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Stewart v. Allstate Insurance Co.

Decided: April 15, 1986.


On appeal from the Superior Court, Appellate Division, whose opinion is reported at 200 N.J. Super. 350 (1985).

For reversal -- Chief Justice Wilentz, and Justices Clifford, Handler, Pollock, O'Hern, Garibaldi and Stein. For affirmance -- None.

Per Curiam

[103 NJ Page 140] Plaintiff Pamela Stewart was rendered a paraplegic as a result of an automobile accident of June 7, 1981, when she was sixteen years old. She is permanently paralyzed and confined to a wheelchair. Since the accident she has succeeded in becoming an internationally-known wheelchair athlete. This suit seeks recovery for certain medical expenses under the personal injury protection (PIP) provisions of an applicable

policy of defendant, Allstate Insurance Company (Allstate). Our specific concern is whether plaintiff is entitled to recover the cost of a specially-modified van that plaintiff can operate independently. Allstate acknowledges its liability for the cost of modifications, in excess of $11,000, but disputes the approximately $8,300 basic cost of the van. The trial court granted summary judgment in favor of plaintiff. The Appellate Division reversed so much of the plaintiff's judgment as included the basic cost of the van, which Judge Dreier, in a partial dissent, would have allowed. Stewart v. Allstate Ins. Co., 200 N.J. Super. 350 (1985). Plaintiff's appeal is therefore here as of right under Rule 2:2-1(a)(2).

The parties have couched the limited issue before us in terms of whether the basic cost of the van can be viewed as a medical expense within the meaning of the PIP provisions of the New Jersey Automobile Reparation Reform Act, N.J.S.A. 39:6A-1 to -20. The policy itself is not in evidence, but we assume that its coverage provisions track the statute. The definition of "medical expenses" is set forth in N.J.S.A. 39:6A-2(e) as follows:

"Medical expenses" means expenses for medical treatment, surgical treatment, dental treatment, professional nursing services, hospital services expenses, rehabilitation services, X-ray and other diagnostic services, prosthetic devices, ambulance services, medication and other reasonable and necessary expenses resulting from the treatment prescribed by persons licensed to practice medicine and surgery pursuant to R.S. 45:9-1 et seq., dentistry pursuant to R.S. 45:6-1 et seq., psychology pursuant to P.L. 1966, c. 282 (C. 45:14B-1 et seq.) or chiropractic pursuant to P.L. 1953, c. 233 (C. 45:9-41,1 et seq.) or by persons similarly licensed in other states and nations or any non-medical remedial treatment rendered in accordance with a recognized religious method of healing (emphasis added).

Allstate argues that the cost of the van does not satisfy the foregoing statutory definition because the basic vehicle is nothing more than a convenience. It is, according to the carrier, simply a device to "serve the same transportation needs as an automobile does for every individual in our society." That contention was apparently accepted by the majority in the court below, which observed:

The van, as the letters from the physicians point out, is intended to make plaintiff's travel more comfortable, quicker and convenient. To constitute a medical expense the nexus between the expense and desired rehabilitative endeavor must be direct and not merely for the sake of allowing greater independence or convenience. [200 N.J. Super. at 355.]

Although the stated conclusion may be acceptable as an abstract proposition, as applied to this case it is premised on a faulty view of the record. In support of her motion for summary judgment plaintiff submitted the reports of three treating physicians. Those of Drs. Rosenberg and Fleming might be insufficient, standing alone, to meet the statutory definition of a medical expense (the van would be "important" for both her physical and emotional well-being: Rosenberg; the "degree of self-sufficiency" afforded by the van would be "a valuable addition to her continuing development": Fleming); but there is no mistaking the import of the statement of Dr. Bid, from the Kessler Institute for Rehabilitation:

As we know, Pam will be finishing High School pretty soon and she is also involved in active wheelchair sports and has been an internationally known figure. On account of this, the patient needs to continue to practice her wheelchair sports and needs to go to different destinations quite often. As the patient's parents do work full time, the patient needs independence of transportation from one place to the other. As she is now driving with hand controls, she needs a vehicle which should be suitable for her needs.

I am enclosing a copy of the special equipment she would require in a vehicle for her to be able to drive a vehicle independently. The patient is extremely motivated in spite of her severe disability and she has been an extremely good student and a good sport.

For her emotional and physical well being, she definitely needs continuation of her independence and all of her curricular and extracurricular activities, and on account of that, she ...

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