Court Opinion

ID: 9747198
Source: CourtListenerOpinion
Date Created: 2023-08-27 15:02:34.327792+00
Date Added: 2024-06-11T07:25:20.733370
License: Public Domain

VERNIERO, J.,
dissenting.
The Court concludes that plaintiffs 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, 447 A.2d 163 (1982). Therefore, I respectfully dissent.
I.
I begin my analysis with the familiar axiom, “[i]f the statute is clear and unambiguous on its face and admits of only one interpretation, we need delve no deeper than the act’s literal terms to divine the Legislature’s intent.” State v. Butler, 89 N.J. 220, 226, 445 A.2d 399 (1982). Statutes so written must be enforced in accordance with their literal terms. Ibid.
At the time relevant to this dispute, the statute provided:
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 *334an action for further benefits may be commenced not later than 2 years after the last payment of benefits.
[N.J.S.A 39:6A-13.1a.]
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-aceident 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), *335the claimant must file a claim no later than two years from the date of the insurer’s last payment of benefits. Plaintiffs 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, 685 A.2d 1309 (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 325, 744 A.2d at 179. However, when viewed in their grammatical context, those words do not accommodate plaintiffs 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-aecident 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.
*336II.
A.
With the exception of Bell v. Western Employer’s Ins. Co., 173 N.J.Super. 60, 413 A.2d 363 (App.Div.1980), and this Appellate Division decision, which relied heavily on Bell, decisions of this Court and the Appellate Division have applied the plain language of the statute in numerous contexts.
The plaintiff in Bell was injured in an automobile accident on June 12, 1975 and her insurer paid PIP benefits until January 7, 1976. Bell, supra, 173 N.J.Super. at 62, 413 A.2d 363. In December 1977, almost two years later, the plaintiff underwent additional treatment for injuries arising out of the same accident. After her insurer denied additional benefits, the plaintiff filed suit on June 13,1978. Ibid.
The trial court ruled that the plaintiffs action was barred because she had filed suit more than two years after the insurer’s last payment of benefits. The Appellate Division reversed, holding that the plaintiffs suit “may be commenced within two years after the first unpaid expense has been incurred, provided the action is started within four years after the accident and regardless of the date of the last reimbursement.” Id. at 65, 413 A.2d 363. The court reasoned that a denied or rejected claim represented an “expense” within the meaning of that word in the statute, thereby allowing claimant two years from the oldest uncompensated expense and four years from the date of the accident to file suit. Id. at 63, 413 A.2d 363.
Two years after Bell, we decided Ochs v. Federal Ins. Co., supra, 90 N.J. 108, 447 A.2d 163. In that case, the plaintiff was injured when the motorcycle he was riding collided with an automobile on November 10, 1974. He did not request PIP benefits from the insurer until February 18,1978, over three years after he first incurred injury or expense. At the time of the accident, “plaintiffs insurance policy excluded coverage of motorcycles and therefore plaintiff was not entitled to receive any PIP *337benefits.” Id. at 110, 447 A.2d 163. It was only sometime later that the courts concluded such exclusions were void as against public policy. Id. at 115, 447 A.2d 163. The implication is that plaintiff delayed action because of the mistaken belief that he was not entitled to benefits under the policy. The insurer denied benefits and the plaintiff filed suit on May 8, 1978. Id. at 110-11, 447 A.2d 163. The Appellate Division permitted the suit, explaining:
Under our construction of the statute, it bars recovery only of those expenses which are more than two years old when suit is brought and not those expenses which were incurred within the two-year period prior to suit, provided only that the suit is commenced within the four-year period. We regard this construction as sensibly accommodating both the policy of liberal construction and the policy of repose without doing any violence to the language of the limitations provision.
