SUPERIOR COURT OF NEW JERSEY
APPELLATE DIVISION
DOCKET NO. A-2306-00T3
NATALIE GAMBINO, Executrix
of the Estate of Carol
Gambino, and JERRY VARRONE,
Guardian Ad Litem of Thomas
Gambino, Jr., and Anthony
Gambino,
Plaintiffs-Appellants,
v.
STATE FARM INSURANCE CO.,
Defendant-Respondent.
Argued January 24, 2002 _ Decided
February 27, 2002
Before Judges Cuff,See footnote 11 Wecker and Winkelstein.
On appeal from Superior Court of New Jersey,
Law Division, Monmouth County, L-1398-00.
John F. Marshall argued the cause for
appellants.
John A. Camassa argued the cause for
respondent (Connell & Connell, attorneys; Mr.
Camassa, of counsel; Ronald S. Yuro, on the
brief).
The opinion of the court was delivered by
WINKELSTEIN, J.A.D.
On June 7, 1998, Thomas Gambino, Sr., was operating his
automobile when it struck a tree. In the vehicle at the time of
the accident were his wife, Carol Gambino, their two sons, Thomas,
Jr. and Anthony, and an unrelated minor passenger. Carol Gambino
was killed, and their two sons and the unrelated minor passenger
were injured.
Thomas Gambino's vehicle was insured by State Farm Insurance
Company (State Farm) under policy #B073553-E18-30, which provided
split limit liability coverage in the amount of $100,000 per
person, and $300,000 per accident. By way of settlement, State
Farm paid $100,000 to the Estate of Carol Gambino (the Estate),
$50,000 each on behalf of Thomas, Jr. and Anthony, and $100,000 to
the unrelated passenger, exhausting the total liability limits.
Thomas Gambino had a second State Farm policy in effect, #Y43-5107-
E17-30,See footnote 22 which provided split limit underinsured motorist (UIM)
benefits of $250,000 per person and $500,000 per accident.
In this appeal we are asked to decide whether defendant should
receive a $200,000 aggregate credit against the $500,000 UIM per
accident UIM limit, leaving only $300,000 available to satisfy all
of plaintiffs' claims, or whether the credit is computed by
separately deducting the amount of liability insurance proceeds
received by each injured party from the $250,000 UIM per person
limitation.See footnote 33 The latter method would leave the Estate with
$150,000 in available UIM coverage ($250,000 less $100,000 received
under the liability policy) and each child with $200,000 available
UIM coverage ($250,000 less $50,000 received under the liability
policy). Although this calculation would make the aggregate UIM
recovery $550,000, plaintiffs concede that their aggregate recovery
is capped at $500,000. The Law Division applied an aggregate
credit of $200,000 against the $500,000 per accident policy limit.
We conclude that N.J.S.A. 17:28-1.1e, which defines underinsured
automobile insurance coverage, and case law which has interpreted
the statute, require a different result. Under the statute, when,
as here, there are multiple claimants who have exhausted the
tortfeasor's liability insurance, and UIM coverage is available
through a split limit policy, the appropriate credit is determined
by applying each injured party's recovery of liability insurance
against that party's per person UIM coverage, subject only to the
total per accident UIM cap set forth in the policy. Accordingly,
we reverse.
I
Plaintiffs demanded arbitration under the UIM policy. State
Farm refused to arbitrate until a declaratory ruling was obtained
determining the amount of UIM benefits at stake. As a result, on
March 24, 2000, plaintiffs filed a complaint and order to show
cause seeking to compel State Farm to arbitrate the UIM claims and
to provide UIM coverage of $250,000 per person, with a cap of
$500,000 for the accident. On the return day of the order to show
cause, May 26, 2000, the Law Division heard oral argument. No
testimony was taken since the question presented was purely a
matter of law. On November 22, 2000, the judge placed an oral
decision on the record and issued a written decision. Considering
the issue as one of first impression, the court phrased the
question as "whether claimants may recover $500,000 from a split
limit UIM policy when they've already received settlement monies
from the tortfeasor's liability policy for a total of $200,000."
The judge found in favor of State Farm. The court, after reading
various provisions of the insurance policy into the record,
concluded that the "language of the policy is clear that State Farm
is obligated to pay the [$]500,000 per accident and is not
obligated to pay more than that aggregate sum to satisfy claims
arising from a single accident regardless of the number of
claimants." Given this conclusion, the judge decided "to subtract
the $200,000 previously recovered from the $500,000 per accident
limit under the UIM policy, leaving $300,000. Then the parties can
either divide evenly the $300,000 or can seek arbitration if State
Farm is not willing to pay the total amount of the remaining UIM
policy."
