MARTIN V. HOME INSURANCE COMPANY V. UNSATISFIED CLAIM AND JUDGMENT FUND
Case Date: 07/31/1995
Docket No: SYLLABUS
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(This syllabus is not part of the opinion of the Court. It has been prepared by the Office of the Clerk for
the convenience of the reader. It has been neither reviewed nor approved by the Supreme Court. Please
note that, in the interests of brevity, portions of any opinion may not have been summarized).
CHARLES MARTIN V. HOME INSURANCE COMPANY V. UNSATISFIED CLAIM AND JUDGMENT
FUND (and other related matters) (A-114-94)
Argued March 14, 1995 -- Decided July 31, 1995
O'HERN, J., writing for a unanimous Court.
The New Jersey Automobile Reparation Reform Act (No-Fault Law) requires that every private-passenger automobile registered in New Jersey be insured under a policy containing personal-injury-protection (PIP) benefits. Since 1977, pursuant to N.J.S.A. 39:6A-4(a) (the PIP Act) the responsibility of any
PIP carrier for medical expenses has been limited to the first $75,000. The burden for any remaining
expenses are to be covered by the Unsatisfied Claim and Judgment Fund (UCJF). Pursuant to N.J.S.A.
39:6-73.1 (the reimbursement provision), the UCJF is to "reimburse" carriers for such PIP benefits in excess
of $75,000.
As a condition of doing business in New Jersey, pursuant to N.J.S.A. 17:28-1.4 (the conformity
statute), an insurance company must, in accordance with New Jersey law, provide PIP coverage for an out-of-state vehicle. Under the conformity statute, any policy issued by an insurance company qualified to do
business in New Jersey covering a vehicle, while it is being operated in New Jersey, is to be construed as
providing the same type of PIP benefits as are required under New Jersey law. Thus, the occupants of an
out-of-state car travelling in New Jersey have the same financial protections as occupants of in-state cars
travelling the same roadways.
The issue before the Court is whether the UCJF must reimburse insurers of out-of-state vehicles for
PIP medical benefits in excess of $75,000 paid under the conformity statute.
At the time of her automobile accident, Edith Robinson was a resident of Virginia. On May 6,
1988, she was injured in New Jersey while a passenger in an automobile insured under a Virginia automobile
insurance policy issued by Progressive Casualty Insurance Co. (Progressive). Robinson's injuries from the
accident were severe, and by July 1992, her medical expenses exceeded $700,000. She sued Progressive,
claiming entitlement to New Jersey PIP benefits, including the payment of reasonable medical expenses.
Progressive claimed that the UCJF was required to participate in the payment of Robinson's medical
expenses. The Law Division ruled that the UCJF was not responsible for providing reimbursement to
Progressive for any excess PIP benefits paid to Robinson.
On September 28, 1987, New Jersey resident Charles Martin was struck, while riding his bicycle, by
an out-of-state vehicle driven by Diana Celeste and insured by Home Insurance Co. (Home). Martin was
seriously injured, and by 1989, he had incurred medical expenses in excess of $100,000. The auto was insured
under a policy issued to Antonia Celeste, a Pennsylvania resident. Home is authorized to issue automobile
liability insurance in New Jersey. Martin sued Home to compel payment of New Jersey PIP benefits. Home
then joined the UCJF in the lawsuit, asserting a right to reimbursement of medical expense benefits. The
Law Division held that Home was entitled to the reimbursement provisions of the UCJF. The Robinson and Martin appeals were consolidated in the Appellate Division. That court affirmed the decision in Martin and reversed the decision in Robinson, concluding that the No-Fault Law authorized the reimbursement sought by the insurers in both cases. The Appellate Division held that the conformity statute should be construed in conjunction with the PIP Act and the reimbursement provisions because those
statutes deal with the same subject matter and seek to achieve the same legislative purpose. According to
the court, reimbursement was authorized by those statutes.
The Supreme Court granted the UCJF's petition for certification.
HELD: The Unsatisfied Claim and Judgment Fund is not required to reimburse insurers of out-of-state
vehicles for personal-injury-protection medical benefits in excess of $75,000 paid under the
conformity statute, N.J.S.A. 17:28-1.4.
