Reilly v. AAA Mid-Atlantic Insurance

946 A.2d 564, 194 N.J. 474, 2008 N.J. LEXIS 425
CourtSupreme Court of New Jersey
DecidedMay 14, 2008
DocketA-122 September Term 2006
StatusPublished
Cited by50 cases

This text of 946 A.2d 564 (Reilly v. AAA Mid-Atlantic Insurance) is published on Counsel Stack Legal Research, covering Supreme Court of New Jersey primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Reilly v. AAA Mid-Atlantic Insurance, 946 A.2d 564, 194 N.J. 474, 2008 N.J. LEXIS 425 (N.J. 2008).

Opinions

Justice HOENS

delivered the opinion of the Court.

In this matter, we consider whether, and under what circumstances, a driver who is involved in a single-vehicle accident may be considered to be “at-fault” for purposes of assessing insurance eligibility rating points. Because we conclude that, under the circumstances presented, the Department of Banking and Insurance has applied its regulations in a manner that exceeds the scope of its statutory authority, we reverse.

I.

The facts are not disputed. Plaintiff Glen Reilly was returning home from a ski trip in Pennsylvania on January 2, 2003. He was driving on Route 15 in northwestern New Jersey in weather that was cold and rainy. There had been no snow or ice warnings in the weather forecast. Because of the rain, all of the cars on the road, including plaintiffs, were traveling approximately 45 m.p.h. in a 55 m.p.h. speed limit zone, each driver leaving several car lengths between vehicles. Shortly before 7:30 p.m., plaintiff suddenly and without warning came upon a patch of black ice and lost control of his car. The vehicle spun 180 degrees and slid from the left lane until it collided with the guardrail on the right side of the road. No other vehicles were involved and the investigating police [479]*479officer did not issue a ticket or traffic citation to plaintiff as a result of the accident.

Plaintiff testified that he had not seen any accidents that night prior to his own, but witnessed many on the remainder of his trip home. Newspaper accounts the next day described the conditions throughout northern New Jersey as a “Black Ice Nightmare” that created “treacherous” driving conditions. George Berken and Mark Mueller, Black Ice Nightmare, The Star Ledger, Jan. 3, 2003, at 1. The weather “spark[ed] hundreds of accidents” and “[bjesieged police departments” unable to keep pace with the resulting “mayhem.” Ibid.

At the time of the accident, plaintiff had automobile insurance through State Farm Insurance Company (State Farm), which reimbursed him in excess of one thousand dollars for damage that the vehicle sustained in the incident. At the same time, State Farm, without alerting plaintiff, determined that the January 2, 2003 accident was an “at-fault” accident and assigned five insurance eligibility points to him for future underwriting purposes. For reasons not specified in the record, plaintiff later decided to change insurance companies and applied for automobile coverage from defendant AAA Mid-Atlantic Insurance Company of New Jersey (AAA). Although defendant issued an insurance policy to plaintiff, the company also concluded that the January 2, 2003 accident was an “at-fault” accident and also assigned plaintiff five eligibility points, along with two points based on an unrelated moving violation on September 28, 2001. As a result, defendant assigned plaintiff a total of seven insurance eligibility points.

The applicable regulations in effect at the time of plaintiff’s accident permitted an insurer to voluntarily decline coverage to any driver who had nine eligibility points, see N.J.A.C. 11:3—34.4(a)(8) (2002) amended by 35 N.J.R. 3260(a) (Jul. 21, 2003). In December 2003, however, the regulation was amended so as to lower the threshold from nine to seven points, see 35 N.J.R. 3260(a) (Jul. 21, 2003). Based on plaintiff’s seven points, he could [480]*480not meet this requirement, as a result of which defendant declined to renew plaintiffs policy in April 2004.

Plaintiff challenged his non-renewal and the five point assessment through an appeal to the Department of Banking and Insurance (“the Department”). After the Department issued a preliminary finding that defendant’s assessment of points was correct, plaintiff again appealed, and the matter was transferred to the Office of Administrative Law for a hearing.

