Court: New Jersey Superior Court Appellate Division; December 15, 1993; New Jersey; State Appellate Court
Plaintiff Brian Lihou appeals a summary judgment in favor of Aetna Casualty Surety Company (Aetna), which denied his claim for extended medical benefits under Aetna's policy following a motorcycle accident. On October 26, 1987, Lihou was injured when his motorcycle was rear-ended by an automobile, leading to medical expenses exceeding $35,000. At the time, he held an automobile insurance policy with the New Jersey Full Automobile Insurance Underwriting Association (JUA), which included a $10,000 extended medical pay benefit. JUA agreed to pay this amount, settling the case.
Lihou's mother was insured under an Aetna policy that also had a $10,000 extended medical benefit provision. Aetna denied coverage, prompting litigation. The court granted Aetna's motion for summary judgment, which Lihou contested unsuccessfully, leading to this appeal. Lihou acknowledges he cannot claim basic medical expenses under the JUA policy since he was on a motorcycle, which does not meet the criteria outlined in N.J.S.A. 39:6A-4. The court referenced the case Truppa v. Prudential, which established that Lihou could not claim statutory medical coverage due to the 1983 amendment to N.J.S.A. 39:6A-4.
Lihou argues that, since he is not entitled to benefits under the basic medical expenses provision, he should receive extended medical expense benefits from Aetna. However, he concedes that if entitled to basic medical benefits under N.J.S.A. 39:6A-4, he would not be eligible for extended benefits under Aetna's policy. Lihou received $10,000 from JUA under the extended medical benefit, which qualifies as "other automobile medical payments insurance" in the Aetna policy. Thus, he does not satisfy a specific condition for coverage under Aetna’s policy, and the court affirmed the summary judgment in favor of Aetna.
Aetna's argument, although not presented in the Law Division or on appeal, highlights that appeals are based on judgments rather than the reasoning behind them, allowing for alternative bases for affirmance. The court agrees with Aetna that the extended medical benefits provision in its policy constitutes "personal injury protection coverage" subject to New Jersey's anti-stacking provisions (N.J.S.A. 39:6A-4.2). This provision is part of the mandated Basic Personal Injury Protection endorsement of Bonnie Ingersoll's auto policy with Aetna, even though the statute does not specifically define extended medical benefits. The Commissioner of Insurance, however, required insurers to provide excess medical payments coverage, aligning with the extended benefits coverage in Aetna's policy, which complies with state regulations. The validity of such regulations is presumed, and the Aetna policy's condition limiting coverage to instances where the plaintiff lacks other extended benefits supports compliance with the anti-stacking laws. Given that Brian Lihou, the plaintiff, was the named insured under the JUA policy—which provided primary coverage for injuries sustained in the accident—he cannot recover additional personal injury protection benefits from any other policy. The court affirms the decision, noting that Bonnie Ingersoll's claim is irrelevant to this appeal, and the claims against the Herbert E. Gaskill Insurance Agency were resolved prior to the summary judgment in favor of Aetna. The absence of a transcript or written opinion leads to the assumption that the Law Division judge did not provide further reasoning for the decision.