1. The language of the relevant statutes do not plainly resolve the issues. Therefore, the intent of the
Legislature must be discerned not only from the terms of the No-Fault Act but also from its structure,
history and purpose. If there is one definite principle that emerges from PIP law, policy and precedent, it is
that there shall be no double recovery of PIP benefits. Moreover, limiting reimbursement to the insurers of
in-state automobiles does not mean that the operators of out-of-state motor vehicles will forfeit the defense
of the verbal threshold. (pp. 8-13)
2. The policy concerns and the probable intent of the Legislature regarding the verbal threshold, tort
immunity, and subrogation are different from the concerns regarding reimbursement from the UCJF. The
occupants of out-of-state cars are treated the same as the occupants of an in-state car; however, car insurers
are different from car occupants. The insurer of the out-of-state automobile has not made the same
contribution to the UCJF as the in-state carrier. The legislative history of the reimbursement provisions
relate to New Jersey insurers and the New Jersey insurance market; reimbursement is paid by the UCJF, to
which insurers contribute a proportion to their percentage of the market; and, the relevant insurers under the
reimbursement provisions are insurers writing policies on New Jersey vehicles. That history suggests that
reimbursement is to be provided solely to New Jersey insurers writing policies on New Jersey automobiles.
(pp. 13-15)
3. Although there are sound policy reasons that favor reimbursement of the insurers of out-of-state vehicles,
the question comes down to an assessment of legislative intent. The "internal sense" of the law does not
require the UCJF to reimburse insurers of out-of-state vehicles. While the opposing arguments are strong,
they do not outweigh the reasons for the Court's conclusion that reimbursement is not required here.
4. Because of the procedural posture of this case, the Court does not address the issue of administrative due
process with respect to the adoption of the UCJF's no-reimbursement policy or the issue of lack of equal
protection due to the classification that denies reimbursement rights to the insurers of non-resident
motorists. If the Legislature agrees with the Court's interpretation of the No-Fault Law, the Court is
satisfied that the UCJF's implementation of legislative intent does not require the adoption of a regulation
that its classification is reasonable. (pp. 16-17)
Judgment of the Appellate Division is REVERSED. The judgment of the Law Division is
REINSTATED in Robinson. Martin is REMANDED to the Law Division for further proceedings consistent
with this opinion.
JUSTICES HANDLER, POLLOCK, GARIBALDI, STEIN, and COLEMAN join in JUSTICE
O'HERN's opinion. CHIEF JUSTICE WILENTZ did not participate.
SUPREME COURT OF NEW JERSEY
CHARLES MARTIN,
Plaintiff,
v.
HOME INSURANCE COMPANY,
Defendant and Third-Party
v.
UNSATISFIED CLAIM AND JUDGMENT
Third-Party
Plaintiffs,
and
PROGRESSIVE CASUALTY INSURANCE
COMPANY,
Plaintiff-Respondent,
v.
L.G. DEWITT TRUCKING COMPANY, INC.,
COLLIE B. ADAMS and THE NEW JERSEY
TURNPIKE AUTHORITY,
Defendants.
Plaintiffs,
v.
Defendant-Respondent,
and
UNSATISFIED CLAIM AND JUDGMENT FUND
and SAMUEL F. FORTUNATO,
Commissioner of Insurance,
Defendants-Appellants,
and
PRUDENTIAL PROPERTY AND CASUALTY
COMPANY,
Intervenor-Respondent.
Plaintiffs,
v.
PROGRESSIVE CASUALTY INSURANCE
COMPANY,
Defendant-Respondent,
and
L.G. DEWITT TRUCKING COMPANY,
COLLIE B. ADAMS, and EDITH M.
ROBINSON,
Defendants,
and
THE UNSATISFIED CLAIM AND JUDGMENT
FUND and SAMUEL F. FORTUNATO,
Commissioner of Insurance,
Defendants-Appellants.
Argued March 14, 1995 -- Decided July 31, 1995
On certification to the Superior Court,
Appellate Division, whose opinion is reported
at
276 N.J. Super. 378 (1994).
Karen L. Jordan, Deputy Attorney General,
argued the cause for appellants (James J.
Ciancia, Acting Attorney General of New
Jersey, attorney; Joseph L. Yannotti,
Assistant Attorney General, of counsel).
Elliott Abrutyn argued the cause for
respondent Home Insurance Company (Morgan,
Melhuish, Monaghan, Arvidson, Abrutyn &
Lisowski, attorneys; Sandra Lawrence Paz, on
the brief).
Kevin R. Gardner argued the cause for
respondent Progressive Casualty Insurance
Company (Connell, Foley & Geiser, attorneys;
Mr. Gardner and George J. Kenny, of counsel).
Ross A. Lewin argued the cause for respondent
Prudential Property and Casualty Insurance
Company (Jamieson, Moore, Peskin & Spicer,
attorneys; Thomas P. Weidner, of counsel).
The opinion of the Court was delivered by
enormous open-ended liability for insurance companies. In 1977,
the Legislature revised the PIP laws, limiting the responsibility
of any PIP carrier for medical expenses to the first $75,000, and
shifting the burden for any remaining expenses to the Unsatisfied
Claim and Judgment Fund (UCJF).See footnote 1 N.J.S.A. 39:6A-4a. Under that
law the UCJF was to "reimburse" carriers for such PIP benefits in
excess of $75,000. N.J.S.A. 39:6-73.1.
same financial protections as occupants of in-state cars
traveling the same roadways. The question in this case is
whether the UCJF must reimburse insurers of out-of-state vehicles
for PIP medical benefits in excess of the $75,000 paid under New
Jersey's conformity statute, N.J.S.A. 17:28-1.4.
