KIMBERLY BRITTEN,
Plaintiff-Respondent,
vs.
LIBERTY MUTUAL INSURANCE
COMPANY,
Defendant-Appellant.
___________________________________
Argued December 6, 2006 - Decided
Before Judges Lefelt, Parrillo and
Sapp-Peterson.
On appeal from the Superior Court of New Jersey, Law Division, Ocean County,
L-1418-05.
Donna M. Hawley argued the cause for appellant (Sherman & Viscomi, attorneys; Ms.
Hawley, on the brief).
Eugene C. Hendrickson argued the cause for respondent (Hendrickson & Edelstein, attorneys; Mr.
Hendrickson, of counsel and on the brief).
The opinion of this court was delivered by
SAPP-PETERSON, J.S.C. (temporarily assigned).
Defendant insurer, Liberty Mutual Insurance Company, appeals the entry of orders denying its
motion for summary judgment but granting plaintiff Kimberly Britten's cross-motion for summary judgment.
The motion judge ruled that plaintiff was entitled to recover Personal Injury Protection
(PIP) benefits under her personal automobile insurance policy as well as her mother's
personal automobile insurance policy. The court rejected the defendant's contention that the anti-stacking
provisions of N.J.S.A. 39:6A-4.2 preclude plaintiff from securing benefits under both policies. We
reverse.
The facts are not disputed. Plaintiff was involved in a motor vehicle accident
on May 19, 2004, while operating her privately owned vehicle. This vehicle was
insured by State National Insurance Company (SNIC). Under the terms of the policy,
plaintiff selected $75,000 worth of PIP benefits. At the time of the accident,
plaintiff resided with her mother, Janet Britten, who was the named insured on
an automobile policy issued by defendant that included PIP benefits up to $250,000.
Janet Britten's policy also extended coverage to her resident relatives, subject to exclusions.
One such exclusion denies liability coverage and PIP benefits to resident relatives for
injuries sustained as a result of an accident involving a vehicle owned by
a resident family member other than Janet Britten.
As a result of the accident, plaintiff sustained injuries requiring numerous medical procedures.
The medical bills associated with these injuries exceeded the $75,000 PIP benefits available
under plaintiff's SNIC policy. As a result, plaintiff filed a claim with defendant
seeking additional PIP benefits under her mother's policy. Defendant denied the claim.
Plaintiff filed a complaint on May 5, 2005, seeking declaratory relief against defendant,
declaring that as a resident member of her mother's household, she was eligible
to recover PIP benefits under her mother's policy in addition to the benefits
she secured under her own personal auto insurance policy. In granting plaintiff's summary
judgment cross-motion and denying defendant's summary judgment motion, the court found that as
a resident family member:
[plaintiff] was already in a sense insured under the $250,000. She had a
right as a household member to collect under the $250,000. What she did
not have a right to collect on was that portion in which she
had other insurance in which she was the primary insured. And so I
agree that she is entitled to the coverage under her mother's policy less
the insurance that she had purchased, the $75,000, which results in $175,000 worth
of coverage under her mother's policy.
From this decision, defendant filed a timely appeal. Defendant contends the trial court
failed to apply the applicable case law. A trial court's interpretation of the
law and the legal consequences that flow from established facts are not entitled
to any special deference. State v. Brown,
118 N.J. 595, 604 (1990); Dolson
v. Anastasia,
55 N.J. 2, 7 (1969); Pearl Assurance Co. Ltd. v. Watts,
69 N.J. Super. 198, 205 (App. Div. 1961).
N.J.S.A. 39:6A-4.2 authorizes PIP benefits to the named insured and resident members of
the insured's household, provided the resident member is "not a named insured under
an automobile insurance policy of his own." Recovery of PIP benefits is further
circumscribed under this section. "No person shall recover personal injury protection benefits under
more than one automobile insurance policy for injuries sustained in any one accident."
Ibid. This provision is part of the Automobile Insurance Cost Reduction Act, (AICRA),
N.J.S.A. 39:6A-1.1 to -35, enacted in 1998.
AICRA represents the most recent effort to provide comprehensive benefits to automobile accident
victims at reduced costs. These efforts commenced in 1972 with enactment of the
New Jersey Automobile Reparation Reform Act (No Fault) and have continued over the
years, albeit without accomplishing the level of success envisioned.
In the area of PIP benefits, prior to AICRA, all underwriters of New
Jersey auto insurance policies were required to include PIP coverage of $250,000. With
the enactment of AICRA, the Legislature added N.J.S.A. 39:6A-4.3, which provides in pertinent
part:
With respect to personal injury protection coverage provided on an automobile in accordance
with section [39:6A-4], the automobile insurer shall provide the following coverage options:
. . . .
e. Medical expense benefits in amounts of $150,000, $75,000, $50,000 or $15,000 per
person per accident; . . . . The coverage election form shall contain
a statement, clearly readable and in 12-point bold type, . . . that
election of any of the aforesaid medical expense benefits options results in less
coverage than the $250,000 medical expense benefits coverage mandated prior to the effective
date of [AICRA].
If none of the aforesaid medical expense benefits options is affirmatively chosen in
writing, the policy shall provide $250,000 medical expense benefits coverage[.]
[N.J.S.A. 39:6A-4.3(e).]
Under this provision, the Legislature eliminated the mandatory $250,000 PIP coverage and afforded
to insureds, at reduced costs, a wide range of PIP benefit levels with
commensurate premiums. See Id.
