Title: Rosa Aponte-Correa v. Allstate Insurance Company
Citation: N/A
Docket Number: a-82-98
State: new-jersey
Issuer: new-jersey Supreme Court
Date: February 1, 2000

(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). STEIN, J., writing for a majority Court. In this appeal, the Court interprets the provision of the No Fault Insurance Act (the Act), N.J.S.A. 39:6A-1 to -35, that prescribes limitations periods for suits arising out of the refusal by an insurer to pay medical expenses incurred as a result of an automobile accident. Under the limitations provisions of the Act, the first portion of the statute requires claimants to file suit within two years of the known injuries or expenses and within four years of the date of the accident, whichever is earlier. The second portion of the statute provides that an action seeking payment for further benefits may be instituted within two years of the insurer's last payment of benefits. The specific issue before the Court is whether Personal Injury Protection (PIP) claimants who receive from their insurance carrier a payment of medical benefits at any time within the limitations period set forth in the first part of the statute are restricted in bringing suit against their carrier to the limitations period provided in the second portion of the statute, or whether they may take advantage of either the limitations period of the first or second portion of the statute. The facts are undisputed. On November 22, 1992, Rosa Aponte-Correa was injured in a car accident. After undergoing certain tests, Aponte-Correa was diagnosed with borderline Carpal Tunnel Syndrome and also was treated for neck pain. Allstate Insurance Company (Allstate) paid Aponte-Correa's medical expenses from December 1992 until December 28, 1993. On July 10, 1995, Aponte-Correa underwent further testing for symptoms related to the 1992 car accident. The tests revealed continued borderline Carpal Tunnel Syndrome and neck pain. She submitted the bills to Allstate for payment. Despite repeated requests, Allstate never issued a cut-off letter to Aponte-Correa. Nor did Allstate respond to Aponte-Correa's requests for payment of her bills. Allstate subsequently declined either to pay or reject the bills submitted by Aponte-Correa. On July 24, 1996, Aponte-Correa filed suit against Allstate for payment of her PIP benefits. The complaint was filed within four years of the accident and within two years of the date that Aponte-Correa incurred her first uncompensated expense. However, suit was filed more than two years after Allstate's last payment of PIP benefits. The matter proceeded to arbitration, resulting in Allstate being ordered to pay Aponte-Correa's medical bills, counsel fees and costs. Allstate refused to pay and moved for summary judgment. The trial court granted the motion, finding that the suit was barred because it was instituted more than two years after the last payment by Allstate. The Appellate Division reversed, holding that the statute of limitations is satisfied if the date of initiation of suit meets either of the two alternative limitations portions of the statute. HELD: When a claimant has received PIP benefits, an action for further benefits is timely if it is filed either within four years of the accident and two years of the first uncompensated expense, whichever is earlier, or within two years of the last payment of benefits. 1. The statute is susceptible to more than one interpretation; therefore, extrinsic factors may be considered in order to ascertain the Legislature's intent. When a literal reading will lead to a result not in accord with the essential purpose and design of the legislation, the spirit rather than the letter of the law will control. The underlying purpose of the Act is reparation -- to assure that injured parties are compensated promptly for medical treatment resulting from injuries obtained in an automobile accident. (pp. 5-8) 2. The first portion of the statute uses the prefatory phrase shall be commenced before setting forth the applicable limitations period, while the second portion uses the phrase may be commenced. Where a statutory provision contains both may and shall, it is presumed that the lawmaker intended to distinguish between them; shall being construed as mandatory and may as permissive. (pp. 8-9) 3. The better interpretation of the limitations period of the Act is the one that is less restrictive, more faithful to the underlying purpose of the Act and better reconciles the two portions of the provision. The Legislature's obvious purpose in enacting the permissive portion of the statute was to allow those who have already received PIP benefits to file within two years after the last payment of benefits even if that suit is filed more than four years after the occurrence of the accident. That legislative objective is consistent with the reparations policy underlying the statute and with the Court's decisions in Zupo v. CNA Insurance Company and Rahnefeld v. Security Insurance Company of Hartford. (pp. 10-18) 4. The narrow construction urged by Allstate is inconsistent with the reparations policy underlying the Act. Allstate's construction would permit an insurer to benefit from a limitations period triggered by its last payment of benefits while that same insurer delays (as Allstate did here) the processing of a later claim. No compelling rationale supports so inequitable an interpretation of the limitations period. (pp. 18-19) 5. Principles of statutory construction also support the less restrictive construction. The Legislature's use of the words may and shall in the same sentence indicates its intent that the limitations period in the second portion be an alternative to the primary limitations period in the first portion. Because the second portion of the statute is permissive, the Appellate Division correctly interpreted the first portion, establishing that the limitations period for claimants who receive PIP benefits during the four years following the accident begins to run from the incurrence of the first uncompensated expense. (pp. 19-21) Judgment of the Appellate Division is AFFIRMED and the matter is REMANDED to the Law Division for further proceedings consistent with this opinion. JUSTICE VERNIERO, dissenting, believes that the majority opinion is at odds with the plain language of the statute in that its interpretation of the statutory construction of the statute runs counter to the rationale expressed in the unanimous opinion in Ochs v. Federal Insurance Co. CHIEF JUSTICE PORITZ and JUSTICES O'HERN, and LONG join in JUSTICE STEIN's opinion. JUSTICE VERNIERO has filed a separate dissenting opinion, in which JUSTICE GARIBALDI joins. JUSTICE COLEMAN did not participate. ROSA APONTE-CORREA, formerly known as Rosa Aponte, Plaintiff-Respondent, v. ALLSTATE INSURANCE COMPANY, Defendant-Appellant. Argued September 27, 1999 -- Decided February 1, 2000 On certification to the Superior Court, Appellate Division, whose opinion is reported at 317 N.J. Super. 