovery.
This case does not involve a double recovery. Prudential urges that Allstate's $10,000 payment under Martin's Pennsylvania-issued policy cut off any obligation it had to pay PIP benefits for her injuries. This interpretation requires us to conclude that the Legislature had some additional interest in placing a limitation on the source of PIP medical benefits, apart from its obvious interest in avoiding a double recovery. We find neither authority for this view nor reason behind it. The PIP statute provided for medical benefits coverage (unlimited in 1989) to "persons sustaining bodily injury while occupying" the automobile of the named insured. N.J.S.A. 39:6A-4. No attempt was made to limit the rights of nonresident guest passengers in New Jersey-insured vehicles who might have modest medical expense benefits under their own family policies in our sister
states under diverse or disparate statutory
schemes. We conclude that the Legislature did
not intend by N.J.S.A. 39:6A-4.2 to preclude a
seriously injured victim from recovering the
statutorily-mandated benefits from an other-wise primarily liable insurer merely because
of an inconsequential medical benefits
payment, such as Allstate made in this case.
[Citations omitted.]
[255 N.J. Super. at 526-528]
We fully endorse that reasoning and conclude that it applies
here. See also Martin v. Home Ins. Co.,
141 N.J. 279 (1995). We
see little difference between an out-of-state medical pay coverage
with a $10,000 maximum and an out-of-state no-fault coverage
affording $50,000 maximum coverage for all economic losses
attributable to the accident. In our view, the New York no-fault
policy here, like the Pennsylvania policy in Martin, fits the
category of "modest medical expense benefits under ... family
policies [issued] in sister states under diverse or disparate
statutory schemes." Id. at 527. And such policies do not come
within the anti-stacking bar.
In further support of the applicability of Judge King's
reasoning here, we point out that in Martin v. Home Ins. Co.,
supra, 141 N.J. at 281-282, the Supreme Court emphasized the
legislative policy, expressed in part through the so-called deemer
statute, that persons injured in automobile accidents in this
State, whether or not resident here, should be entitled to the full
economic protection afforded by New Jersey's generous no-fault
benefits. We think it clear that this policy is advanced by
permitting a non-resident injured in New Jersey to have recourse to
available New Jersey PIP coverage after exhausting the modest
benefits available under her home state laws. In any event, we
need not further address this issue in view of Aetna's decision to
abandon the anti-stacking defense.
With respect to the statute of limitations defense, N.J.S.A.
39:6A-13.1a provides as follows:
Every action for the payment of benefits
set forth in sections 4 and 10 of this act,
except an action by a decedent's estate, shall
be commenced not later than 2 years after the
injured person or survivor suffers a loss or
incurs an expense and either knows or in the
exercise of reasonable diligence should know
that the loss or expense was caused by the
accident, or not later than 4 years after the
accident whichever is earlier, provided,
however, that if benefits have been paid
before then an action for further benefits may
be commenced not later than 2 years after the
last payment of benefits.
We recognize that the statute imposes a four-year bar, measured from the date of the accident, on the bringing of a PIP action and that this action was not commenced until more than four and a half years had elapsed.See footnote 2 We agree, however, with the trial judge that in the special circumstances here, the bar does not apply. That is so because in the ordinary case, the cause of action against the PIP carrier accrues when the accident occurs. The primary carrier is immediately responsible for the medical expenses. Here, however, there was a different primary carrier on an out-of-state policy against whose coverage plaintiff was first
obliged to seek recourse. Her right to benefits under the Aetna
policy did not, therefore, accrue until her primary coverage was
exhausted or, at the earliest, until she knew or was reasonably
chargeable with knowledge that they would be exhausted. See, e.g.,
Arico v. Township of Brick,
281 N.J. Super. 471, 475 (App. Div.),
certif. denied,
142 N.J. 515 (1995), making clear that the excess
insurer's obligation to pay does not accrue until the occurrence of
the condition triggering the obligation. See also 8A Appleman,
Insurance Law and Practice, § 4909 at 390, 393 (1981). In this
posture, we think it plain that plaintiff did not have a right
against Aetna until exhaustion of her New York policy benefits and
that any claim she might have earlier made against it would have
been premature. Indeed, Aetna itself so recognized since the first
affirmative defense of the eight pleaded in its answer asserted
that "[n]o right or benefit, either contractual or statutory, has
accrued or matured to the benefit of plaintiff...." Thus it is
clear that if the limitations statute were strictly and literally
construed in this instance, coverage would be defeated ab initio.
We do not believe that the Legislature intended such a result. We
conclude, therefore, that in the special situation of inter-state
coverages where the New Jersey PIP policy serves as excess
insurance, the limitations period does not begin to run until the
right against the carrier accrues.
Finally, we note that in this case we do not see how Aetna has
been prejudiced by the delay, and indeed, it does not assert that
it has been. It has long since undertaken the defense of its
insureds, the tortfeasors in plaintiff's automobile negligence
action. It is fully aware of her damage claims as well as her
liability claims, has had full access to her medical records, and
has the right to have her examined by physicians of its own
choosing.
We address one final matter. Plaintiff points to that
provision of N.J.S.A. 39:6A-13.1 extending the limitations period
to two years following the last payment of benefits. She argues
that that provision applies here even though the suit is not
against the same carrier that made the payments. While we are
satisfied that identity of the carrier was probably contemplated by
the statute, we do not altogether reject the applicability of the
proviso. To the extent the provision imposes upon the injured
person the necessity of acting promptly following the last payment,
that is, within two years, this plaintiff has met that requirement.
The order denying defendant's motion for summary judgment and
granting plaintiff's cross motion for declaratory judgment is
affirmed.
Footnote: 1It appears that plaintiff had not opted for the maximum $25,000 supplemental benefits at additional premium provided for by N.Y. Ins. Law § 5102(a)(5). Footnote: 2Clearly, if the action had been brought within the four-year "cap," it would not have been barred by the two-year limitation if the primary benefits had not by then been exhausted.