Court Opinion

ID: 9699397
Source: CourtListenerOpinion
Date Created: 2023-08-25 20:22:19.734443+00
Date Added: 2024-06-11T18:20:49.784754
License: Public Domain

Schreiber, J.,
dissenting. In my opinion the reasonable interpretation of N, J. S. A. 39:6A-4 requires an insurance company to pay only for essential services benefits which, have been incurred. The essential services benefits provision must be viewed' in the light of the statutory scheme for the payment of personal injury protection (PIP) benefits, N. J. S. A. 39 :6A-4. That section reads as follows:
Every automobile liability, insurance policy insuring an automobile as defined in this act against loss resulting from liability imposed by law for bodily injury, .death and property damage sustained by any person arising out of ownership, operation, maintenance or use *580of an automobile shall provide additional coverage, as defined herein below, under provisions approved by the Commissioner of Insurance, for the payment of benefits without regard to negligence, liability or fault of any kind, to the named insured and members of his family residing in his household who sustained bodily injury as a result of an accident involving an automobile, to other persons sustaining bodily injury while occupying the automobile of the named insured or while using such automobile with the permission of the named insured and to pedestrians, sustaining bodily injury caused by the named insured’s automobile or struck by an object propelled by or from such automobile. “Additional coverage” means and includes:
a. Medical expense benefits. Payment of all reasonable medical expenses incurred as a result of personal injury sustained in an automobile accident. In the event of death, payment shall be made to the estate of the decedent.
b. Income continuation benefits. The payment of the loss of income of an income producer as a result of bodily injury disability, subject to a maximum weekly payment of $100.00, per week. Such sums shall be payable during the life of the injured person and shall be subject to an amount or limit of $5,200.00, on account of injury to any one person, in any one accident.
c. Essential services benefits. Payment of essential services benefits to an injured person shall be made in reimbursement of necessary and reasonable expenses incurred for such substitute essential services performed by the injured person for himself, his family and members of the family residing in the household, subject to an amount or limit of $12.00 per day. Such benefits shall be payable during the life of the injured person and shall be subject to an amount or limit of $4,380.00, on account of injury to any one person in any one accident.
d. Survivor benefits. In the event of the death of an income producer as a result of injuries sustained in an accident entitling such person to benefits under section 4 of this act,1 the maximum amount of benefits which could have been paid to the income producer, but for his death, under section 4 b. shall be paid to the surviving spouse, or in the event there is no surviving spouse, then to the surviving children, and in the event there are no surviving spouse or surviving children, then to the estate of the income producer.
In the event of the death of one performing essential services as a result of injuries sustained in an accident entitling such person to benefits under section 4 e. of this act, the maximum amount of benefits which could have been paid such person, under section 4 c., shall be paid to the person incurring the expense of providing such essential services.
*581e. Funeral expenses benefits. All reasonable funeral, burial and cremation expenses, subject to a maximum benefit of $1,000.00, on account of the death to any one person in any one accident shall be payable to decedent’s estate.
1This section.
It may be seen that subsection (e) provides that payment of essential services benefits to an injured person shall be made in reimbursement of necessary and reasonable expenses incurred for such substitute essential services ordinarily performed by the injured person for his family and himself. Certainly no one would quarrel with the fact that this plain and unambiguous language contemplates an expenditure by the insured and then reimbursement by the insurance company of those .expenditures.
The same scheme, involving reimbursement for expenditures incurred for essential services, is embraced under subsection (d), survivor benefits. This subsection provides for the effect on income continuation benefits under (b) and essential services benefits under (c) which may arise if the insured dies. In that event payments are then to be made to the person incurring the expense of providing such essential services. Subsection (d) must he read in the light of subsection (c). While the injured person lives, he is to be reimbursed for essential expenditures up to $12.00 per day and the same situation is to continue upon death until the aggregate maximum amount of $4380 is expended. That this was the understanding of the proponents of the legislation may be gathered from the comments of the Legal Counsel to the Legislature’s Automobile Insurance Study Commission.1 In discussing survivor essential services benefits, he wrote:
One must note carefully that the relationship of the decedent to the one incurring the expense of providing the substituted essential services is of no import. However, in order to qualify as an essential service it must be a service ordinarily performed by the *582decedent for himself (or herself) for his or her family and members of the family residing in the household. Therefore, if a grandmother or aunt or an unrelated individual incurs expense in providing the substituted essential services, for example, for the children of the decedent who resided within the household, such person incurring the expense will receive the essential services survivor benefits, in order to satisfy the payment of such expenses. [M. Iavicoli, No Fault & Comparative Negligence in New Jersey at 73-74 (1973) (emphasis supplied)]
The Automobile Insurance Study Commission determined and concluded that the objectives of its recommended no fault legislation were reparations, minimization of claim costs, reasonable relationship between claims and premiums, and reduction of judicial workload. Reparation Reform for New Jersey Motorists, Report to the Governor and Legislature at 155 (1971). The first three objectives are related to compensating an injured victim for the “loss sustained,” id. at 25. Counsel to the Commission, in discussing these aspects, wrote as follows:
It must be emphasized that the Act provides for reimbursement of expenditures; therefore, an actual expenditure is required. If the husband performs the injured wife’s household services without an economic loss to the wife, no payment will result from essential services benefits. [M. Iavicoli, supra at 61]
The Appellate Division in this ease aptly stated:
This construction of the enactment is most compatible with the overall purpose of the legislation which is, as its title implies, “reparation.” [150 N. J. Super. at 160]
We abided by that construction recently when considering subsection (a) of N. J. S. A. 39 :6A-4, which provides for payment of all reasonable medical expenses incurred as a result of personal injury sustained in an automobile accident. Sanner v. Government Employees Ins. Co., 150 N. J. Super. 488 (App. Div. 1977), aff’d o.b. 75 N. J. 460 (1978). In that case we refused to sanction payment to a serviceman *583for free medical treatment administered to him at a Veterans Administration Hospital. We adhered to the legislative purpose that recovery was not warranted “where liability for such expenses was not incurred or paid,” 150 N. J. Super. at 492, and we could not “conceive [of] the public interest to be served by such a result.” Id. at 493.
Support for the principle that the act contemplates reimbursement only of actual expenditures may also be found in the statutory provisions which prevent the recipient of PIP benefits from maintaining a suit for damages based on tort liability. N. J. S. A. 39:6A-8. The legislative intent was that the injured person recover his actual losses and not be able to obtain a double recovery. See Cirelli v. Ohio Casualty Insurance Co., 72 N. J. 380, 387 (1977).
Indeed, viewing the statute in its entirety, one discerns a pattern of reimbursement, whether for medical expenses, funeral expenses, loss of income, or essential service benefits. The intent certainly was not to provide someone with a windfall, a result which conflicts with another major purpose of the no fault law — to decrease the cost of automobile liability insurance to the motoring public. M. Iavicoli, supra at 20. Reimbursement and reparations are the keys to the legislative intent.
I would affirm the judgment of the Appellate Division.
Justice Clifford joins in this opinion.
For reversal and remandment — Chief Justice Hughes and Justices Sullivan, Pashman and Handler and Judge CONFORD-5.
For affirmance — Justices Clifford and Schreiber — 2.

The Commission was created by Joint Res. No. 4, L. 1970.