III
Our decision is guided by an interpretation of N.J.S.A. 17:28-
1.1e, which reads:
e. For the purpose of this section, (1)
'underinsured motorist coverage' means
insurance for damages because of bodily injury
and property damage resulting from an accident
arising out of the ownership, maintenance,
operation or use of an underinsured motor
vehicle. . . . A motor vehicle is
underinsured when the sum of the limits of
liability under all bodily injury and property
damage liability bonds and insurance policies
available to a person against whom recovery is
sought for bodily injury or property damage
is, at the time of the accident, less than the
applicable limits for underinsured motorist
coverage afforded under the motor vehicle
insurance policy held by the person seeking
that recovery. A motor vehicle shall not be
considered an underinsured motor vehicle under
this section unless the limits of all bodily
injury liability insurance or bonds applicable
at the time of the accident have been
exhausted by payment of settlements or
judgments. The limits of underinsured
motorist coverage available to an injured
person shall be reduced by the amount he has
recovered under all bodily injury liability
insurance or bonds;
[emphasis added.]
Although we have not before been presented with an opportunity
to interpret the last sentence of N.J.S.A. 17:28-1.1e where the UIM
coverage is split limits, in Calabrese we addressed the issue of
credits available to reduce UIM coverage where the tortfeasor had
a split limit policy, while the insured's UIM coverage was single
limit. 297 N.J. Super. at 432. In Calabrese, four passengers
sustained serious injuries in a two-car collision. The tortfeasor
possessed a $100,000/$300,000 policy which was paid out in
increments of $75,000 to each of the four claimants, exhausting the
policy limits of $300,000. The driver of the vehicle, who was not
the owner, sought UIM benefits under her own policy issued by
Selective Insurance Company (Selective). The two passengers sought
UIM benefits under the owner's policy, also issued by Selective.
Each Selective policy carried combined single limit
uninsured/underinsured motorist coverage of $300,000. Each injured
party's arbitration award exceeded the $75,000 paid under the
tortfeasor's policy. To determine the amount of UIM coverage
available to pay the arbitration awards, each claimant's UIM
coverage was reduced by the $75,000 each received from the
tortfeasor, not by the total $300,000 paid to all of the claimants.
Id. at 434-35.
We are also guided by Filippatos v. Selective Ins. Co. of
America,
241 N.J. Super. 236 (App. Div. 1990). In Filippatos,
plaintiff was one of two passengers injured in a one-car accident;
the other passenger later died of his injuries. The driver had
single limit liability policy coverage of $300,000, and the carrier
exhausted the policy limits by paying $150,000 each to the
plaintiff and to the estate of the other passenger. Plaintiff's
single UIM limits were $500,000. The UIM arbitrator fixed
plaintiff's damages at $375,000. The insurer argued that only the
$75,000 that exceeded the tortfeasor's $300,000 limits should be
recoverable; plaintiff argued that he was entitled to the full
$225,000 in unrecovered damages .. the difference between the
arbitrators' $375,000 damage award and the $150,000 plaintiff
received from the tortfeasor's coverage. 241 N.J. Super. at 238.
In determining there was $350,000 of UIM coverage available, we
reduced the $500,000 UIM policy limit by deducting only the
$150,000 the plaintiff had received from the tortfeasor. This left
sufficient coverage to pay the plaintiff the $225,000 unrecovered
damages. We did not reduce the available coverage by the $150,000
paid to the other injured party. Ibid.
In Filippatos, therefore, it was the amount recovered from the
tortfeasor by the UIM claimant that dictated the credit against
that claimant's UIM coverage. Accord, French v. New Jersey School
Bd. Ass'n. Ins. Group,
149 N.J. 478, 484 (1997) (holding that where
"multiple claimants exhaust all of the liability limits available
to an underinsured tortfeasor and when a claimant 'holds' a UIM
policy that creates coverage when compared with the underinsured
tortfeasor's total liability limits, the amount that the injured
claimant is able to recover from the liability policy (as opposed
to the liability policy limit itself) serves as the appropriate
setoff") (citing Filippatos, 241 N.J. Super. at 237).