For purposes of this appeal, we rely generally on briefs of Progressive Casualty Insurance Company (Progressive) for the procedural history and facts of Robinson, and on briefs of Home Insurance Company (Home) for the procedural history and facts of Martin. At the time of the automobile accident, plaintiff Edith Robinson was a resident of Virginia. She was injured in New Jersey while a passenger in an automobile insured under a Virginia automobile insurance policy issued by Progressive. The accident occurred on May 6, 1988, when an automobile driven by Robert Mattie, collided with a tractor trailer owned by L. G. DeWitt Trucking Company (DeWitt) and driven by one of its employees, Collie Adams. Robinson's injuries from the accident were severe, and by July 1992, her expenses exceeded $700,000. She sued Progressive, claiming entitlement to New Jersey PIP benefits, including the payment of her reasonable medical
expenses.See footnote 2 Progressive claimed that the UCJF was required to
participate in the payment of Robinson's medical expenses.
The two appeals were consolidated in the Appellate Division.
That court affirmed the decision in Martin and reversed the
decision in Robinson.
276 N.J. Super. 378 (1994). The court
concluded that when read together, N.J.S.A. 39:6-73.1, N.J.S.A.
39:6-62, and N.J.S.A. 39:6A-4a authorized the reimbursement
sought by the insurers in both cases. 276 N.J. Super. at 391.
N.J.S.A. 39:6-73.1 grants a right of reimbursement to any insurer
paying PIP benefits in accordance with N.J.S.A. 39:6A-4a.
(Medical expense benefits are a form of PIP benefits.) N.J.S.A.
39:6-62 defines an insurer as "any insurer authorized in this
State to write the kinds of insurance specified in [N.J.S.A.]
17:17-1."
We granted UCJF's petition for certification.
139 N.J. 184
(1994).
The conformity statute, N.J.S.A. 17:28-1.4, provides: Any insurer authorized to transact or transacting automobile or motor vehicle insurance business in this State * * * which sells a policy providing automobile or motor vehicle liability insurance coverage * * * in any other state or in any province of Canada, shall include in each policy coverage to satisfy * * * personal injury protection [PIP] benefits coverage pursuant to [N.J.S.A. 39:6A-4] * * * whenever the automobile or motor vehicle insured under the policy is used or operated in this State.
Among the PIP benefits required to be provided under N.J.S.A.
39:6A-4 are medical expense benefits. N.J.S.A. 39:6A-4a. The
reimbursement provision, N.J.S.A. 39:6-73.1, provides:
See N.J.A.C. 11:3-28.7 (outlining reimbursement procedures).
Each party relies on the language of the statutes. The UCJF
claims that because reimbursement is called for only on policies
written "in accordance with [N.J.S.A. 39:6A-4a]," i.e., policies
required to be placed on New Jersey cars, it is not responsible
to provide reimbursement for medical benefits paid on out-of-state policies in accordance with the conformity statute,
N.J.S.A. 17:28-1.4. Progressive and Home insist that their
policies are written pursuant to N.J.S.A. 39:6A-4 because they
must provide the benefits set forth in that statute as required
by N.J.S.A. 17:28-1.4. Therefore, they argue that because
N.J.S.A. 39:6-73.1 provides for reimbursement of excess medical
expenses paid pursuant to N.J.S.A. 39:6A-4, the UCJF must
reimburse medical expenses paid under an out-of-state policy.
See Adams v. Keystone Ins. Co.,
264 N.J. Super. 367, 372 (App.
Div. 1993) (noting that "the UCJF * * * pursuant to N.J.S.A.
39:6A:4a * * * may be required to reimburse an [out-of-state]
insurer for PIP benefits in excess of $75,000").
The policy argument against reimbursement is that
reimbursement of the out-of-state carriers does not advance any
of the purposes of the provisions limiting an insurer's
liability, the goals of which are to improve New Jersey's rate-making structure. That is, the elimination of an insurer's need
to maintain large reserves in anticipation of potentially large
medical-expense claims curtails the distortion of rates caused by
such reserves. Thus, the risks for the private-passenger
automobile-insurance market in New Jersey are stabilized, and,
instead, insurers in that market maintain adequate reserves for
their market participation through contribution to the UCJF. The
UCJF is funded primarily by contributions assessed against
insurers on the basis of insurance policies written on vehicles
garaged in New Jersey. (We are informed that more than 90" of
those funds are allocated for reimbursement.) If insurers of
out-of-state automobiles involved in accidents in New Jersey
receive a reimbursement, they will receive what the UCJF regards
as a "windfall," funded by New Jersey insurers, and indirectly
funded by New Jersey motorists, who will have to pay higher rates
as a result of increased contributions to the UCJF by their
carriers.
