Lead Opinion
This appeal requires us to interpret the provision of the No Fault Insurance Act (the Act), N.J.S.A. 39:6A-1 to -35, that prescribes limitations periods for suits arising out of the refusal by an insurer to pay medical expenses resulting from an automobile accident. The Act provides in pertinent part:
Every action for the payment of benefits ... shall be commenced not later than 2 years after the injured person or survivor suffers a loss or incurs an expense and either knows or in the exercise of reasonable diligence should know that the loss or expense was caused by the accident, or not later than 4 years after the accident whichever is earlier, provided* however, that if benefits have been paid before then an action for further benefits may be commenced not later than % years after the last payment of benefits.
[N.J.S.A. 39:6A-13.1a1 (emphasis added).]
I
The critical facts of this case are undisputed. On November 22, 1992, plaintiff Rosa Aponte-Correa was injured in an automobile accident. After undergoing a series of tests, plaintiff was diagnosed with borderline Carpal Tunnel Syndrome and also was treated for neck pain. Defendant Allstate Insurance Company (Allstate) paid plaintiffs medical expenses from December 1992 until December 28, 1993. On July 10, 1995, plaintiff underwent further medical testing for symptoms related to the 1992 accident. Those tests revealed continued borderline Carpal Tunnel Syndrome and- neck pain. Despite repeated telephone calls and letters from plaintiff to Allstate between February 1,1996 and the filing of suit, Allstate never issued a “cut-off’ letter to plaintiff. Because of her concern about the statute of limitations, plaintiff pressed Allstate for an answer about whether it intended to pay the bills or whether she should file suit. Allstate responded that it had not received the bills and that plaintiff should “do whatever she has to do.” Allstate subsequently declined either to pay or to reject the bills submitted by plaintiff.
On July 24, 1996, plaintiff filed a complaint for payment of her PIP benefits. Although the complaint was filed within four years of the accident and within two years of the date that plaintiff incurred her first uncompensated expense, the filing date was more than two years after Allstate’s last payment of PIP benefits. Subsequently, the parties proceeded to an arbitration hearing that resulted in Allstate being ordered to pay plaintiffs medical bills, counsel fees, and costs. Allstate refused to pay and moved for summary judgment, asserting the protection of the statute of limitations provision of the Act, N.J.S.A. 39:6A-13.1a. Allstate contended that plaintiffs claim was time-barred because it was not filed within two years of its last payment of benefits.
Accepting Allstate’s assertion, the trial court found that plaintiffs suit was barred because it was commenced more than two years after the last payment by Allstate, and therefore granted summary judgment to Allstate. The Appellate Division reversed. It held that “[t]he statute of limitations is satisfied if the date of commencement of suit meets either of the[ ] two alternative tests.” Aponte-Correa v. Allstate Ins. Co., 317 N.J.Super. 597, 606,
II
A
The view of our dissenting colleagues, the decisions of the various Appellate Division panels that have construed the statute, and the literal language of the statute persuade us that the statute at issue is susceptible to more than one interpretation.
The underlying purpose of the No Fault Act is reparation. See Automobile Insurance Study Commission, Reparation Reform for New Jersey Motorists at 7 (December 1971) (Commission’s Report). It was enacted primarily to assure that injured plaintiffs are compensated promptly for medical treatment resulting from injuries received in an automobile accident. Id. at 7 (stating that one of four objectives of No Fault Law is to ensure “the prompt and efficient provision of benefits for all accident injury victims”).
