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Haines v. Taft

Supreme Court of New Jersey

October 22, 2018, Argued; March 26, 2019, Decided

A-13/14 September Term 2017, 079600

Opinion

 [*273]   [**264]  JUSTICE LaVECCHIA delivered the opinion of the Court.

In this consolidated appeal, we consider one question of law: Did the Legislature intend to deviate from its highly regulated no-fault system of first-party self-insurance to cover medical expenses arising from automobile accidents when it amended the statutory scheme to allow an insured to elect smaller [***10]  amounts of personal injury protection (PIP) under a standard policy?

 [*274]  Each plaintiff in this appeal was injured in a car accident. Each was insured under a standard policy with insurance that provided for $15,000 in PIP coverage instead of the default amount of $250,000. Neither plaintiff was able to sustain a claim for bodily injury (noneconomic loss) due to each policy's limitation-on-lawsuit option. Each was suing for outstanding medical provider charges in excess of their elected PIP coverage ($28,000 and $10,000, respectively). The trial court record reveals that the outstanding provider charges had not been subjected to the cost  [**265]  containment requirements under the PIP regulatory scheme.

The Appellate Division concluded that plaintiffs could introduce evidence of their outstanding medical bills in excess of the elected PIP policy coverage in support of fault-based claims for economic damages against their respective tortfeasors.

For the reasons that follow, we reverse. ] We cannot conclude that there is evidence of a clear intention on the part of the Legislature to deviate from the carefully constructed no-fault first-party PIP system of regulated coverage of contained medical expenses [***11]  and return to fault-based suits consisting solely of economic damages claims for medical expenses in excess of an elected lesser amount of available PIP coverage. Unless the Legislature makes such an intent clearly known, we will not assume that such a change was intended by the Legislature through its amendments to the no-fault system in the Automobile Insurance Cost Reduction Act (AICRA).

Indeed, ] in the opening findings and declarations section of AICRA, it was the Legislature's belief that "it is good public policy to provide medical benefits on a first party basis, without regard to fault, to persons injured in automobile accidents," but "in order to keep premium costs down, the cost of the benefit must be offset by a reduction in the cost of other coverages, most notably a restriction on the right of persons who have non-permanent or non-serious injuries to sue for pain and suffering." N.J.S.A. 39:6A-1.1(b) (1998). Upon consideration of the coordinated amendments accomplished through AICRA to tighten up medical  [*275]  utilization, contain insurance costs, and make first-party no-fault insurance coverage more affordable and available, we find the Appellate Division's conclusion counter-intuitive and look for [***12]  greater guidance from the Legislative Branch.

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237 N.J. 271 *; 204 A.3d 263 **; 2019 N.J. LEXIS 441 ***; 2019 WL 1339479

JOSHUA HAINES, PLAINTIFF-RESPONDENT, v. JACOB W. TAFT, BONNIE L. TAFT, JOINTLY, SEVERALLY AND/OR IN THE ALTERNATIVE, DEFENDANTS-APPELLANTS, AND JOHN MCHENRY, DEFENDANT. TUWONA LITTLE, PLAINTIFF-RESPONDENT, v. JAYNE NISHIMURA, DEFENDANT-APPELLANT.

Prior History: On certification to the Superior Court, Appellate Division, whose opinion is reported at 450 N.J. Super. 295, 162 A.3d 296 (App. Div. 2017) [***1] .

Haines v. Taft, 450 N.J. Super. 295, 162 A.3d 296, 2017 N.J. Super. LEXIS 64 (App.Div., June 1, 2017)

CORE TERMS

coverage, medical expenses, insured, no-fault, benefits, uncompensated, costs, automobile insurance, drivers, fault, economic loss, wrongdoer, automobile insurance policy, amounts, premiums, deductibles, injuries, automobile accident, medical costs, unpaid, collectible, tortfeasor, expenses, reimbursement, medical bill, residents, legislative intent, bodily injury, fault-based, copayments

Governments, Legislation, Interpretation, Insurance Law, No Fault Coverage, Personal Injury Protection, Medical Benefits, State & Territorial Governments, Legislatures, Types of Insurance, Motor Vehicle Insurance, Liability Limitations