[ 177 N.J.Super. 19, 24, 424 A.2d 849 (App.Div.1980). ]
The above rationale by the Appellate Division is similar to the one advanced by the Court today. Ante at 331, 744 A.2d at 182 (“If an insured injured in an automobile accident continues regularly to receive PIP benefits during the four years following the accident, the Legislature understandably would have intended that the limitations period for that insured should extend for two years from the date she incurred her first uncompensated expense.”). However, we previously rejected that rationale in reversing the Appellate Division in Ochs. We held that the plaintiffs claim, filed within four years of the accident, was nonetheless barred having been commenced more than two years after claimant incurred expenses. Ochs, supra, 90 N.J. at 115, 447 A.2d 163.
In support of our holding in Ochs, we relied on a prior Appellate Division decision, Danilla v. Leatherby Ins. Co., 168 N.J.Super. 515, 403 A.2d 925 (App.Div.1979). In that case, the trial court interpreted the statute to mean that the two-year period of limitation commenced to run “after the incurrence of each medical expense which was related to the accident, regardless of when the accident occurred or when the first medical expense related thereto was incurred.” Id. at 517, 403 A.2d 925. The Appellate Division disagreed, explaining:
*338The statute recites that the two-year period begins “after the injured person ... incurs an expense ...” (emphasis supplied). There is no further qualification of the word “expense.” Thus, it is possible to view that language as did the trial judge in the present case. However, given the purpose and function of statutes of limitation as well as the legislative history of the no-fault insurance legislation, we do not think the Legislature intended such a construction to be ascribed to the statute.
We do not deem it likely ... that the Legislature would have chosen to adopt a statute of limitations which would begin to run each time a new medical expense related to the accident was incurred.
[Id- at 518-19, 403 A.2d 925.]
In accepting that rationale, we stated: “[T]here is no reason to believe the Legislature intended the period of limitations to commence anew with each medical expense. If the Legislature wished to allow an action to be brought at any time during the four-year period, it would not have chosen to foreclose compensation for expenses incurred more than two years before suit.” Ochs, supra, 90 N.J. at 114, 447 A.2d 163.
Today, the Court implicitly rejects our previous rationale in Ochs by holding, in essence, that a plaintiff may bring suit any time during the four-year-after-accident period irrespective of the date of the carrier’s previous payment. By marking plaintiffs “uncompensated” expense as the statute’s trigger point, the Court’s ruling starts anew the limitations period based solely on a new medical expense — an interpretation rejected by Ochs.
Two years after our decision in Ochs, the Appellate Division decided Zupo v. CNA Ins. Co., 193 N.J.Super. 374, 474 A.2d 259 (App.Div.), aff'd as modified, 98 N.J. 30, 483 A.2d 811 (1984). In that case, the injured plaintiff obtained PIP payments from the insurer, within two years of the accident, receiving the last payment in 1975. During that first period of treatment, plaintiff developed an osteomyelitic infection, which required extensive medical attention. In November 1980, the plaintiff suffered a recurrence of the osteomyelitis, requiring a new round of treatment and therapy. Asserting the familiar bar of N.J.S.A. 39:6A-13.1a, the insurer rejected the plaintiffs benefit claim for that second period of treatment. Id. at 377-78,474 A.2d 259.
*339The Appellate Division determined that the plaintiffs claim would not be time-barred “if the original medical, condition for which the PIP carrier [had] assumed a payment obligation [was] by its nature subject to the probability of recurrence or to the probability of the need for future treatment____” Id. at 382, 474 A.2d 259. The court reasoned that the insurer was “chargeable at the outset with knowledge of these inherent probabilities” and, therefore, should not be entitled to the protection of the statute. Id. at 382-83, 474 A.2d 259.
We affirmed the judgment of the Appellate Division. In my view, that disposition did not “illustrate the beneficent purposes of the statute,” ante at 324, 744 A.2d at 178, but rather was based entirely on fact-specific, narrowly-drawn equitable principles. To emphasize that point, we stated: “The principle [adopted in Zupo ] embraces a severely limited class of causally related medical conditions, namely, those whose insidious nature is such that their recurrence after an extended period of time is probable.” Zupo, supra, 98 N.J. at 33, 483 A.2d 811.