During an April 4, 2005, hearing before an Administrative Law Judge (ALJ), both plaintiff and Danielle Sease, an underwriter for defendant AAA, testified. Plaintiff testified about the road conditions on the night of the accident and offered evidence to support his assertion that the black ice condition was unexpected and created an extraordinarily hazardous emergency.

Sease offered no contrary version of the facts, but testified that the accident was, nevertheless, properly classified as “at-fault.” She explained that the 2003 accident was reviewed twice by AAA for its underwriting purposes. First, when plaintiff applied for coverage, another underwriter determined that plaintiffs 2003 accident was “at-fault,” and five points were assigned at that time. In addition, Sease testified that she had independently reviewed the 2003 accident and concluded that it was correctly deemed to be an “at-fault” accident. According to Sease, because a driver is expected to maintain control of his or her vehicle at all times, the driver is deemed “at-fault” for an accident unless there is another party to whom fault can be attributed.

The ALJ found Reilly’s testimony “to be credible and consistent throughout,” while Sease’s was not. He found that defendant had no guidelines for determining fault in single-car accidents and that, as a result, those decisions were left to each individual underwriter’s judgment. He further found that Sease had not independently reviewed the circumstances surrounding the accident but had merely accepted the conclusion about fault that had been made by another, unidentified underwriter. Comparing the facts relating to the accident to an emergency, the ALJ reasoned [481]*481that because the accident was unforeseeable, unavoidable, and caused by black ice on the roadway, it should not be considered a chargeable “at-fault” accident. Rather, the ALJ specifically found that the accident “took place through no fault” of plaintiff. The ALJ therefore ordered that the five points be rescinded.

The Commissioner of the Department issued his final decision on May 17, 2005. The Commissioner accepted all of the ALJ’s factual findings, but rejected his legal conclusion. Instead, the Commissioner reasoned that a single-car accident can be deemed “at-fault” for insurance rating purposes, regardless of the driver’s culpability, as long as the criteria set forth in the applicable regulation, see N.J.A.C. 11:3-34.3, are met. The Commissioner explained:

Pursuant to N.JAC. 11:3-34.3, an accident is an “at-fault accident” for which eligibility points should accrue if it: involved a driver insured under the policy; resulted in payment of a claim of $500 or more for accidents that occurred before June 9, 2003, or $1,000 or more, for accidents that occurred on or after June 9, 2003 ... which payment was not recouped from another tortfeasor; is not specifically excepted as set forth in the rule; and the driver is not excused by application of the proportionate responsibility standard.

The Commissioner therefore concluded that defendant had properly deemed the accident to be an “at-fault” accident and upheld defendant’s decision to decline to renew plaintiffs policy.

Plaintiff appealed and, in a published decision, Reilly v. AAA Mid-Atlantic Ins. Co., 390 N.J.Super. 496, 915 A.2d 1105 (App.Div.2007), the Appellate Division affirmed. Reasoning that because the enabling statute, N.J.S.A

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Alfred Petrossian v. Cindy R. Jebb, Etc.
New Jersey Superior Court App Division, 2026
Arrow Ball LLC v. Alex Peled
New Jersey Superior Court App Division, 2026
George Lewis v. Board of Trustees, Etc.
New Jersey Superior Court App Division, 2025
In the Matter of Fabio Cologna
New Jersey Superior Court App Division, 2025
Michael Picariello v. Board of Trustees, Etc.
New Jersey Superior Court App Division, 2025
Jerald Lee v. Board of Trustees, Etc.
New Jersey Superior Court App Division, 2024
In Re Application of K.D. for a Permit to Carry a Handgun, Etc.
New Jersey Superior Court App Division, 2024
New Jersey Real Estate Commission v. Richard A. Karpf
New Jersey Superior Court App Division, 2024

Cite This Page — Counsel Stack

Bluebook (online)
946 A.2d 564, 194 N.J. 474, 2008 N.J. LEXIS 425, Counsel Stack Legal Research, https://law.counselstack.com/opinion/reilly-v-aaa-mid-atlantic-insurance-nj-2008.