SUPERIOR COURT OF NEW JERSEY
APPELLATE DIVISION
A-3469-97T2
ROSA APONTE-CORREA, formerly
known as Rosa Aponte,
Plaintiff-Appellant,
v.
ALLSTATE INSURANCE COMPANY,
Defendant-Respondent.
_________________________________________________________________
Submitted November 10, 1998 - Decided January 15, 1999
Before Judges Pressler, Brochin and Steinberg
On appeal from the Superior Court of New
Jersey, Law Division, Cumberland County
Radano & Lide, attorneys for appellant
(Melville D. Lide, on the brief).
Green, Lundgren & Ryan, attorneys for
respondent (David A. Grabowski, on the
brief).
The opinion of the court was delivered by
BROCHIN, J.A.D.
Plaintiff Rosa Aponte-Correa sued defendant Allstate
Insurance Company for PIP benefits. Summary judgment was granted
dismissing her complaint on the ground that it was barred by the
applicable statute of limitations, N.J.S.A. 39:6A-13.1a. We
reverse.
N.J.S.A. 39:6A-13.1a consists of two parts, a proviso and
the language that precedes it. To facilitate our discussion of
the statute, we will refer to the language that precedes the
proviso as the first part of the statute, and the language of
the proviso as the second part.See footnote 1 The first part of the
statute states:
Every action for the payment of [PIP]
benefits . . . 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,
The second part states:
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.
Plaintiff was injured in an automobile accident on November
22, 1992. She filed a claim, and defendant paid her bills for
medical services. It made its last payment to plaintiff on
December 28, 1993. The first medical services for which
defendant refused to pay were provided to plaintiff on July 10,
1995. Plaintiff filed her complaint on July 24, 1996.
Plaintiff argues that her suit was filed within time
because, Where no-fault benefits have been paid, a suit for
further no-fault benefits is timely if brought within four years
of the date of the accident, and within two years after the
oldest uncompensated expense is incurred. As to the first of
these conditions for maintaining an action, it is undisputed that
plaintiff's suit was commenced within four years after the date
of her accident. The are two other implied premises of
plaintiff's argument, both of which are contested. These are,
first, that the statutory requirement to commence a PIP suit
within 2 years after the injured person . . . incurs an expense
means within two years after the injured person has first
incurred an uncompensated expense for medical treatment
necessitated by the accident; and, secondly, that commencing the
suit within four years after the accident and within two years
after the first uncompensated expense makes the suit timely, even
if the insurer has paid benefits and the suit, although for
further benefits, was instituted more than "2 years after the
last payment of benefits," as required by the second part of the
statute.
Defendant contends that the suit is barred by operation of
the second part of the statute because it was commenced more than
two years after the last payment of benefits to plaintiff on
December 28, 1993. In other words, defendant reads the statute
to mean that, if benefits have been paid prior to suit, an action
for additional benefits must satisfy the timeliness criteria of
the second part of the statute in order to proceed, regardless of
whether or not it satisfies the timeliness criteria of the first
part.
Bell v. Western Employer's Ins. Co.,
173 N.J. Super. 60, 64
(App. Div. 1980), supports plaintiff's position. The Bell
plaintiff was injured in an automobile accident on June 12, 1975.
The defendant insurer paid her PIP benefits until January 7,
1976. But it refused to pay for necessary dental care which she
received from December 1977 to August 21, 1978. The plaintiff
commenced her suit on June 13, 1978.
Our opinion does not state specifically when the Bell
plaintiff incurred her first expense, but it was necessarily a
date prior to January 7, 1976, when the insurer made its last
payment. Consequently, it is clear that although the suit was
commenced within four years after the accident and within two
years after the plaintiff incurred her first uncompensated
expense, it was commenced more than two years after she incurred
her first compensated expense and more than two years after the
insurer's last payment.
If the two-year period of limitations established by the
first part of N.J.S.A. 39:6A-13.1a were measured from the
plaintiff's first expense, the suit commenced June 13, 1978 would
have been untimely because it would not have complied with the
requirement of either the first or the second part of the
statute. In fact, plaintiff undoubtedly incurred her first
medical expense on or shortly after June 12, 1975, the date of
the accident. If that expense, although compensated by the
insurer, triggered the running of the period of limitations
established by the first part of the statute, the Bell
plaintiff's suit would have been barred even before December
1977, the date when she first incurred a medical expense for
which the insurer refused to pay. It would be grossly unfair to
interpret a statute of limitations to bar a suit because it was
not commenced before the potential plaintiff had anything to sue
about. Because we did not think that the Legislature, in
N.J.S.A. 39:6A-13.1, was concerned with barring actions for
claims voluntarily paid, Bell, supra, 173 N.J. Super. at 64, we
held that the Bell action was timely because it had been
commenced not later than two years after the plaintiff incurred
her first uncompensated expense caused by the accident. That
ruling supports plaintiff's argument in the present case that she
is entitled to maintain her suit because she commenced it within
two years after she incurred her first uncompensated medical
expense resulting from the accident.
