On appeal from the Superior Court, Law Division, Union County.
Allcorn, Francis and Morton I. Greenberg. The opinion of the court was delivered by Morton I. Greenberg, J.A.D.
This matter comes on appeal to this court as a result of a construction of the New Jersey Automobile Reparation Reform Act (No Fault Act), N.J.S.A. 39:6A-1 et seq. , by a judge of the Superior Court, Law Division. We deal with a question concerning the interplay between N.J.S.A. 39:6A-4 and N.J.S.A. 39:6A-12. Specifically, our problem is whether evidence of medical bills incurred by a person injured in an automobile accident for which personal injury protection benefits (PIP) may be collectible may, as a matter of law, be introduced in a damage action against another party brought by the injured person if payment of the bills is refused under PIP coverage on the ground that the medical procedures for which the bills were rendered were for conditions unrelated to the accident.
The procedural and factual history of this action is not complicated. Plaintiff Henrietta Tullis was operating an automobile in Newark on December 20, 1977. At that time there was a collision between her automobile and an automobile driven by defendant Teial and owned by defendant Ramirez. There is no doubt that Henrietta Tullis suffered some injury in the accident. As a result plaintiff Henrietta Tullis brought an action against defendants for personal injuries. Richard Tullis, her husband, joined per quod. Additionally, she submitted bills under her no fault coverage to her insurance company for treatments and tests which she alleged were for injuries suffered in the accident. The carrier refused to pay certain bills for examination, tests and treatment of her neck. Its refusal was predicated on a medical opinion that the neck injury was not related to the accident. Plaintiff did not bring an action directly against her company to recover on her own policy for these expenses.
In the personal injury action defendants duly answered through counsel retained by their insurance carrier. By coincidence it happened that the carrier was the same company which was plaintiff's no fault carrier and thus was responsible for her PIP benefits. A jury trial was held on both liability and damages.*fn1 Evidence at the trial showed that Henrietta Tullis was taken to Beth Israel Hospital on the day of the accident. She was discharged that day but then remained bedridden at home for two weeks. She suffered pain in her neck which was treated with prescription muscle relaxers and warm compresses. Her voice changed and became hoarse. For several months she suffered from headaches and pain and muscle spasms in the neck. In February or March 1979 a lump-type swelling in the right side of her neck became enlarged. A surgeon who examined her was concerned about a palpable mass on her neck and chronic inflammation of her throat. The surgeon preliminarily thought that the symptoms were related to the accident but he was also suspicious of the possibility of cancer. He prescribed antibiotics to clear up the inflammation but they did not work. The surgeon sent her to the hospital to see if she had cancer. Ultimately, when a biopsy proved negative, the surgeon concluded that her neck problems were related to the accident.
Plaintiffs, over defendants' objection, were permitted to prove as elements of damage medical expenses not compensated for by PIP coverage. Defendants' objection was premised on the theory that the bills were for benefits recoverable on plaintiffs' own PIP policy required by N.J.S.A. 39:6A-4. Under N.J.S.A. 39:6A-12 evidence of amounts collectible or paid pursuant to N.J.S.A. 39:6A-4 are inadmissible in a civil action for recovery for bodily injury. The trial court overruled the objection. In her charge to the jury the judge told it that a plaintiff awarded a verdict "is entitled to damages for his or her expenses, for medical services, hospital services, medicines and medical supplies
which are reasonably required for the examination, treatment and care of the injuries sustained by him as a proximate result of the defendants' negligence." The judge generally described the testimony and said that the jury did not have to award the full amount of a bill that it found was not fair or reasonable or of a bill for services that were not necessary to any extent. The judge indicated that the verdict could include up to $5,279.85 for medical expenses for bills she listed. The jury then returned a verdict for damages against defendants for $125,000 for Henrietta Tullis and $25,000 for Richard Tullis.
Defendants moved for a new trial on the grounds that the verdict was against the weight of the evidence, the damages were excessive and the trial judge erred in admitting evidence of plaintiff's medical expenses. The trial judge denied the motion. In her written opinion she cited Rybeck v. Rybeck , 141 N.J. Super. 481, 508 (Law Div. 1976), app. dism. 150 N.J. Super. 151 (App.Div.1977), for the proposition that N.J.S.A. 39:6A-12 is intended to bar double recovery for medical benefits. Here there could be no double recovery for expenses not compensated for by the no fault coverage. She also thought it inequitable that the same insurance carrier which rejected the PIP claim for medical expense benefits then urged in the civil damage action that plaintiff could not recover for her medical expenses. Defendants subsequently appealed from the judgment entered on the verdict and the order denying a new trial.
The result reached in the Law Division was wrong. N.J.S.A. 39:6A-4(a) requires that a policy issued pursuant to the No Fault Act provide for "payment of all reasonable medical expenses incurred as a result of personal injury sustained in an automobile accident." The term "medical expenses" is broadly defined to include, among other items, expenses for medical treatment, surgical treatment, medication and hospital services. Plaintiff makes no suggestion here that the disputed expenses were not of the character of medical expenses as defined in the No Fault Act. Compensation for medical expenses can be
recovered from a defendant in a damage action only if related to the injury for which damages are sought. See Theobold v. Angelos , 40 N.J. 295, 304 (1963). But such expenses would be incurred "as a result of personal injury sustained in an automobile accident" and would be recoverable under the No Fault Act. Thus, necessarily, if the medical expenses as a matter of evidence in the absence of the No ...