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Sanders v. Langemeier

May 4, 2009

OMAR SANDERS, PLAINTIFF-RESPONDENT,
v.
NORMA K. LANGEMEIER, PATRICIA L. LESLIE AND CLARENDON NATIONAL INSURANCE COMPANY, DEFENDANTS, AND NEW JERSEY PROPERTY-LIABILITY INSURANCE GUARANTY ASSOCIATION, DEFENDANT-APPELLANT.



On certification to the Superior Court, Appellate Division, whose opinion is reported at 401 N.J. Super. 125 (2008).

SYLLABUS BY THE COURT

(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).

The issue in this appeal is whether an individual who was entitled to emergency medical services pursuant to the special automobile insurance coverage known as the "Dollar-A-Day" policy has a right to seek reimbursement from the Unsatisfied Claim and Judgment Fund (UCJF) for the cost of additional, non-emergency, medical treatments he later received after his discharge from emergency care.

Plaintiff Omar Sanders was a passenger who was riding in a vehicle owned and operated by defendant Patricia Leslie when it was involved in a collision with a vehicle operated by defendant Norma Langemeier. Sanders was taken to the hospital, where he received emergency treatment for the injuries he had sustained, following which he was released. Approximately two weeks later, Sanders began a further course of treatment which continued for several months on a non-emergency basis and for which he incurred $2,305 in medical bills.

Sanders did not own an automobile and had no insurance policy of his own. Leslie's vehicle, in which he was a passenger, was insured by a "special automobile insurance policy" issued by defendant Clarendon National Insurance Company. That policy, often referred to as "Dollar-A-Day" coverage, entitled Sanders to "emergency personal injury protection" (emergency PIP) benefits. Although Clarendon had paid for all of the emergency care Sanders received at the hospital, it denied his claim for the subsequent treatment because that treatment did not meet the definition of "emergency" care. Also, defendant Langemeier's insurance policy did not afford Sanders any PIP benefits because he was not a passenger in Langemeier's vehicle. Consequently, Sanders concluded that he had an unsatisfied claim.

Sanders sought payment for his non-emergency medical expenses from the New Jersey Property-Liability Insurance Guaranty Association (NJPLIGA), in its capacity as the statutory administrator of the UCJF. When NJPLIGA denied the claim, Sanders filed suit against both drivers, Clarendon, and NJPLIGA, seeking damages for pain and suffering and for payment of his non-emergency medical bills. He settled his claim against Langemeier and dismissed his complaint against Leslie and Clarendon, her insurer.

Plaintiff and NJPLIGA filed cross-motions for summary judgment directed to the only question that remained, namely, whether the UCJF is responsible for plaintiff's non-emergency medical care. The trial court granted summary judgment in plaintiff's favor, and denied both NJPLIGA's motion for summary judgment and its motion for reconsideration. The court concluded that the special policy's limited PIP coverage was equivalent to an absence of full PIP coverage, rendering plaintiff uninsured and, therefore, entitling him to coverage from the UCJF. NJPLIGA appealed, and the Appellate Division affirmed in a published opinion.

The Supreme Court granted NJPLIGA's petition for certification and also granted leave to the Commissioner of Banking and Insurance, the Association of Trial Lawyers of America-New Jersey and a group of insurance industry representatives to file briefs or to participate as amici curiae.

HELD: The Court's reading of the plain language of the statute creating the Unsatisfied Claim and Judgment Fund (UCJF) benefits and of the statutes governing automobile insurance demonstrates that the Legislature intended that an individual covered by a special automobile insurance ("Dollar-A-Day") policy would not be entitled to secure such further benefits from the UCJF.