597 (1999). Francis X. Ryan argued the cause for appellant (Green, Lundgren &amp; Ryan, attorneys; Mr. Ryan and David A. Grabowski, on the briefs). Melville D. Lide argued the cause for respondent (Radano &amp; Lide, attorneys). The opinion of the Court was delivered by STEIN, J. This appeal requires us to interpret the provision of the No Fault Insurance Act (the Act), N.J.S.A. 39:6A-1 to -35, that prescribes limitations periods for suits arising out of the refusal by an insurer to pay medical expenses resulting from an automobile accident. The Act provides in pertinent part: Every action for the payment of benefits . . . shall be commenced not later than 2 years after the injured person or survivor suffers a loss or incurs an expense and either knows or in the exercise of reasonable diligence should know that the loss or expense was caused by the accident, or not later than 4 years after the accident whichever is earlier, provided, however, that if benefits have been paid before then an action for further benefits may be commenced not later than 2 years after the last payment of benefits. ROSA APONTE-CORREA, formerly known as Rosa Aponte, Plaintiff-Respondent, v. ALLSTATE INSURANCE COMPANY, Defendant-Appellant. VERNIERO, J., dissenting. The Court concludes that plaintiff's claim for PIP benefits is timely, notwithstanding the fact that it was filed more than two years after the carrier's last payment of benefits. I believe that conclusion is at odds with the plain language of the PIP statute. Even if we assume that the statute is susceptible to more than one interpretation, the construction advanced by the majority runs counter to the rationale expressed in our unanimous opinion in Ochs v. Federal Ins. Co., 90 N.J. 108 (1982). Therefore, I respectfully dissent. The wording is indeed complex; that alone, however, does not render the statute susceptible to different meanings. When carefully parsed, the statute unambiguously establishes two basic time frames for the filing of actions. First, when the insurer has not paid benefits, a claimant must file the action within two years of suffering the loss or incurring an expense caused by the accident, or not later than four years after the accident, whichever is earlier. In those instances, claims must be filed within two years of the known injury or expense but not later than four years from the date of the accident, the outer limit. Timely claims must be filed within both time frames. Second, when the insurer has paid some benefits, a claimant must file the action within two years of the insurer's last payment of benefits. For those instances, the Legislature eliminated the two-years-after-expense and four-years-after accident limitation periods, allowing for claims potentially several years after the first incurred expense or accident, provided a claimant acts no later than two years from the date of the insurer's last payment. The statute provides that the two-years-after-payment bar is applicable if benefits have been paid before then . . . . Ibid. (emphasis added). In my view, then refers back to whichever is earlier. Those words, in turn, relate to both the two-years-after-expense and four-years-after-accident time frames. The statute bears repeating: Every action . . . shall be commenced not later than 2 years after the injured person . . . incurs an expense . . . , or not later than 4 years after the accident whichever is earlier, provided, however, that if benefits have been paid before then an action for further benefits may be commenced not later than 2 years after the last payment of benefits. Ibid. In other words, when a claimant has been paid benefits within two years of an incurred expense (the fact here), and there has been a gap in payment between periods of treatment (also the fact here), the claimant must file a claim no later than two years from the date of the insurer's last payment of benefits. Plaintiff's claim falls outside of that window; therefore, it is untimely. I could subscribe to a contrary interpretation if the statute included the word uncompensated as a modifier to expense and if it did not contain the words whichever is earlier in the context noted above. If the statute were so worded, the two-years-after-payment bar would not be connected to the two-years-after-expense time frame. That, in turn, would permit the interpretation that the two-years-after-payment time frame provides an alternate window within which to file claims. It would also allow for claims to be filed at any time within four years from the date of the accident regardless of the date of the carrier's previous payments. The statute is not so worded. Our duty is to enforce the statute's precise words and phrases -- all of them. This Court has held that statutory 'construction that will render any part of a statute inoperative, superfluous or meaningless, is to be avoided.' N.J. Carpenters v. Borough of Kenilworth, 147 N.J. 171, 179-80 (1996) (citations omitted), cert. denied, 520 U.S. 1241, 117 S. Ct. 1845, 137 L. Ed. 2d 1048 (1997). The United States Supreme Court has similarly warned: [J]udges cannot cause a clear text to become ambiguous by ignoring it. Deal v. United States, 508 U.S. 129, 136, 113 S. Ct. 1993, 1998, 124 L. Ed. 2d 44 (1993). The Court relies on the statute's distinctive uses of the words shall and may. Ante at ___ (slip op. at 8). However, when viewed in their grammatical context, those words do not accommodate plaintiff's claims. The two-years-after-payment provision is set off by the word may because it eliminates the two-years-after-expense and four-years-after-accident windows. In other words, although a claim is otherwise barred because of those other limitation periods, it may nonetheless proceed, provided it is filed within two years of the last payment of benefits. In that context, may is mandatory, not permissive. NO. A-82 ROSA APONTE-CORREA, formerly known as Rosa Aponte, Plaintiff-Respondent, v. ALLSTATE INSURANCE COMPANY, Defendant-Appellant. DECIDED February 1, 2000 Chief Justice Poritz