In three other decisions, the Appellate Division applied the “two years after payment” language literally, further isolating Bell from the heartland of cases. In Still v. Ohio Cas. Ins. Co., 189 N.J.Super. 231, 459 A.2d 1195 (App.Div.1983), the court disallowed a claim filed more than two years from the insurer’s last payment of benefits, concluding that the statutory language unambiguously required that result. The court distinguished itself from Bell, stating “we are not necessarily in agreement with all that is said in Bell.” Id. at 234, 459 A.2d 1195.
Similarly, the court disallowed the plaintiffs claim in Sotomayor v. Allstate Ins. Co., 273 N.J.Super. 165, 641 A.2d 554 (App.Div.), certif. denied, 139 N.J. 184, 652 A.2d 173 (1994). In that ease, the plaintiff sustained injuries from an automobile accident in January 1988. She underwent treatment on a regular basis until the insurer made the last benefit payment on February 23, 1989. After a gap in treatment, the plaintiff returned to her doctor for additional care. She filed suit against the insurer on September *34016, 1991, more than two years after the insurer tendered its last payment.
The Appellate Division held that the plaintiffs claim was time barred. It reached that result notwithstanding the fact that plaintiffs doctor had rendered a “permanency opinion” and the trial court had observed that “ ‘the carrier ... could surely know of a probable reoccurrence’ of medical treatment.” Id. at 168, 641 A.2d 554. After reviewing the holding of Zupo and other case law, the Appellate Division applied the limitations provision literally, stating “[a]n insured cannot sit back and wait any period of time to bring an action for incurred medical expenses merely because there was a probability of recurrence or the need for related treatment.” Id. at 171, 641 A.2d 554. Notably, the court made no reference to Bell in its opinion.
Finally, in Washington v. Market Transition Facility, 295 N.J.Super. 368, 685 A.2d 57 (App.Div.1996), the Appellate Division again considered the question of when to trigger the statute in an instance where there has been voluntary compensation for previous medical expenses. The court stated squarely: “To the extent that question may still be regarded as open, we hold that this limitations period is triggered by the last payment made by the carrier on account of the injuries sustained in the original accident.” Id. at 374, 685 A.2d 57. The court noted candidly, “[i]n retrospect, the rationale of Bell may not be free from flaw.” Id. at 373, 685 A.2d 57.
B.
As indicated, the court in Bell equated an “expense” with a denied claim, which it recast as an “uncompensated expense,” thereby affording the plaintiff two years from the oldest uncompensated claim to file suit. That interpretation, adopted by the Court today, ante at 333, 744 A.2d at 183, is inconsistent with the language of the statute for two reasons. First, as noted above, the statute does not include the word “uncompensated” as a *341modifier to “expense.” That reason, standing alone, is sufficient to dispose of the issue.
Second, a claim is a right to payment that accrues after a plaintiff incurs an expense. That is why, in my view, the statute refers only to an injured person who “incurs an expense.” N.J.S.A. 39:6A-13.1a (emphasis added). Injured persons incur expenses upon receipt of medical services; only afterwards do they learn whether an insurer will pay or reimburse them for their claims. See Black’s Law Dictionary 224 (5th ed.1979) (defining “claim” as a “right to payment” regardless of whether that right is “disputed” or “undisputed”). By drawing distinctions between “compensated” and “uncompensated” expenses, the statute is transformed.
To restate: In Ochs, where the insurer had not yet made a payment, we held plaintiff to a strict two-years-after-expense bar, putting no interpretative gloss on “expense.” Today, the Court holds that, when an insurer has paid some claims but denied others, plaintiffs action for additional benefits is considered timely because the “uncompensated” expense marks the commencement of the two-year limitations clock. I do not believe the Legislature intended that claimants in the Ochs context and those in the present context would be subject to such different treatment. Stated differently, I do not believe that the Legislature intended that the interpretation of “expense” would depend on the action or inaction of an insurer, or that the statute would afford either party an alternate limitations window. I find nothing in the text or history of N.J.S.A. 39:6A-13.1a to indicate that the Legislature intended the statute to be that elastic.
C.
