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Martin v. Prudential Insurance Co.

Decided: April 20, 1992.

ALICE MARTIN, PLAINTIFF-APPELLANT,
v.
PRUDENTIAL INSURANCE COMPANY, DEFENDANT-RESPONDENT



On appeal from the Superior Court of New Jersey, Law Division, Atlantic County.

King, Dreier and Gruccio. The opinion of the court was delivered by King, P.J.A.D.

King

The Opinion of the court was delivered by

KING, P.J.A.D.

This case involves the right of a Pennsylvania resident, injured in a New Jersey accident while a passenger in a vehicle insured and registered in New Jersey, to recover medical benefits under her host's PIP coverage. We reject her host's carrier's argument that acceptance of the maximum benefits, $10,000, under plaintiff's own Pennsylvania family policy defeats her PIP claim under New Jersey's No-Fault Law.

This is a declaratory judgment action brought by a seriously injured passenger, Alice Martin, involved in an automobile accident in Margate, New Jersey on June 23, 1989. She seeks PIP benefits from defendant Prudential Insurance Company, the carrier for her host driver, Anne Dowling, under a policy issued for the Dowling vehicle which was registered in New Jersey. The Law Division Judge ruled that Alice Martin could not recover PIP benefits under her host driver's policy because she had collected $10,000 in medical benefits payments under her family automobile policy issued by Allstate in Pennsylvania where she and her husband live. This was the maximum medical benefit under Allstate's policy.

Prudential admits the existence of PIP coverage but denies the claim. Prudential asserts that the claim is barred by N.J.S.A. 39:6A-4.2 which states in pertinent part:

[T]he personal injury protection coverage of the named insured shall be the primary coverage for the named insured and any resident relative in the named insured's household who is not a named insured under an automobile insurance policy of his own. No person shall recover personal injury protection benefits under more than one automobile insurance policy for injuries sustained in any one accident.

The Law Division Judge concluded that once the plaintiff had collected $10,000 under her family automobile policy issued in Pennsylvania, she had no rights under her host's New Jersey policy. The Judge said: "She had her benefits. She collected under them. I think that's the remedy." We disagree and reverse.

Plaintiff-appellant contends that N.J.S.A. 39:6A-4.2 "was intended to establish a priority of payments and to avoid a payment of double benefits," not to defeat payment of substantial PIP benefits because of minimal out-of-state medical benefits coverage. Prudential contends that the statutory language of § 39:6A-4.2 is a clear bar to any attempt to recover under both a New Jersey host's PIP benefits and the claimant's own automobile's $10,000 Pennsylvania medical benefits feature. The Prudential policy, which insured the host car, was issued pursuant to the New Jersey Automobile Reparation Reform Act (No-Fault Law), N.J.S.A. 39:6A-1 to -35, and provided for PIP benefits, including unlimited medical expense benefits, for any occupant of an insured vehicle, as required by N.J.S.A. 17:28-1.3 and N.J.S.A. 39:6A-4. By L. 1990, c. 8, § 4 the Legislature has since limited medical expense benefits to $250,000.

Allstate's policy on its Philadelphia insureds, the Martins, was issued pursuant to the Pennsylvania Motor Vehicle Financial Responsibility Law, 75 Pa.Cons.Stat.Ann. §§ 1701 to 1799.7. That policy provided the minimum coverage for medical expenses then mandated by the Pennsylvania statute; $10,000. 75 Pa.Cons.Stat.Ann. § 1711. Allstate paid the $10,000 medical benefits provided by its policy on demand by Alice Martin. By statute, insurers must offer optional medical benefits up to $100,000. Id. at § 1715.

While the language of N.J.S.A. 39:6A-4.2 may arguably support more than one interpretation, including that advanced here by Prudential, we conclude that the construction urged by appellant ...


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