This Court’s decisions in Zupo v. CNA Insurance Company, 98 N.J. 30,
Similarly, in Rahnefeld, supra, 115 N.J. 628,
B
Although the first portion of the statute uses the prefatory phrase “shall be commenced” before setting forth the applicable limitations period, the second portion of the statute uses the phrase “may be commenced.” Settled principles of statutory construction guide us in our interpretation of the legislature’s use of the words “may” and “shall” in the same statutory sentence. Under the “plain meaning” rule of statutory construction, the word “may” ordinarily is permissive and the word “shall” generally is mandatory. See, e.g., Harvey v. Board of Chosen Freeholders of Essex County, 30 N.J. 381, 391,
C
This Court first addressed the issue of when the Act’s statute of limitations is triggered in Ochs v. Federal Insurance Company, 90 N.J. 108,
That question was first considered in Andrito v. Allstate Insurance Company, 161 N.J.Super. 409,
The Appellate Division reached a similar result two years later in Bell, supra, 173 N.J.Super. 60,
In Still v. Ohio Casualty Insurance Company, 189 N.J.Super. 231,
In a decision inconsistent with both Andrito and Bell, the Appellate Division in Sotomayor v. Allstate Insurance Company, 273 N.J.Super. 165,
In Washington v. Market Transition Facility, 295 N.J.Super. 868,
Our review of those decisions leads us to consideration of a secondary issue: when the limitations period in the first portion of the statute commences for claimants who receive PIP benefits within four years of the accident. • The Appellate Division in Bell, supra, concluded that the “loss or expense referred to in [the No Fault Act] is the loss or expense for which recovery is sought in the action unless there had been a prior uncompensated expense attributable to the accident, in which event the loss or expense ... would be the oldest uncompensated expense.” 173 N.J.Super. at 63,
In Aponte-Correa, supra, the Appellate Division also concluded that, for purposes of triggering the first portion of the statute of limitations with respect to a claimant who receives PIP benefits, an “expense” is the “oldest uncompensated expense.” 317 N.J.Super. at 604,
Ill
To recapitulate, in the case before us plaintiff was injured in an automobile
Allstate contends that the plain language of the statute compels a finding that a claimant who has previously received PIP benefits must file a claim not later than two years after the last payment of benefits. Plaintiff submits that she may avail herself of either the limitations period in the first or second portion of the statute. As between the two interpretations of the limitations period of the Act advanced by the parties, we are confident that the better interpretation is the one that is less restrictive, more faithful to the underlying purpose of the Act and better reconciles the two portions of the statute. In our view, the Legislature’s obvious purpose in enacting the permissive portion of the statute was to permit those who have already received PIP benefits to file suit within two years after the last payment of benefits even if that suit is filed more than four years after the accident occurred. That legislative objective is consistent with the reparations policy underlying the statute and with this Court’s decisions in Zupo and Rahnefeld. If an insured injured in an automobile accident continues regularly to receive PIP benefits during the four years following the accident, the Legislature understandably would have intended that the limitations period for that insured should extend for two years from the date she incurred her first uncompensated expense.
We are also persuaded that the narrow construction urged by Allstate is inconsistent with the reparations policy underlying the Act. That construction would permit an insurer to derive a benefit from a limitations period triggered by its last payment of benefits while that same insurer delays, as Allstate did here, the processing of a later claim. No compelling rationale supports so inequitable an interpretation of the limitations statute, and its application has been criticized as illogical:
Consider the following hypothetical: a plaintiff involved in an auto accident in January of 1988 accedes to the entreaties of first aid personnel on the scene to be checked out at the local hospital, submits the bill to his PIP carrier and receives the payment check from the PIP carrier in February. In March of 1990, after suffering steadily worsening back pains, the plaintiff seeks medical attention and discovers that he had injured his back in the auto accident and will require extensive corrective surgery. Applied literally, the holding in Still [189 N.J.Super. 231,459 A.2d 1195 ], would act as a total bar to recovery in this hypothetical case. By contrast, a PIP claimant who had refused to be examined on the day of the accident would be allowed, under N.J.S. 39:6A-13.1(a), to file suit seeking reimbursement for the 1990 expenses as late as January of 1992 (up to two years after incurring the expense or four years after the accident, whichever is earlier). There is no rational basis for the distinction between the two eases.
[Cynthia M. Craig and Daniel J. Pomeroy, New Jersey Insurance Law § 11:2-2 at 159 (1997).]
Because the second portion of the No Fault Act’s statute of limitations is merely permissive, we are persuaded that the Appellate Division’s interpretation of the first portion, which establishes that the limitations period for claimants who receive PIP benefits during the four years following the accident begins to run from the incurrence of the first uncompensated expense, Aponte-Correa, supra, 317 N.J.Super. at 604,
We hold that when a claimant has received PIP benefits, an action for further benefits is timely if it is filed either within four years of the accident and two years of the first uncompensated expense, whichever is earlier, or within two years of the last payment of benefits. Accordingly, we affirm the judgment of the Appellate Division and remand the matter to the Law Division for further proceedings consistent with this opinion.