We also determined in Bell that even though an insurer had
paid benefits, the period within which suit could be commenced
was not defined exclusively by the second part of the statute.
Otherwise, we would have had to affirm the dismissal of the
action because, as we have noted, it was commenced more than two
years after the last payment of benefits by the insurer. We held
that an insured claiming PIP benefits could maintain her suit if
it was timely according to the limitations criteria of either the
first or the second part of the statute. We stated:
The proviso in N.J.S.A. 39:6A-13.1 . . .
does not narrow plaintiff's rights under the
statute. It is clear that the proviso was
necessary, for without it the payment of
benefits could not be enforced after four
years following an accident since N.J.S.A.
39:6A-13.1 bars an action for recovery of
benefits after the earlier of two years after
the expense is incurred or four years after
the accident. There is certainly no
indication elsewhere in the No Fault Act that
the Legislature intended to limit liability
for benefits to a four-year period following
an accident.
[Id. at 64-65.]
In other words, the proviso permits suits to be brought which
could not be maintained in its absence; it does not prohibit
suits which, absent the proviso, the preceding language would
permit. This holding supports the argument of plaintiff in the
present case that her action is timely, even though its
commencement date does not satisfy the criteria of the second
part of the statute. If Bell is still good law, plaintiff's
complaint should therefore not have been dismissed.
In Ochs v. Federal Ins. Co.,
90 N.J. 108, 112-13 (1982), the
Supreme Court held that the two-year period for bringing suit
established by the first part of N.J.S.A. 39:6A-13.1a should be
measured from the date on which the insured sustained an injury
or incurred the first expense for treatment of injuries resulting
from the accident. Because the insurer in Ochs had not made any
payment of PIP benefits, the Court expressly left open the
question of the appropriate starting date of the period of
limitations where there has been voluntary compensation for
previous medical expenses, id. at 112 n.1, citing Bell, supra,
173 N.J. Super. 60. We interpret this citation of Bell as the
Court's signal that it was cognizant we had considered the issue
of the starting point of the two-year period after some
compensation has been paid, but that it did not choose to express
an opinion on that question. The validity of Bell is therefore
unaffected by Ochs.
We again applied N.J.S.A. 39:6A-13.1a to a case in which the
insurer had made voluntary PIP payments in Sotomayor v. Allstate
Ins. Co.,
273 N.J. Super. 165 (App. Div.), certif. denied,
139 N.J. 184 (1994). The plaintiff in that case was injured in an
automobile accident that occurred in January 1988. The defendant
insurer made its last payment for plaintiff's medical treatment
on February 23, 1989, after sending her a cut-off letter on
December 28, 1988, advising her that it would not pay for any
further treatment. Plaintiff received further medical treatment
for injuries related to the accident beginning in May 1990, and
she continued to receive treatment later in 1990 and in 1991.
The insurer did not pay the bills submitted for that treatment.
The plaintiff filed her complaint September 16, 1991.
To recapitulate, the Sotomayor plaintiff commenced her suit
within four years after her accident, within two years after she
incurred her first uncompensated expense, but more than two years
after the insurer's last payment of benefits. The critical facts
of Sotomayor are thus identical with those of Bell. However,
even though the Sotomayor suit was commenced within four years
after the accident and within two years after the earliest
uncompensated medical expense, the case holds that the
plaintiff's suit was barred because it had not been commenced
within two years after the insurer's last payment of benefits.
Sotomayor's stated rationale for its holding is that the
lapse of more than two years between the insurer's last payment
and the plaintiff's commencement of suit was fatal to plaintiff's
case because the facts before the court did not fall within the
exception to N.J.S.A. 39:6A-13.1a which Rahnefeld v. Security
Ins. Co. of Hartford,
115 N.J. 628 (1989), and Zupo v. CNA Ins.
Co.,
193 N.J. Super. 374 (App. Div.), aff'd o.b. as modified,
98 N.J. 30 (1984), had created for conditions that the insurer knew
or should have known would require treatment for a period longer
than two years. In our view, however, Rahnefeld and Zupo are
irrelevant to the Sotomayor case because in those cases, unlike
Sotomayor or the present case, the date of commencement of suit
did not comply with the requirements of either the first or
second part of the statute.
Sotomayor does not cite Bell. It is contrary to Bell, and
if we were to follow it, we would have to affirm the dismissal of
plaintiff's suit in the present case.
In Washington v. Market Transition Facility,
295 N.J. Super. 368 (App. Div. 1996), we again applied N.J.S.A. 39:6A-13.1a to a
case in which the insurer had made voluntary payments of PIP
benefits before suit. In that case, the plaintiff sustained the
injuries for which she claimed PIP payments as the result of an
automobile accident that occurred January 23, 1993. The insurer
paid some PIP claims beginning some time after the date of the
accident. It made its last payment August 9, 1993. However, it
did not pay for emergency room expenses incurred January 23,
1993, and it did not pay part of the bills for services incurred
between then and August 9, 1993. The plaintiff filed suit June
20, 1995, within four years of the accident and within two years
after the insurer's last payment, but not within two years after
the plaintiff's uncompensated expense for the emergency room
services provided to the plaintiff on the date of the accident.
