Kurcsics v. Merchants Mutual Insurance

65 A.D.2d 192, 411 N.Y.S.2d 90, 1978 N.Y. App. Div. LEXIS 13407
Appellate Division of the Supreme Court of the State of New York·Decided December 15, 1978·Published·Cited by 4 cases

Opinion

OPINION OF THE COURT

Witmer, J.

This appeal depends upon the meaning of "first party benefits” in article 18 of the Insurance Law (§§670-678), New York’s Comprehensive Automobile Insurance Reparations Act, providing for no-fault insurance protection to "covered persons” and requires us to construe that law with particular reference to paragraph (a) of subdivision 2 of section 671 thereof. Plaintiff has lost in excess of $1,000 per month in earnings since his motor vehicle accident on April 1, 1977, but defendant insurance carrier has paid him only 80% thereof, to wit, $800 per month. In this action plaintiff seeks judgment declaring that defendant must pay him 100% of his lost earnings up to $1,000 per month. The question appears to be one of first impression in the appellate courts of this State.

Plaintiff was injured while riding a motorcycle on April 1, 1977, as a result of which he has sustained monthly loss of earnings since that date in the sum of $1,400. At that time an operator of a motorcycle was equated to a pedestrian or bicyclist, and was a "covered person” under subdivision 10 of section 671 of the Insurance Law (see 1 NY PJI2d 217, 1978 Supp, pp 39-40).* The insurer of the operator of the automobile with which plaintiff collided is the defendant, Merchants Mutual Insurance Company. It had issued a policy of liability insurance on the automobile with which plaintiff collided, and the policy complies with the requirements of section 672 of the Insurance Law. Plaintiff satisfied defendant that he was sustaining lost earnings in excess of $1,000 per month and, pursuant to defendant’s interpretation of paragraph (b) of subdivision 1 and paragraph (a) of subdivision 2 of section 671 of the Insurance Law, it has paid to plaintiff as no-fault "first party benefits” the sum of $800 per month from the date of the accident. No question of medical expenses is presented in [194] this case; nor are we concerned with an injured person’s right to maintain a tort action in case of serious injury.

Claiming that the statute requires defendant to pay him $1,000 per month for lost earnings, plaintiff instituted this declaratory judgment action to require defendant to pay him the remaining $200 per month from the date of the accident, plus 2% interest thereon and attorneys’ fees as provided in section 675 of the Insurance Law. Special Term granted plaintiff’s motion for summary judgment upon the complaint. Special Term wrote a thoughtful memorandum in support of its decision and held that the Legislature did not mean, by paragraph (a) of subdivision 2 of section 671 of the Insurance Law, to reduce by 20% the basic economic loss of earnings (up to $1,000 per month for not more than three years from the date of the accident) as defined in paragraph (b) of subdivision 1 of that section, which Special Term held that the Legislature meant to be paid to a covered person. It was the court’s view that the provision was inserted in the statute to solve an income tax problem, and that under defendant’s interpretation insurance companies instead of covered persons would be getting the benefit of 20% of the wages lost under $1,000 per month. It should be observed that, contrary to the analysis of the statute made by Special Term, section 671 of the Insurance Law makes no provision for payments to or for injured persons—it only contains definitions which, as terms of art, are used in the related sections of the act wherein the rights and obligations of covered persons and others are provided.

In view of the history of the no-fault law in its enactment and its interpretation by scholars, by the State Superintendent of Insurance in his promulgated regulations and by others, we disagree with Special Term.

The pertinent portions of section 671 of the Insurance Law are as follows:

"1. 'Basic economic loss’ means, up to fifty thousand dollars per person: * * *
"(b) loss of earnings from work which the injured person would have performed had he not been injured, and reasonable and necessary expenses incurred by such person in obtaining services in lieu of those that he would have performed for income, up to one thousand dollars per month for not more than three years from the date of the accident causing the injury * * *
"2. 'First party benefits’ means payments to reimburse a [195] person for basic economic loss on account of personal injury arising out of the use or operation of a motor vehicle in this state, less:
"(a) twenty percent of lost earnings pursuant to paragraph (b) of subdivision one of this section”.

In the course of presenting the no-fault legislation to the Legislature for its consideration, Senator Gordon, Chairman of the State Insurance Committee, explained and defended the provision in paragraph (a) of subdivision 2 of section 671 which provides for the reduction by 20% of the amount of lost earnings as defined in paragraph (b) of subdivision 1 of that section, stating:

" 'We have provided for loss of earnings from work for up to three years in the sum of $1,000 a month, and I will immediately clarify the question that was raised to me. If you are out one day, you do not get $1,000 worth of loss of earnings. That would be prorated, certainly, but from the $1,000 we deducted 20 percent, and I know Senator Griffin has been very concerned about the 20 percent and whether it might not be 15 percent or even 10 percent, and I want to point out that the 20 percent deduction from the $1,000 was predicated on the fact that the gross payment to the victim would not be subject to income tax. It would not be subject to Social Security payments, and, incidentally, Senator, Social Security payments amount to almost 6 percent. I think it is 5.8 percent, so you subtract that from the 20 and you are getting closer to the figure that you would be interested in.

" 'Many people today are at least in the 15 percent category, so that again when you are adding 15 and almost 6, you are over the 20 percent immediately.

" 'We felt also that the provision for coming back to work or inducing people to come back to work should be attractive enough in the sense that if they are going to take the deduction—we did not want them malingering—and that they should return to their jobs.’ ” (Report of Joint Legis Committee on Ins Rates, Regulation and Recodification of Insurance Law, NY Legis Doc, 1973, No. 18, p 10.)

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Kurcsics v. Merchants Mutual Insurance, 65 A.D.2d 192, 411 N.Y.S.2d 90, 1978 N.Y. App. Div. LEXIS 13407 (N.Y. Ct. App. 1978).

65 A.D.2d 192 (Kurcsics v. Merchants Mutual Insurance) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

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