In the present matter, it is undisputed that for her own personal vehicle,
plaintiff selected medical expense benefits in the amount of $75,000. In making this
selection, not only was plaintiff afforded medical expense benefits at a lower cost,
but she was also on notice that "election of [the $75,000] medical expense
benefits option[] result[ed] in less coverage than the $250,000 medical expense benefits coverage
mandated prior to the effective date of [AICRA]." Id. By its plain language,
this section clearly contemplates that consumers who elect lesser benefits in exchange for
lower premiums will not be eligible for greater benefits.
Plaintiff, relying upon pre-AICRA cases, argues that she is not precluded from recovering
PIP benefits as a resident insured under her mother's policy by virtue of
her own personal auto insurance policy. Rather, she is only precluded from a
double recovery, which plaintiff maintains results from recovery under her mother's policy, without
crediting the $75,000 in PIP benefits to which she is entitled under her
own insurance policy. See Martin v. Prudential Ins. Co.,
255 N.J. Super. 524,
526-28 (App. Div. 1992); Parisi v. Aetna Cas. Sur. & Co.,
296 N.J.
Super. 179, 183-84 (App. Div. 1997). We disagree.
The plain language of N.J.S.A. 39:6A-4.3(e) puts consumers on notice that election of
a lower benefits option, in consideration of a reduced premium, denies eligibility for
the $250,000 of benefits formerly mandated and evidences the clear intent of the
Legislature that New Jersey PIP policies will often not contain identical benefits. Furthermore,
Martin and Parisi are distinguishable.
In Martin, supra, we rejected the insurer's contention that N.J.S.A. 39:6A-4.2 precludes recovery
of medical benefits from multiple sources. Martin, supra, 255 N.J. Super. at 527-28.
We instead concluded 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 . . .
merely because of an inconsequential medical benefits payment." Ibid. In Parisi, supra, the
insurer appealed the trial court decision, declaring that the injured pedestrian plaintiff could
recover medical benefits under both automobile policies issued to her in New York
and also from the New Jersey policy issued to the insured driver that
struck her. Although the insurer, in seeking summary judgment, initially argued that recovery
under both polices was banned under the anti-stacking provisions of N.J.S.A. 39:6A-4.2, that
argument was abandoned prior to the return date of the summary judgment motion.
Therefore, that issue was not before us on appeal. We indicated, however, that
we assumed the insurer abandoned its position in light of "Judge King's analysis
in Martin, [supra,] of the import of N.J.S.A. 39:6A-4.2." Parisi, supra, 296 N.J.
Super. at 183-84. Thus, in Parisi, we affirmed our endorsement of Martin and
its application to the facts before us at that time. Id. at 185.
We agree that a fair reading of Martin and Parisi arguably supports plaintiff's
position that as long as defendant is credited with the $75,000 medical benefits
payable under plaintiff's policy, there is no double recovery in contravention of N.J.S.A.
39:6A-4.2. Because of plaintiff's status as a resident member of Janet Britten's family,
however, this interpretation falls short in light of the clear language contained in
N.J.S.A. 39:6A-7(b)(4), enacted in 1997 subsequent to the decisions in Martin and Parisi.
N.J.S.A. 39:6A-7(b)(4) provides "[e]xclusions from certain insurance benefits" and states in relevant part:
b. An insurer may also exclude from the benefits provided in section[] .
. . [39:6A-4] . . . any person having incurred injuries or death,
who, at the time of the accident:
. . . .
(4) was a member of the named insured's family residing in the
named insured's household, if that person is entitled to coverage under section .
. . [39:6A-4] . . . as a named insured under the terms
of another policy.
[Ibid.]
As amended, this section allows carriers to deny benefits to resident relatives of
the named insured who are themselves named insureds on their own policy. This
exclusion, unaddressed by the motion judge, is precisely the factual scenario presented in
this matter.
The motion judge's finding that plaintiff had a right to PIP benefits under
her mother's policy as a resident relative ignores the plain language of N.J.S.A.
39:6A-7(b)(4) and the web it weaves with N.J.S.A. 39:6A-4.2 and N.J.S.A. 39:6A-4.3(e). These
provisions reflect the Legislature's constant fight to control costs. The lower court erroneously
characterized the situation when it stated that to find for defendant would "penalize[]"
plaintiff for "purchasing additional insurance to cover her own vehicle."
The primary purposes behind auto insurance regulation in New Jersey have always been
the provision of prompt medical expense repayment and cost control. N.J. Coalition of
Health Care Prof'ls, Inc. v. N.J. Dep't of Banking & Ins.,
323 N.J.
Super. 207 (App. Div.), certif. denied,
162 N.J. 485 (1999). By enacting AICRA,
the Legislature has abandoned a "one size fits all" approach in favor of
a scheme that offers consumers the freedom of choice. Swydersky v. Prudential Commercial
Ins. Co.,
263 N.J. Super. 544 (Law Div. 1993). This scheme is designed
to ensure prompt payment and to offer reduced costs to consumers by allowing
them to pick a policy with a premium they can afford and with
benefits commensurate to the premium. By abandoning the former mandatory coverage amount of
$250,000 in favor of a wide array of policies with coverage as low
as $15,000, the Legislature surely contemplated that situations would arise where insureds would
chose, or could only afford, primary policies insufficient to cover medical expenses incurred.
This appeal is an example of that situation.
The plain language of N.J.S.A. 39:6A-4.2 establishes that plaintiff does not qualify as
a primary insured under her mother's policy, and N.J.S.A. 39:6A-7(b)(4) permitted defendant to
deny PIP benefits to plaintiff as a resident relative under her mother's policy.
The motion judge therefore erred, as a matter of law, in granting plaintiff's
summary judgment motion and denying defendant's cross-motion for summary judgment.
Reversed and remanded for the entry of summary judgment in favor of defendant,
dismissing plaintiff's complaint with prejudice.
A-