Court Opinion

ID: 9699423
Source: CourtListenerOpinion
Date Created: 2023-08-25 20:23:19.580928+00
Date Added: 2024-06-11T18:20:50.146991
License: Public Domain

Schreiber, J.,
concurring. Rose Lee Muschette was killed in an automobile accident on July IS, 1973. At that time she and her husband Milton J. Muschette were insured by the defendant The Gateway Insurance Co. under its automobile policy for bodily injury and property damage liability. The policy also provided uninsured motorist coverage, personal injury protection, and additional personal injury protection. Plaintiff Milton J. Muschette, individually and as administrator of his wife’s estate, brought this action to recover the additional personal injury protection benefits afforded by the policy. The trial judge awarded the plaintiff as additional personal injury benefits the maximum statutory amounts for income loss and loss of essential services under N. J. S. A. 39:6A-4 and -10, and a $10,000 death benefit. The Appellate Division affirmed. 149 N. J. Super. 89 (1977).
The defendant did not issue an insurance policy in its usual form. Instead it delivered to the insured, with an identification card reflecting that there was insurance coverage for the plaintiff’s 1964 Chevrolet, an indorsement sheet which stated in part that insurance was afforded with re*566spect to those coverages indicated by a specific premium charge. Under coverages there was listed “Additional PIP (opt. #5)” and alongside that notation a reference to the premium charge of $9.00. “PIP” refers to personal injury protection coverage which is required irrespective of fault by N. J. S. A. 39:6A-4 and -10.
The main issues are what additional personal injury protection benefits were purchased by the insured and to what he is entitled. To ascertain the coverage afforded by the policy it is necessary to examine the underlying statute. The pertinent sections read 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 of 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 or 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 ordinarily performed by the injured person for himself, his *567family 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 aet,i 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.
e. 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.l This section [N. J. S. A. 39:6A-4]
Insurers shall make available to the named insured covered under section 4,1 suitable additional first-party coverage for income continuation benefits, essential services benefits, survivor benefits and funeral expense benefits. Income continuation in excess of that provided for in section 4 must be provided as an option by insurers to persons for disabilities, as long as the disability persists, up to an income level of $35,009.00 per year, with the excess between $5,200.00 and the amount of coverage contracted for to be written on the basis of 75% of said difference. The Commissioner of Insurance is hereby authorized and empowered to establish, by rule or regulations, the amounts and terms of income continuation insurance to be provided pursuant to this section.
1Section 39:6A-4. [N. J. S. A. 39:6A-10]
The 'Commissioner of Insurance has promulgated the following schedule of additional personal injury protection benefits :
*568Minimum schedule of additional personal injury protection
(a) Appendix A outlines the minimum schedule of “additional personal injury protection” coverage benefits that insurers must make available in accordance with Section 10 of the Act.
(b) In the Appendix A table, only five weekly indemnity schedules are shown, with a two-year benefit duration. It is believed that these ranges of benefits will meet the demand for this additional coverage in most cases.
(c) Consequently, at least for the initial period, it will be sufficient if your manuals exhibit these minimum benefit schedules with corresponding rates.
(d) However, benefits in excess of those set forth in Appendix A must be made available at the option of the named insured at reasonable intervals subject to the specific approval by the Commissioner, up to a maximum additional weekly loss of income benefit of $35,000 per year, as well as reasonable essential service benefits, survivor benefits and funeral expense benefits, as required by Section 10 of the Act.
APPENDIX A
ADDITIONAL PERSONAL INJURY PROTECTION
Maximum Additional Weekly Loss of Income Benefit
During Period of Basic Benefits Payments (a)
After Period of Basic Benefits Payments (b)
Total Maximum Income Benefits
Maximum Essential During Basic Payments
Additional Services After Basic Payments
Total Max. E. Serv.
