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Everett v. State Farm Indemnity Co.12/31/2002
on of evidence of "the amounts of any deductibles, copayments or exclusions" in a civil action for the recovery of damages for bodily injury. The Court concluded from the statute's incremental changes, as well as the No Fault Law's goal of reducing litigation, that the deductible mandated by the No Fault Law constitutes an amount to be borne by the insured: by mandating the $250 deductible and the twenty-percent copayment, the Legislature guaranteed that in every automobile accident some medical expenses would not be paid under PIP. For those below-deductibles and copayments, the insured was responsible, either though the insured's other insurance coverage, or, if the insured had no other insurance, as in this case, out of the insured's own pocket. [135 N.J. at 509 (emphasis added).]
Roig considered, and rejected, the idea that an injured party could seek recovery of expenses falling within a deductible against a tortfeasor.
Roig's message for the present case, and for cases in which the statute of limitations is implicated, is clear: an insured's incurring of medical expenses falling within a mandatory deductible does not constitute a relevant occurrence in determining the party's rights and obligations under the No Fault Law. To be consistent with the notion that all provisions within a statutory scheme ought to be construed so they will act in harmony, Matter of J.W.D., 149 N.J. 108, 115-16 (1997); Burt v. West Jersey Health Systems, 339 N.J. Super. 296, 304 (App. Div. 2001), the meaning of the phrase "payment of benefits" contained in the No Fault Law's statute of limitations should be construed to require an actual payment by the insurer, not just a notation in its records that a particular bill falls within the insured's deductible.
VI.
In the final analysis, an acknowledgement of an expense falling within an insured's deductible does not constitute a "payment" by the insurer nor a "benefit" to the insured. This construction, in my view, (1) is strongly suggested by the plain and ordinary meaning of "payment," (2) further justified by prior judicial construction of the word "payment," (3) should not be broadened because of possible arbitrary results which might otherwise attach, (4) is compelled by the well-settled goals of the No Fault Law to eliminate minor tort lawsuits and reduce escalating insurance premiums, and (5) to be in accord with Roig v. Kelsey, is further mandated by the insignificant role deductibles should play in the application of the No Fault Law. Notwithstanding this persuasive evidence of the probable intent of N.J.S.A. 39:6A-13.1a, the majority has concluded that the incurring of an expense not covered by PIP is the equivalent of a "payment of benefits" for purposes of determining the timeliness of a claim for PIP benefits. Because I view that hypothesis as erroneous, I respectfully dissent. I would affirm the summary judgment entered by the motion judge.
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