litigation in our courts whenever an out-of-state vehicle is
involved in an automobile accident within our borders.
business in New Jersey, does not violate Equal Protection
Clause); Watkins v. Davis,
268 N.J. Super. 211 (App. Div. 1993)
(holding that an automatic reformation of out-of-state policies
issued by insurers doing business in New Jersey to apply verbal
threshold requirements is justified by significant and legitimate
public purpose, and does not violate Equal Protection Clause);
Phillips v. Phillips,
267 N.J. Super. 305 (App. Div. 1993)
(holding that out-of-state defendants are entitled to protections
of the verbal-threshold statute). The claim for subrogation in
the Robinson case is not against a vehicle required to maintain
the full measure of PIP benefits. N.J.S.A. 39:6A-9.1 now allows
for reimbursement in certain such instances but requires that the
claims be resolved by intercompany agreement or arbitration.
requires the commissioner to calculate for each year the probable
amount of money that will be needed to support the UCJF during
the ensuing year. That amount is then assessed against insurers.
An insurer's contribution is determined by the net direct written
premiums each insurer bears in relation to the aggregate net
direct written premiums of all insurers. N.J.S.A. 39:6-62
defines "net direct written premiums" to include premiums written
on motor vehicles "principally garaged" in New Jersey. We are
informed that this assessment applies to commercial vehicles that
are not subject to the No-Fault Law. However, commercial-vehicle
insurers are required to "provide personal injury protection
coverage benefits, in accordance with [N.J.S.A. 39:6A-4] to
pedestrians * * * ," N.J.S.A. 17:28-1.3, and buses must maintain
no-fault medical expense benefits for passengers, N.J.S.A. 17:28-1.6. The UCJF argues that "an insurer [that] has written many
policies on New Jersey automobiles will make a relatively larger
contribution to the UCJF. This is appropriate, in view of the
greater risk that one or more of those automobiles will be
involved in an accident resulting in reimbursable medical
benefits."
Moreover, reimbursement is paid by the UCJF, to which insurers
contribute in proportion to their percentage of the market. The
relevant market is the New Jersey insurance market; insurers are
assessed, and contribute to the UCJF, in proportion to their
share of that market. Consequently, the relevant insurers under
the reimbursement provisions are insurers writing policies on New
Jersey vehicles. That history suggests that reimbursement is to
be provided solely to New Jersey insurers writing policies on New
Jersey automobiles.
are nonetheless recoverable in a tort action against the alleged
tortfeasor. The language of the No-Fault Law did not preclude
such recovery. We noted, however, that legislative intent
controls over plain language. Id. at 515.
[Id. at 516 (quoting Wollen v. Fort Lee,
27 N.J. 408, 418 (1958)).]
To us, the "internal sense" of the law does not require the UCJF
to reimburse insurers of out-of-state vehicles. We acknowledge
the strength of the counterarguments, but they do not outweigh
the reasons for our conclusion that reimbursement is not required
in this case.
the No-Fault Law, we are satisfied that the UCJF's implementation
of legislative intent does not require the adoption of a
regulation and that its classification is reasonable. JUSTICES HANDLER, POLLOCK, GARIBALDI, STEIN, and COLEMAN join in JUSTICE O'HERN's opinion. CHIEF JUSTICE WILENTZ did not participate.
NO. A-114 SEPTEMBER TERM 1994
CHARLES MARTIN,
Plaintiff,
v.
HOME INSURANCE COMPANY,
Defendant and Third-Party
v.
UNSATISFIED CLAIM AND JUDGMENT
Third-Party
(and other related matters)
DECIDED July 31, 1995
Footnote: 1A 1990 amendment to N.J.S.A. 39:6A-4a capped PIP benefits at $250,000. Presumably, the cost of automobile and accident reparations in excess of that sum will be paid through general health insurance, private insurers, or public-assistance health programs. Because of the dates of the accidents in these cases, that amendment is not applicable. Footnote: 2New York Life Insurance Company and Wholesaler-Distributors Insurance Trust (collectively New York Life) provided Robinson with medical, dental, and accidental death or dismemberment insurance through a group policy issued from the State of Illinois to Robinson's Virginia employer. Those companies paid medical benefits in excess of $400,000 to Robinson. Progressive, however, had a duty to pay Robinson's medical expenses as the "primary insurer," and New York Life was entitled to reimbursement from Progressive for benefits paid. 276 N.J. Super. 378, 396 (App. Div. 1994).
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