Death Benefits (c)
1. SO $100 $5,200 $0 $12 $4,380 $10,000
2. 25 125 7,800 8 20 10,220 10,000
3. 75 175 13,000 20 10,220 10,000
4. 150 250 20,800 20 10.220 10,000
5. 300 400 36,400 20 10,220 10,000-
NOTES TO TABLE
(a) Subject to 75 per cent of the amount of weekly income in excess of $100.00 per week.
(b) Subject to 75 per cent of the total weekly income.
(c) Death benefit shall be payable provided death occurs within 90 days from date of accident.
GENERAL: Above schedules applicable to named insured as defined ; limits apply per person, per accident.
Broader forms of additional personal injury protection benefits are available on a “refer to company” basis.
Nothing herein is intended to prohibit the marketing of additional coverage on a per car basis.
[N. J. A. C. 11:3-7.3]
*569The “opt. #5” in the Muschette policy refers to the tabulation next to numeral 5 in Appendix A of the above schedule. This tabulation prescribes a maximum additional weekly loss of income benefit during the period of basic benefits payments of $300 per week. As can be seen under N. J. S. A. 39:6A-4(b), basic income payments for loss of income are not to exceed $100 per week with a maximum of $5200. The additional coverage under option 5 of $300 would increase the weekly payments from $100 to $400 during the basic period. Furthermore, under that option, payments of $400 per week would continue after the basic period until the total aggregate additional income payments of $36,400 had been made. The total income payments which could be made therefore amount to $41,600.
Option 5 also increases the amount payable for essential services. Under N. J. S. A. 39:6A-4(c), reimbursement of necessary and reasonable expenses incurred for such services ordinarily performed by the injured person are limited to $12 per day and a maximum of $4380. Under option 5 the allowable daily maximum payment is increased by $8 to $20. After the time period during which the basic essential services may be reimbursed has elapsed, the allowable daily maximum rate is continued at $20 per day until the maximum additional essential services benefits of $10,220 have been expended. The total essential services benefits which could be made therefore amount to $14,600. See General Accident Group v. Shimp, 147 N. J. Super. 404, 411 (Law Div. 1977).
The last column in option 5 provides for a death benefit of $10,000, payable provided death occurs within 90 days from the date of the accident.
The insurance contract contemplates that the insured will be entitled to receive the loss of income benefits and the essential services benefits provided in N. J. S. A. 39:6A-4 as enlarged by option 5. I agree that, if the statutory conditions are satisfied, that is, the individual’s income level and essential services expenses are at least equal to the statutorily *570required amounts, the insurance carrier would be responsible for the aggregate maximum losses of income and essential services. Furthermore, under this insurance agreement the insurance company is also obligated to pay death benefits of $10,000 in the event that death occurs within 90 days from the date of the accident. This death benefit is prescribed independently of the maximum weekly loss of income benefit and maximum essential services. M. Iavicoli, No Fault & Comparative Negligence in New Jersey at 59 (1973).
Defendant has also questioned the propriety of the judgment having included interest at the rate of 10% per annum. The applicable statute, N. J. S. A. 39:6A-5(c), provides that “[a]ll overdue payments shall bear simple interest at the rate of 10% per annum.” Defendant’s reliance upon N. J. S. A. 59:9-2(a), which precludes interest prior to the entry of judgment against a public entity, is misplaced. That provision is a part of the New Jersey Tort Claims Act, N. J. S. A. 59:1-1 et seq., and is not applicable to the instant contractual action.
I have hitherto pointed out that plaintiff is entitled to total income payments of $41,600, total essential services benefits of $14,600 and a death benefit of $10,000. However, the plaintiff sought $36,400 of income payments and $10,200 of essential service benefits. Judgment was entered in those amounts and the Appellate Division affirmed. Ho cross-appeal was filed in this Court. Accordingly, the judgment in favor of the plaintiff must be affirmed. It may be that plaintiff’s calculation was due to a mistake or inadvertence in examining option 5 in the regulation promulgated by the 'Commissioner of Insurance. If so, he may seek appropriate relief from the trial court in accordance with R. 4:50-l.
I concur in the affirmance of the judgment.
Justice Clifpoed joins in this opinion.