The Court relies on case law in Massachusetts, Delaware and Florida as support for its holding. However, none of those jurisdictions has a statute of limitations similar to the one at issue here. Instead, courts there rely on contract principles in determining when a PIP claim becomes timely. The PIP statute in *342Massachusetts speaks specifically of “an action in contract,” Mass. Gen. Laws Ann. ch. 90, § 34M (West 1999), and courts in the other two jurisdictions rely on general statutes of limitation, not specific to PIP matters, when determining the timeliness of claims. See, e.g., DelCode Ann. tit. 10, § 8106 (1998); Fla. Stat. Ann. § 95.11 and § 627.736(4)(b) (West 1999). Because of those major distinctions, case law from those jurisdictions should be accorded little or no weight in resolving the present dispute.
III.
Public policy considerations also support a literal application of the statute. It is reasonable that the Legislature would want to provide a measure of repose in those instances where there has been a gap in medical treatment and corresponding cessation of benefits. This Court suggested as much when we noted in a prior case: “The ‘two years after payment’ bar would surely apply ... were the injuries [of claimant] such that the carrier could not know of any such probable recurrence.” Rahnefeld v. Security Ins. Co. of Hartford, 115 N.J. 628, 637, 560 A.2d 670 (1989).
For the Legislature to conclude that, at some point, a matter must be brought to closure is also reasonable. The Legislature determined that point to be two years from the date of the carrier’s last payment to the insured in eases in which there has been a gap in treatment and benefits. The prospect of definite closure “helps speed the litigation of claims and protects the rights of both the insur[er] and the insured.” Ochs, supra, 90 N.J. at 113-14, 447 A.2d 163. Although I might be tempted to extend the time frame to accommodate more claims, the statute leaves me no room for that accommodation. Put another way, although I sympathize with plaintiff and might prefer a more generous limitations provision, such a statute must come from the Legislature, not the judiciary. “We are charged with the duty of interpreting statutes, not of legislating.” State v. Fearick, 69 N.J. 32, 38, 350 A.2d 227 (1976).
Justice Garibaldi’s observation in Zupo, supra, is instructive:
*343[T]here are few areas in which the legislature has been more active than in no fault insurance. The statute as enacted is the result of much discussion and compromise among various interest groups. I believe that it is eminently logical that the legislature intended to impose a strict two-year-after-payment bar. The legislature is interested in limiting the cost of automobile insurance to the public. It may well have concluded that without such a bar, numerous claims would be filed years after an accident and such open-ended claims would increase the cost of insurance to the public.
[Zupo, supra, 98 N.J. at 35,483 A.2d 811 (Garibaldi, J., dissenting).]
The Legislature has spoken time and again on the issue of insurance reform. Perhaps it is time for another look; if so, lawmakers, not judges, must drive any effort to revise the statute. Until that happens, we are bound by the statute’s literal terms.
I would preserve, in appropriate cases, plaintiffs’ ability to demonstrate that their conditions fall within the purview of Zupo. I do not depart from that case law. However, nowhere in the argument by plaintiff here was there a demonstration that an equitable exception might apply; thus, that issue is not before us.
In the same vein, I find no indication in the record for the Court’s suggestion that the' carrier delayed the processing of plaintiffs claim to obtain some strategic advantage or benefit. Ante at 331-32, 744 A.2d at 182. There is no finding or even mention of that fact in the decisions of the lower courts. Additionally, plaintiff did not raise that issue in her brief or at oral argument. Thus, the suggestion should play no role in the disposition of this appeal.
IV.
For the reasons noted, I would hold that when an insurer has made some «payment of benefits to the insured but then denies further benefits following a gap in treatment, a claimant must file an action for additional benefits within two years of the insurer’s last payment of claims. That holding would apply even if the insurer’s last payment occurred within four years of the accident. One may reach a contrary result only by disregarding the literal language of the statute and rejecting prior case law.
*344Accordingly, I would reverse the judgment of the Appellate Division.
Justice GARIBALDI joins in this opinion.
For affirmance and remandment — Chief Justice PORITZ and Justices O’HERN, STEIN and LONG — 4.
For reversal — Justices GARIBALDI and VERNIERO — 2.