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Maros v. Transamerica Insurance Co.

Decided: July 6, 1976.


Rosenberg, J.s.c.


This proceeding is a reargument of plaintiff's motion for summary judgment. By way of verified complaint and affidavit the following facts are brought to the court's attention. Defendant Transamerica Insurance Company (Transamerica) issued policy #PE264461 to plaintiff's husband, Julius Maros, on November 17, 1975. The policy, entitled "Paramount Plan Automobile Policy," includes coverage required under N.J.S.A. 39:6A-1 et seq. , the New Jersey Automobile Reparation Reform Act.

On December 15, 1975 Maros was involved in an automobile accident in which he sustained serious personal injuries. As a result of these injuries he died four days later. Plaintiff alleges that her husband was not an "income producer" at the time of the accident, but was one who performed "essential services." Mrs. Maros further alleges that she is the person now incurring the expense of providing the essential services previously performed by Julius Maros. Transamerica has paid medical and funeral expense benefits due under the policy. On February 10, 1976 plaintiff applied to defendant for payment of $4,380 believed to be due under the insurance policy as "survivor essential services benefits." Transamerica has refused to pay such sum, claiming that it was only liable for such sums as plaintiff actually expended for substituted essential services as verified by receipts. Plaintiff seeks (1) a declaratory judgment on the insurance policy under N.J.S.A. 39:6A-4(d) requiring the insurance company to pay the sum of $4,380; (2) counsel fees pursuant to R. 4:42-9(a); (3) interest pursuant to N.J.S.A. 39:6A-5(c), and (4) costs of suit.

At issue is the meaning of N.J.S.A. 39:6A-4(d). Although the terms of the insurance policy may also be considered in resolution of this problem, the relevant statutory provisions control the contract of insurance. Downs v. Prudential Ins. Co. of America , 130 N.J. Super. 558, 564 (Law Div. 1974); see also, Peraglia v. Jones , 120 N.J. Super. 518

(App. Div. 1972). In relevant part N.J.S.A. 39:6A-4 provides:

Every automobile liability insurance policy insuring an automobile as defined in this act against loss resulting from liability imposed by law for bodily injury, death and property damage sustained by any person arising out of ownership, operation, maintenance or use of an automobile shall provide additional coverage, as defined herein below, under provisions approved by the Commissioner of Insurance, for the payment of benefits without regard to negligence, liability or fault of any kind, to the named insured and members of his family residing in his household who sustained bodily injury as a result of an accident involving an automobile, to other persons sustaining bodily injury while occupying the automobile of the named insured or while using such automobile with the permission of the named insured and to pedestrians, sustaining bodily injury caused by the named insured's automobile or struck by an object propelled by or from such automobile. "Additional coverage" means and includes:

c. Essential services benefits. Payment of essential services benefits to an injured person shall be made in reimbursement of necessary and reasonable expenses incurred for such substitute essential services ordinarily performed by the injured person for himself, his family and members of the family residing in the household, subject to an amount or limit of $12.00 per day. Such benefits shall be payable during the life of the injured person and shall be subject to an amount or limit of $4,380.00, on account of injury to any one person in any one accident.

d. Survivor benefits. * * *

In the event of the death of one performing essential services as a result of injuries sustained in an accident entitling such person to benefits under section 4 c. of this act, the maximum amount of benefits which could have been paid such person, under section 4 c., shall be paid to the person incurring the expense of providing such essential services.

The term "essential services" is defined as "those services performed not for income which are ordinarily performed by an individual for the care and maintenance of such individual's family or family household." N.J.S.A. 39:6A-2(b).

In interpreting a statute the initial tasks of the court are to discern and effectuate the intent of the Legislature. State v. Madden , 61 ...

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