Aponte-Correa v. Allstate Insurance

722 A.2d 955, 317 N.J. Super. 597, 1999 N.J. Super. LEXIS 7
CourtNew Jersey Superior Court Appellate Division
DecidedJanuary 15, 1999
StatusPublished
Cited by3 cases

This text of 722 A.2d 955 (Aponte-Correa v. Allstate Insurance) is published on Counsel Stack Legal Research, covering New Jersey Superior Court Appellate Division primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Aponte-Correa v. Allstate Insurance, 722 A.2d 955, 317 N.J. Super. 597, 1999 N.J. Super. LEXIS 7 (N.J. Ct. App. 1999).

Opinion

The opinion of the court was delivered by

BROCHIN, J.A.D.

Plaintiff Rosa Aponte-Correa sued defendant Allstate Insurance Company for PIP benefits. Summary judgment was granted dismissing her complaint on the ground that it was barred by the applicable statute of limitations, N.J.S.A 39:6A-13.1a. We reverse.

N.J.S.A 39:6A-13.1a consists of two parts, a proviso and the language that precedes it. To facilitate our discussion of the statute, we will refer to the language that precedes the proviso as the “first part” of the statute, and the language of the proviso as the “second part.”1 The first part of the statute states:

[599]*599Every action for the payment of [PIP] 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 aeeident[,] whichever is earlier,

The second part states:

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.

Plaintiff was injured in an automobile accident on November 22, 1992. She filed a claim, and defendant paid her bills for medical services. It made its last payment to plaintiff on December 28, 1993. The first medical services for which defendant refused to pay were provided to plaintiff on July 10, 1995. Plaintiff filed her complaint on July 24,1996.

Plaintiff argues that her suit was filed within time because, “Where no-fault benefits have been paid, a suit for further no-fault benefits is timely if brought within four years of the date of the accident, and within two years after the oldest uncompensated expense is incurred.” As to the first of these conditions for maintaining an action, it is undisputed that plaintiffs suit was commenced within four years after the date of her accident. The are two other implied premises of plaintiffs argument, both of which are contested. These are, first, that the statutory requirement to commence a PIP suit within “2 years after the injured person ... incurs an expense” means within two years after the injured person has first incurred an uncompensated expense for medical treatment necessitated by the accident; and, secondly, that commencing the suit within four years after the accident and within two years after the first uncompensated expense makes the suit timely, even if the insurer has paid benefits and the suit, although for “further benefits,” was instituted more than “2 years after the last payment of benefits,” as required by the second part of the statute.

Defendant contends that the suit is barred by operation of the second part of the statute because it was commenced more than two years after the last payment of benefits to plaintiff on [600]*600December 28, 1993. In other words, defendant reads the statute to mean that, if benefits have been paid prior to suit, an action for additional benefits must satisfy the timeliness criteria of the second part of the statute in order to proceed, regardless of whether or not it satisfies the timeliness criteria of the first part.

Bell v. Western Employer’s Ins. Co., 173 N.J.Super. 60, 64, 413 A.2d 363 (App.Div.1980), supports plaintiffs position. The Bell plaintiff was injured in ah automobile accident on June 12, 1975. The defendant insurer paid her PIP benefits until January 7,1976. But it refused to pay for necessary dental care which she received from December 1977 to August 21, 1978. The plaintiff commenced her suit on June 13,1978.

Our opinion does not state specifically when the Bell plaintiff incurred her first expense, but it was necessarily a date prior to January 7,1976, when the insurer made its last payment. Consequently, it is clear that although the suit was commenced within four years after the accident and within two years after the plaintiff incurred her first uncompensated expense, it was commenced more than two years after she incurred her first compensated expense and more than two years after the insurer’s last payment.

If the two-year period of limitations established by the first part of N.J.S.A. 39:6A-13.1a were measured from the plaintiffs first expense, the suit commenced June 13, 1978 would have been untimely because it would not have complied with the requirement of either the first or the second part of the statute. In fact, plaintiff undoubtedly incurred her first medical expense on or shortly after June 12, 1975, the date of the accident. If that expense, although compensated by the insurer, triggered the running of the period of limitations established by the first part of the statute, the Bell plaintiffs suit would have been barred even before December 1977, the date when she first incurred a medical expense for which the insurer refused to pay. It would be grossly unfair to interpret a statute of limitations to bar a suit because it was not commenced before the potential plaintiff had anything to [601]*601sue about. Because we did “not think that the Legislature, in N.J.S.A. 39:6A-13.1, was concerned with barring actions for claims voluntarily paid,” Bell, supra, 173 N.J.Super. at 64, 413 A.2d 363, we held that the Bell action was timely because it had been commenced not later than two years after the plaintiff incurred her first uncompensated expense caused by the accident. That ruling supports plaintiffs argument in the present case that she is entitled to maintain her suit because she commenced it within two years after she incurred her first uncompensated medical expense resulting from the accident.

We also determined in Bell that even though an insurer had paid benefits, the period within which suit could be commenced was not defined exclusively by the second part of the statute. Otherwise, we would have had to affirm the dismissal of the action because, as we have noted, it was commenced more than two years after the last payment of benefits by the insurer. We held that an insured claiming PIP benefits could maintain her suit if it was timely according to the limitations criteria of either the first or the second part of the statute. We stated:

The proviso in N.J.S.A 39:6A-13.1 ... docs not narrow plaintiffs rights under the statute. It is clear that the proviso was necessary, for without it the payment of benefits could not be enforced after four years following an accident since N.J.S.A 39:6A-13.1 bars an action for recovery of benefits after the earlier of two years after the expense is incurred or four years after the accident. There is certainly no indication elsewhere in the No Fault Act that the Legislature intended to limit liability for benefits to a four-year period following an accident.
Id. at 64-65, 413 A.2d 363.]

In other words, the proviso permits suits to be brought which could not be maintained in its absence; it does not prohibit suits which, absent the proviso, the preceding language would permit.

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Related

Fireman's Fund Insurance v. New Jersey Manufacturers Insurance
775 A.2d 625 (New Jersey Superior Court App Division, 2001)
Aponte-Correa v. Allstate Insurance
744 A.2d 175 (Supreme Court of New Jersey, 2000)

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Bluebook (online)
722 A.2d 955, 317 N.J. Super. 597, 1999 N.J. Super. LEXIS 7, Counsel Stack Legal Research, https://law.counselstack.com/opinion/aponte-correa-v-allstate-insurance-njsuperctappdiv-1999.