We turn now to the application of these principles to this
case. The UIM coverage limits are $250,000 for each person injured
in the accident, as long as the total amount paid out by State Farm
in UIM benefits does not exceed $500,000. Therefore, after
deducting each plaintiff's recovery under the tortfeasor's policy,
the available UIM coverage is as follows: (a) the Estate ..
$150,000 ($100,000 credit against $250,000 coverage); (b) Thomas,
Jr. .. $200,000 ($50,000 credit against $250,000 coverage); (c)
Anthony .. $200,000 ($50,000 credit against $250,000 coverage); for
a total of $550,000. Since the total exceeds the $500,000 per
accident coverage, it will have to be reduced by $50,000, capping
the available coverage to all parties at the $500,000 policy
limits.
By following this formula the principles and goals of UIM
coverage and the reasonable expectations of the parties will be
satisfied. The requirement in N.J.S.A. 17:28-1.1e that the limits
of UIM coverage available to an injured person be reduced by the
amount recovered under other bodily injury liability insurance is
accomplished because the appropriate credit for each party's
recovery under the liability policy will be taken against the
$250,000 per person limit for each injured party. Furthermore, the
plaintiffs will receive, by way of UIM coverage, the amount of
coverage they would have received had the tortfeasor's liability
limits equaled the UIM limits. See Calabrese, 297 N.J. Super. at
431. State Farm will not be required to pay more than the $500,000
total per accident limit, while the insureds will receive the total
benefit of the $250,000 per person UIM coverage for which they
bargained. In other words, each party will have its reasonable
expectations satisfied. See Werner Indus., Inc. v. First State
Ins. Co.,
112 N.J. 30, 35 (1988).
State Farm's position that the $200,000 aggregate recovery
should be subtracted from the $500,000 per accident limits would
not provide insureds with the coverage they purchased. Under State
Farm's theory, the UIM per accident limit would never be
recoverable by the insureds, since reducing the per accident UIM
limit by the aggregate recoveries of the insureds will always
reduce the per accident coverage to below that amount which was
purchased. The insurer will never be required to pay the total
coverage per accident purchased by the insured because that sum
would be reduced by the amount paid by the tortfeasor.
IV
In its written opinion the Law Division stated:
To find for the plaintiffs would mean that
carriers are not permitted to cap their
damages to a per accident amount. It would
make the $500,000 per accident meaningless.
Moreover, having reproduced the relevant
portions of the insurance policy, it would fly
in the face of the agreement entered into
between the parties.
The judge misconstrued the language of the policy as well as
plaintiffs' claim. The policySee footnote 44 reads in part as follows:
SECTION III . UNINSURED AND UNDERINSURED
MOTORIST . COVERAGE U
Limits of Liability
1. Bodily Injury
The amount of coverage is shown on the
declarations page [$250,000/$500,000] under
"Limits of Liability . U . Each Person, Each
Accident." Under "Each Person" is the amount
of coverage for all damages due to bodily
injury to one person. "Bodily injury to one
person" includes all injuries and damages to
others resulting from this bodily injury.
Under "Each Accident" is the total amount of
coverage, subject to the amount shown under
"Each Person", for all damages due to bodily
injury to two or more persons in the same
accident.
We agree with the trial court that the policy does not contain
language which would warrant the insurance carrier to pay more than
$500,000 under its UIM coverage. But that is not the issue.
Plaintiffs acknowledge a UIM coverage limit of $500,000.
Plaintiffs are merely asking for the coverage for which they paid
. $250,000 for each claimant. Under the motion judge's reasoning,
focusing solely on the $500,000 policy cap, the $250,000 coverage
for each claimant becomes a nullity.
IV
The decision of the Law Division is reversed and remanded for
further proceedings consistent with our opinion.
Reversed and remanded.
Footnote: 1 1Judge Cuff did not participate in oral argument. However, the parties consented at oral argument to her participation in the decision. Footnote: 2 2At oral argument neither party was able to explain why there were two separate policies, one for liability and one for UIM coverage. That liability coverage and UIM coverage are provided in two separate policies, rather than in one, however, does not affect our decision. Footnote: 3 3The $200,000 represents the $100,000 paid to the Estate plus the $50,000 paid to each child. Defendant does not claim a credit for the $100,000 paid to the unrelated passenger. Footnote: 4 4Only one policy is included in the record and it is not identified as the liability policy or the UIM policy. The policy provided includes, however, sections for both liability and UIM coverage. Our decision assumes the policy language provided in the appendix accurately reflects the UIM policy language.