1. The dispute between the parties requires the Court to consider two separate statutory frameworks. First, it must look at the function and purpose of the UCJF, with particular attention to the role it plays in relation to PIP coverage. Second, it must consider the varying PIP provisions that the Legislature has enacted over time, including the standard PIP coverage, the so-called "basic" PIP coverage, and the emergency PIP coverage included in the policy that applies to plaintiff. To qualify for UCJF benefits, a claimant must satisfy four separate requirements. N.J.S.A. 39:6-86.1. In this case, three of those requirements are not in dispute. That is, there is no debate about whether plaintiff is "qualified to receive" benefits, that he was injured in an accident, and that he was injured while occupying an automobile registered or principally garaged in this State. The focus of this dispute is on whether plaintiff satisfies the fourth requirement, namely that no PIP coverage was in effect. Stated in the alternative, this aspect of the statute provides that UCJF benefits will not be available to one who is injured and for whom PIP benefits were in force. On its face, the UCJF statute makes no distinction among the different types of PIP coverage that might be selected by an automobile's owner. There are three types, each providing a different level of coverage for medical expenses. Of particular concern in this case, the "special" or "Dollar-A-Day" policy provides only "emergency personal injury coverage" up to $250,000 for emergency treatment immediately following an automobile accident and extending until the patient is discharged from acute care. Coverage under a special policy also continues following discharge if the medical procedures or therapies qualify as continued treatment for "permanent or significant brain injury, spinal cord injury or disfigurement." The special policy does not provide for liability, collision, comprehensive, uninsured or underinsured motorist coverage. However, because each type of policy provides PIP protections to passengers, the type of policy chosen by a driver affects not only that driver's benefits under the policy, but also impacts on the benefits available to any passengers in the vehicle. (Pp. 8-13)

2. The heart of the dispute before this Court is whether, when the Legislature referred to PIP benefits in the UCJF statute, it intended to include only PIP as defined in the standard or basic policies, or whether it also meant to refer to the emergency PIP afforded in the special policy. The Court's review of the plain language of the relevant statutes, together with the expressions by the Legislature about its intent in enacting each, compels the Court to conclude that the term "personal injury protection coverage," as used in the UCJF statute, is a general term that encompasses both the "personal injury protection" benefits provided by standard and basic policies and the "emergency personal injury protection" benefits provided by special policies. The use of the phrase in the UCJF statute is general; it makes no reference to any particular kind of policy or any level of PIP benefits. All three policies provide PIP; the difference is in the level of PIP coverage that each of the policies provides. The Court cannot conclude that the Legislature intended that two of the three policies would be interpreted as providing PIP coverage but one would not. Moreover, the UCJF is remedial legislation meant to "protect the public from a noninsured, financially irresponsible motorist, not one who is insufficiently insured." Gorton v. Reliance Ins. Co., 77 N.J. 563, 572 (1978). Seen in this light, the Court finds no basis on which to conclude that the Legislature intended the UCJF to create a remedy for one who is covered under a policy that affords PIP coverage that is limited or that is modest; rather, the UCJF was designed to provide benefits for one who would otherwise be left with no remedy after an automobile accident. Plaintiff's suggestion that he was remediless because he had no remedy with regard to his non-emergency medical expenses overlooks the fact that he was not remediless within the meaning of the statute; he was covered under a special insurance policy that provided him with benefits and ensured that his emergency medical treatment was covered. The Legislature's clear expression of its intent through its statutory pronouncements compels the conclusion that plaintiff received the full benefits of the special policy and is entitled to nothing more through the UCJF. (Pp. 14-19)

The judgment of the Appellate Division is REVERSED and the matter is REMANDED to the Law Division for the entry of an order dismissing plaintiff's complaint against the New Jersey Property-Liability Insurance Guaranty Association (NJPLIGA).

CHIEF JUSTICE RABNER and JUSTICES LONG, LaVECCHIA, ALBIN, WALLACE, and RIVERA-SOTO join in JUSTICE HOENS' opinion.

The opinion of the court was delivered by: Justice Hoens

Argued February 18, 2009

In this matter, we consider whether an individual who was entitled to emergency medical services pursuant to the special automobile insurance coverage known as the "Dollar-A-Day"*fn1

policy, see N.J.S.A. 39:6A-3.3, has a right to seek reimbursement from the Unsatisfied Claim and Judgment Fund (UCJF) for the cost of additional, non-emergency, medical treatments he later received after his discharge from emergency care. Our reading of the plain language of the statute creating the UCJF benefits, N.J.S.A. 39:6-86.1, and of the statutes governing automobile insurance, see N.J.S.A. 39:6A-1 to -35, demonstrates that the Legislature intended that an individual ...


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