Misconstruing our language in Bell, the summary judgment
court dismissed the complaint on the ground that the two-year
period for bringing suit had begun to run on January 23, 1993,
the date of the plaintiff's oldest uncompensated expense, the
emergency room services that the insurer had neglected to pay
for. We reversed, explaining that in Bell we had:
used the phrase oldest uncompensated
expense, to which defendant now ascribes
such significance, in attempting to parse the
two-year/four-year limitation, and not in
construing the meaning of the last-payment
proviso.
[Washington, supra, 295 N.J. Super. at 373.]
In other words, oldest uncompensated expense was the
construction which we placed on the two-year limitation provision
of the first part of the statute, not on the two-year limitation
provision found in the second part of the statute. We pointed
out that in Bell we had concluded
that while ordinarily the two-year period of
the basic formulation is triggered by the
incurring of the first expense, that rule did
not fairly apply to the Bell plaintiff
because, her original expenses having all
been paid, "[s]he had no reason to bring any
action" before the second round of treatment
began.
[Ibid.]
The holding of Washington is that the plaintiff's suit was
timely filed because it was filed not later than 2 years after
the last payment of benefits, precisely what the second part of
the statute requires. This holding and that of Bell are both
consistent with the principle that a suit against an insurer for
PIP benefits is timely if it meets the criteria of either the
first or the second part of N.J.S.A. 39:6A-13.1a, i.e., if it is
brought either within four years after the accident and within
two years after the last uncompensated expense or, alternatively,
within two years after the last payment by the insurer. Bell was
timely because it complied with the requirements of the first
part of the statute and Washington was timely because it complied
with the requirements of the second part.
Referring to the statutory language that our present opinion
has been calling the second part of the statute, our opinion in
Washington observed,
We think it clear that the prior-payment
proviso alone could not by itself have saved
the day for the Bell plaintiff since the last
prior payment had been made more than two
years before suit. . . . In any event, the
point we make is that Bell did not construe
the prior-payment extension of the
limitations period as running from the date
of the first unpaid or partially paid
expense, and we see absolutely no reason to
do so now.
[Id. at 373-74.]
We agree entirely with that reading of Bell. We reiterate,
interpreting expense to refer to the first uncompensated
expense was the gloss Bell put on the first part, not the second
part of the statute.
Our Washington opinion then continued as follows:
In Ochs, supra, 90 N.J. at 112 n. 1, 447 A.2d
163, the Supreme Court, citing Bell, made
clear that it was not there dealing with the
question of the appropriate starting date of
the period of limitations where there has
been voluntary compensation for previous
medical expenses. To the extent that
question may still be regarded as open, we
hold that this limitations period is
triggered by the last payment made by the
carrier on account of the injuries sustained
in the original accident.
[Id. at 374 (emphasis added).]
The phrase, this limitations period, in the last quoted text
refers only to the limitations period imposed by the second part
of the statute. Our statement says that whenever this
limitations period governs, the period begins to run from the
date of "the last payment made by the carrier on account of the
injuries sustained in the original accident." Our statement does
not mean that in any case in which the insurer has made a
voluntary payment of PIP benefits, the exclusive test of the
timeliness of an action on a PIP claim is whether its
commencement date satisfies the requirements of the second part
of the statute. Rather, we held that if the first part of the
statute is satisfied, there is no need to consider the second
part at all; but if the first part is not satisfied and the
second part governs, it is the date of the last payment by the
insurer that controls.
We hold, as we did in Bell, that if an insurer has made
payments on a PIP claim, an action for further benefits is timely
if it complies with either the first part or the second part of
N.J.S.A. 39:6A-13.1a; that is, if the action is commenced either
(1) within four years of the accident that caused the injury for
which treatment is required and payment sought and, in addition,
within two years after the injured person incurred his or her
first uncompensated medical expense, or, (2) as an alternative,
within two years after the insurer's last payment of PIP
benefits. The statute of limitations is satisfied if the date of
commencement of suit meets either of these two alternative tests.
We are satisfied that this rule is consistent with the language
and purpose of N.J.S.A. 39:6A-13.1 and with our prior holdings in
Bell v. Western Employer's Ins. Co., supra, and Washington v.
Market Transition Facility, supra. To the extent that our
holding in the present case differs from Sotomayor v. Allstate
Ins. Co., supra, we disagree with that case and decline to follow
it.
Since plaintiff Aponte-Correa commenced her suit within four
years after her accident and within two years after her earliest
uncompensated expense, it is not barred by N.J.S.A. 39:6A-13.1,
even though it was commenced more than two years after the last
payment by defendant Allstate Insurance Company. We therefore
reverse the judgment appealed from and remand the case for
further proceedings not inconsistent with this opinion. Of
course, we have not considered or decided any aspect of the case
other than the period of limitations issue.
Footnote: 1 N.J.S.A. 39:6A-13.1a was amended by L. 1998, c. 21 § 18. The modifications of this section are of no substantive significance.