Sanders v. Langemeier

949 A.2d 295, 401 N.J. Super. 125
CourtNew Jersey Superior Court Appellate Division
DecidedJune 19, 2008
DocketA-4335-06T3
StatusPublished
Cited by2 cases

This text of 949 A.2d 295 (Sanders v. Langemeier) 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
Sanders v. Langemeier, 949 A.2d 295, 401 N.J. Super. 125 (N.J. Ct. App. 2008).

Opinion

949 A.2d 295 (2008)
401 N.J. Super. 125

Omar SANDERS, Plaintiff-Respondent,
v.
Norma K. LANGEMEIER, Patricia L. Leslie, Clarendon National Insurance Company, Defendants, and
New Jersey Property-Liability Insurance Guaranty Association, Defendant-Appellant.

No. A-4335-06T3

Superior Court of New Jersey, Appellate Division.

Argued May 19, 2008.
Decided June 19, 2008.

*296 Hugh P. Francis, argued the cause for appellant (Francis & Berry, attorneys; Mr. Francis, of counsel and on the brief; Joanna Huc, on the briefs).

Kenneth E. Ryan, Passaic, argued the cause for respondent (Weiner, Ryan & Mazzei, attorneys; Mr. Ryan, on the brief).

Paul G. Witko, Deputy Attorney General, argued the cause for amicus curiae Commissioner of Banking and Insurance (Anne Milgram, Attorney General, attorney; Patrick DeAlmeida, Assistant Attorney General, of counsel; Mr. Witko, on the brief).

Starr, Gern, Davison & Rubin, Roseland, for amicus curiae The Association of Trial Lawyers of America-New Jersey (Jeffrey A. Rizika, of counsel; James A. Meszaros, on the briefs).

Before Judges LINTNER, GRAVES and ALVAREZ.

The opinion of the court was delivered by

LINTNER, P.J.A.D.

This appeal requires us to determine whether an otherwise uninsured passenger, not qualified to receive Medicaid, who is afforded medical payments limited to the emergency personal injury protection coverage afforded under the owner-operator's special insurance policy, is eligible to recover personal injury protection (PIP) *297 benefits for non-emergency medical treatment from the New Jersey Property-Liability Insurance Guaranty Association (PLIGA) as administrator of the Unsatisfied Claim and Judgment Fund (UCJF).[1] We hold that the UCJF is obligated to provide PIP benefits not covered by the emergency personal injury protection coverage payable to those passengers not eligible for Medicaid, as they otherwise would have been protected had PIP coverage been in force to satisfy their medical treatment expenses.

The facts are undisputed. Plaintiff, Omar Sanders, was injured while riding as a passenger in an automobile owned and operated by Patricia Leslie when it was involved in a two-car accident in Bloomfield with a vehicle operated by Norma Langemeier. Leslie's vehicle was insured by a special automobile insurance policy issued by Clarendon National Insurance Company (Clarendon) pursuant to N.J.S.A. 39:6A-3.3. Langemeier was insured with a standard automobile policy issued by Allstate Insurance Company (Allstate). Sanders sustained cervical, thoracic, and lumbar injuries and was taken to St. Mary's Medical Center (St. Mary's) where he was given emergency treatment and released. Thereafter, he came under the care of Dr. Paul Misthos at Sall/Myers Medical Associates where he received treatment and incurred medical bills in the amount of $2305.47.

Allstate's standard policy did not cover Sanders for PIP benefits because he was neither a named insured nor a member of the named insured's family residing in the named insured's household while occupying an automobile, nor a passenger while occupying the named insured's vehicle. See N.J.S.A. 39:6A-4. Under Leslie's special policy, Clarendon only paid Sanders' emergency medical care rendered at St. Mary's. Because the Clarendon policy only afforded emergency personal injury protection coverage, Sanders sought payment of Dr. Misthos' bills from the UCJF. When the UCJF refused payment, Sanders filed suit naming the UCJF as a defendant.[2]

Motions for summary judgment were filed by both Sanders and the UCJF. After oral argument, the motion judge concluded that the UCJF was required to provide the applicable coverage for Sanders' non-emergent care. In a written opinion issued on March 13, 2007, the judge denied the UCJF's motion for reconsideration.[3] This appeal followed.