Notes
N.J.S.A. 39:6A-13.1a was amended in 1998. The amendments to that section are minor and are not implicated in this appeal.
Dissenting Opinion
dissenting.
The Court concludes that plaintiffs claim for PIP benefits is timely, notwithstanding the fact that it was filed more than two years after the carrier’s last payment of benefits. I believe that conclusion is at odds with the plain language of the PIP statute. Even if we assume that the statute is susceptible to more than one interpretation, the construction advanced by the majority runs counter to the rationale expressed in our unanimous opinion in Ochs v. Federal Ins. Co., 90 N.J. 108,
I.
I begin my analysis with the familiar axiom, “[i]f the statute is clear and unambiguous on its face and admits of only one interpretation, we need delve no deeper than the act’s literal terms to divine the Legislature’s intent.” State v. Butler, 89 N.J. 220, 226,
At the time relevant to this dispute, the statute provided:
Every action for the payment of benefits ... shall be commenced not later than 2 years after the injured person or survivor suffers a loss or incurs an expense and either knows or in the exercise of reasonable diligence should know that the loss or expense was caused by the accident, or not later than 4 years after the accident whichever is earlier, provided, however, that if benefits have been paid before then an action for further benefits may be commenced not laterthan 2 years after the last payment of benefits.
[N.J.S.A 39:6A-13.1a.]
The wording is indeed complex; that alone, however, does not render the statute susceptible to different meanings. When carefully parsed, the statute unambiguously, establishes two basic time frames for the filing of actions. First, when the insurer has not paid benefits, a claimant must file the action within two years of suffering the loss or incurring an expense caused by the accident, or not later than four years after the accident, whichever is earlier. In those instances, claims must be filed within two years of the known injury or expense but not later than four years from the date of the accident, the outer limit. Timely claims must be filed within both time frames.
Second, when the insurer has paid some benefits, a claimant must file the action within two years of the insurer’s last payment of benefits. For those instances, the Legislature eliminated the two-years-after-expense and four-years-after-accident limitation periods, allowing for claims potentially several years after the first incurred expense or accident, provided a claimant acts no later than two years from the date of the insurer’s last payment.
The statute provides that the two-years-after-payment bar is applicable “if benefits have been paid before then____” Ibid. (emphasis added). In my view, “then” refers back to “whichever is earlier.” Those words, in turn, relate to both the two-years-after-expense and four-years-after-aceident time frames.
The statute bears repeating: “Every action ... shall be commenced not later than 2 years after the injured person ... incurs an expense..., or not later than 4 years after the accident whichever is earlier, provided, however, that if benefits have been paid before then an action for further benefits may be commenced not later than 2 years after the last payment of benefits.” Ibid. In other words, when a claimant has been paid benefits within two years of an incurred expense (the fact here), and there has been a gap in payment between periods of treatment (also the fact here), the claimant must file a claim no later than two years from the date of the insurer’s last payment of benefits. Plaintiffs claim falls outside of that window; therefore, it is untimely.
I could subscribe to a contrary interpretation if the statute included the word “uncompensated” as a modifier to “expense” and if it did not contain the words “whichever is earlier” in the context noted above. If the statute were so worded, the two-years-after-payment bar would not be connected to the two-years-after-expense time frame. That, in turn, would permit the interpretation that the two-years-after-payment time frame provides an alternate window within which to file claims. It would also allow for claims to be filed at any time within four years from the date of the accident regardless of the date of the carrier’s previous payments.
The statute is not so worded. Our duty is to enforce the statute’s precise words and phrases — all of them. “This Court has held that statutory ‘construction that will render any part of a statute inoperative, superfluous or meaningless, is to be avoided.’ ” N.J. Carpenters v. Borough of Kenilworth, 147 N.J. 171, 179-80,
The Court relies on the statute’s distinctive uses of the words “shall” and “may.” Ante at 325,
II.
A.
