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Martin v. Home Ins. Co.

July 31, 1995

CHARLES MARTIN, PLAINTIFF,
v.
HOME INSURANCE COMPANY, DEFENDANT AND THIRD-PARTY PLAINTIFF-RESPONDENT, V. UNSATISFIED CLAIM AND JUDGMENT FUND, THIRD-PARTY DEFENDANT-APPELLANT. EDITH M. ROBINSON, BY HER GUARDIAN, D. LEWIS MATTIE, TERESA L. MATTIE, THOMAS EVERETT ROBINSON, III, BY HIS GUARDIAN AD LITEM, THOMAS EVERETT ROBINSON, II, D. LEWIS MATTIE, ELLEN MATTIE, AND ROBERT L. MATTIE, 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. EDITH M. ROBINSON, BY HER GUARDIAN D. LEWIS MATTIE, PLAINTIFFS, V. PROGRESSIVE CASUALTY INSURANCE COMPANY, 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. NEW YORK LIFE INSURANCE COMPANY AND WHOLESALER-DISTRIBUTORS INSURANCE TRUST, 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.



On certification to the Superior Court, Appellate Division, whose opinion is reported at 276 N.J. Super. 378 (1994).

O'hern, J., Justices Handler, Pollock, Garibaldi, Stein, and Coleman join in Justice O'HERN's opinion. Chief Justice Wilentz did not participate.

The opinion of the court was delivered by: O'hern

(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 ...


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