We begin our analysis by reviewing the applicable statutes. In 1998, the Legislature adopted the Automobile Insurance Coverage Act (AICRA). Under AICRA, N.J.S.A. 39:6A-3 continued the requirement that every owner of a motor vehicle maintain automobile liability insurance coverage with minimum limits of $15,000 per injury and $30,000 per accident. See also N.J.S.A. 39:6B-1. A policy issued with the required $15,000/$30,000 limits is known as a "standard automobile insurance policy." N.J.A.C. 11:3-3.2.

*298 The standard policy under AICRA was required to "contain personal injury protection benefits." N.J.S.A. 39:6A-4. "`Personal injury protection coverage' means and includes . . . [p]ayment of medical expense benefits" up to $250,000 per person per accident, including "reasonable, necessary, and appropriate treatment . . . to persons sustaining bodily injury." N.J.S.A. 39:6A-4a. The $250,000 medical expense benefit, which had been mandatory prior to the adoption of AICRA, became the default option for a standard policy, with reduced coverage limits of $15,000, $50,000, $75,000, and $150,000 available at the election of the insured. N.J.S.A. 39:6A-4.3e.

With the passage of AICRA, the Legislature introduced a non-compulsory option known as the "basic automobile insurance policy." N.J.S.A. 39:6A-3.1. Later, in 2003, the Legislature created the "special automobile insurance policy," N.J.S.A. 39:6A-3.3.

The basic policy allows for up to $250,000 in medical benefits for injuries to the brain and spinal cord, as well as disfigurement and "other permanent and significant injuries" treated immediately following an accident at an acute care facility. N.J.S.A. 39:6A-3.1. It is also required to contain reduced PIP coverage in an amount not to exceed $15,000 for reasonable and necessary treatment, and $5000 for property damage liability coverage. Ibid. The legislation additionally required carriers issuing basic policies to provide "optional liability insurance coverage" with limits of $10,000. N.J.S.A. 39:6A-3.1c.

The special policy was established by the Legislature "[i]n order to assist certain low income individuals . . . and encourage their greater compliance in satisfying the mandatory private passenger automobile insurance requirements." N.J.S.A. 39:6A-3.3. In setting the limited income criteria for qualification, the statute directs the commissioner to limit the availability of the special policy "to those persons eligible and enrolled in the federal Medicaid program." Ibid. The special policy provides (1) "[e]mergency personal injury protection coverage"; (2) a "[d]eath benefit in the amount of $10,000"; (3) the limited lawsuit option pursuant to N.J.S.A. 39:6A-8a; and (4) no "liability, collision, comprehensive, uninsured or underinsured motorist coverage." Ibid.

The special insurance "[e]mergency personal injury protection coverage," provides benefits for the named insured and dependent family members residing in the named insured's household, "as defined by the federal Medicaid program," and "other persons sustaining bodily injury while occupying . . . the automobile of the named insured." N.J.S.A. 39:6A-3.3b. "Emergency personal injury protection coverage" covers "only payment of treatment for emergency care in an amount not to exceed $250,000 per person per accident." Ibid. "Emergency care" is defined as

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Related

Sanders v. Langemeier
972 A.2d 1103 (Supreme Court of New Jersey, 2009)
McGovern v. Bor. of Harvey Cedars
949 A.2d 302 (New Jersey Superior Court App Division, 2008)

Cite This Page — Counsel Stack

Bluebook (online)
949 A.2d 295, 401 N.J. Super. 125, Counsel Stack Legal Research, https://law.counselstack.com/opinion/sanders-v-langemeier-njsuperctappdiv-2008.