With the exception of Bell v. Western Employer’s Ins. Co., 173 N.J.Super. 60,
The plaintiff in Bell was injured in an automobile accident on June 12, 1975 and her insurer paid PIP benefits until January 7, 1976. Bell, supra, 173 N.J.Super. at 62,
The trial court ruled that the plaintiffs action was barred because she had filed suit more than two years after the insurer’s last payment of benefits. The Appellate Division reversed, holding that the plaintiffs suit “may be commenced within two years after the first unpaid expense has been incurred, provided the action is started within four years after the accident and regardless of the date of the last reimbursement.” Id. at 65,
Two years after Bell, we decided Ochs v. Federal Ins. Co., supra, 90 N.J. 108,
Under our construction of the statute, it bars recovery only of those expenses which are more than two years old when suit is brought and not those expenses which were incurred within the two-year period prior to suit, provided only that the suit is commenced within the four-year period. We regard this construction as sensibly accommodating both the policy of liberal construction and the policy of repose without doing any violence to the language of the limitations provision.
[ 177 N.J.Super. 19, 24,424 A.2d 849 (App.Div.1980). ]
The above rationale by the Appellate Division is similar to the one advanced by the Court today. Ante at 331,
In support of our holding in Ochs, we relied on a prior Appellate Division decision, Danilla v. Leatherby Ins. Co., 168 N.J.Super. 515,
The statute recites that the two-year period begins “after the injured person ... incurs an expense ...” (emphasis supplied). There is no further qualification of the word “expense.” Thus, it is possible to view that language as did the trial judge in the present case. However, given the purpose and function of statutes of limitation as well as the legislative history of the no-fault insurance legislation, we do not think the Legislature intended such a construction to be ascribed to the statute.
We do not deem it likely ... that the Legislature would have chosen to adopt a statute of limitations which would begin to run each time a new medical expense related to the accident was incurred.
[Id- at 518-19,403 A.2d 925 .]
In accepting that rationale, we stated: “[T]here is no reason to believe the Legislature intended the period of limitations to commence anew with each medical expense. If the Legislature wished to allow an action to be brought at any time during the four-year period, it would not have chosen to foreclose compensation for expenses incurred more than two years before suit.” Ochs, supra, 90 N.J. at 114,
Today, the Court implicitly rejects our previous rationale in Ochs by holding, in essence, that a plaintiff may bring suit any time during the four-year-after-accident period irrespective of the date of the carrier’s previous payment. By marking plaintiffs “uncompensated” expense as the statute’s trigger point, the Court’s ruling starts anew the limitations period based solely on a new medical expense — an interpretation rejected by Ochs.
Two years after our decision in Ochs, the Appellate Division decided Zupo v. CNA Ins. Co., 193 N.J.Super. 374,
The Appellate Division determined that the plaintiffs claim would not be time-barred “if the original medical, condition for which the PIP carrier [had] assumed a payment obligation [was] by its nature subject to the probability of recurrence or to the probability of the need for future treatment____” Id. at 382,
We affirmed the judgment of the Appellate Division. In my view, that disposition
In three other decisions, the Appellate Division applied the “two years after payment” language literally, further isolating Bell from the heartland of cases. In Still v. Ohio Cas. Ins. Co., 189 N.J.Super. 231,
Similarly, the court disallowed the plaintiffs claim in Sotomayor v. Allstate Ins. Co., 273 N.J.Super. 165,
The Appellate Division held that the plaintiffs claim was time barred. It reached that result notwithstanding the fact that plaintiffs doctor had rendered a “permanency opinion” and the trial court had observed that “ ‘the carrier ... could surely know of a probable reoccurrence’ of medical treatment.” Id. at 168,
Finally, in Washington v. Market Transition Facility, 295 N.J.Super. 368,
B.
As indicated, the court in Bell equated an “expense” with a denied claim, which it recast as an “uncompensated expense,” thereby affording the plaintiff two years from the oldest uncompensated claim to file suit. That interpretation, adopted by the Court today, ante at 333,
Second, a claim is a right to payment that accrues after a plaintiff incurs an expense. That is why, in my view, the statute refers only to an injured person who “incurs an expense.” N.J.S.A. 39:6A-13.1a (emphasis added). Injured persons incur expenses upon receipt of medical
To restate: In Ochs, where the insurer had not yet made a payment, we held plaintiff to a strict two-years-after-expense bar, putting no interpretative gloss on “expense.” Today, the Court holds that, when an insurer has paid some claims but denied others, plaintiffs action for additional benefits is considered timely because the “uncompensated” expense marks the commencement of the two-year limitations clock. I do not believe the Legislature intended that claimants in the Ochs context and those in the present context would be subject to such different treatment. Stated differently, I do not believe that the Legislature intended that the interpretation of “expense” would depend on the action or inaction of an insurer, or that the statute would afford either party an alternate limitations window. I find nothing in the text or history of N.J.S.A. 39:6A-13.1a to indicate that the Legislature intended the statute to be that elastic.
C.
The Court relies on case law in Massachusetts, Delaware and Florida as support for its holding. However, none of those jurisdictions has a statute of limitations similar to the one at issue here. Instead, courts there rely on contract principles in determining when a PIP claim becomes timely. The PIP statute in Massachusetts speaks specifically of “an action in contract,” Mass. Gen. Laws Ann. ch. 90, § 34M (West 1999), and courts in the other two jurisdictions rely on general statutes of limitation, not specific to PIP matters, when determining the timeliness of claims. See, e.g., DelCode Ann. tit. 10, § 8106 (1998); Fla. Stat. Ann. § 95.11 and § 627.736(4)(b) (West 1999). Because of those major distinctions, case law from those jurisdictions should be accorded little or no weight in resolving the present dispute.
III.
Public policy considerations also support a literal application of the statute. It is reasonable that the Legislature would want to provide a measure of repose in those instances where there has been a gap in medical treatment and corresponding cessation of benefits. This Court suggested as much when we noted in a prior case: “The ‘two years after payment’ bar would surely apply ... were the injuries [of claimant] such that the carrier could not know of any such probable recurrence.” Rahnefeld v. Security Ins. Co. of Hartford, 115 N.J. 628, 637,
For the Legislature to conclude that, at some point, a matter must be brought to closure is also reasonable. The Legislature determined that point to be two years from the date of the carrier’s last payment to the insured in eases in which there has been a gap in treatment and benefits. The prospect of definite closure “helps speed the litigation of claims and protects the rights of both the insur[er] and the insured.” Ochs, supra, 90 N.J. at 113-14,
Justice Garibaldi’s observation in Zupo, supra, is instructive:
[T]here are few areas in which the legislature has been more active than inno fault insurance. The statute as enacted is the result of much discussion and compromise among various interest groups. I believe that it is eminently logical that the legislature intended to impose a strict two-year-after-payment bar. The legislature is interested in limiting the cost of automobile insurance to the public. It may well have concluded that without such a bar, numerous claims would be filed years after an accident and such open-ended claims would increase the cost of insurance to the public.
[Zupo, supra, 98 N.J. at 35,483 A.2d 811 (Garibaldi, J., dissenting).]
The Legislature has spoken time and again on the issue of insurance reform. Perhaps it is time for another look; if so, lawmakers, not judges, must drive any effort to revise the statute. Until that happens, we are bound by the statute’s literal terms.
I would preserve, in appropriate cases, plaintiffs’ ability to demonstrate that their conditions fall within the purview of Zupo. I do not depart from that case law. However, nowhere in the argument by plaintiff here was there a demonstration that an equitable exception might apply; thus, that issue is not before us.
In the same vein, I find no indication in the record for the Court’s suggestion that the' carrier delayed the processing of plaintiffs claim to obtain some strategic advantage or benefit. Ante at 331-32,
IV.
For the reasons noted, I would hold that when an insurer has made some «payment of benefits to the insured but then denies further benefits following a gap in treatment, a claimant must file an action for additional benefits within two years of the insurer’s last payment of claims. That holding would apply even if the insurer’s last payment occurred within four years of the accident. One may reach a contrary result only by disregarding the literal language of the statute and rejecting prior case law.
Accordingly, I would reverse the judgment of the Appellate Division.
Justice GARIBALDI joins in this opinion.
For affirmance and remandment — Chief Justice PORITZ and Justices O’HERN, STEIN and LONG — 4.
For reversal — Justices GARIBALDI and VERNIERO — 2.
