PER CURIAM.
Plaintiff Wendy Fullman commenced this action against defendant Allstate Insurance Company of New Jersey after Allstate, for the fourth time, stopped paying personal injury protection (PIP) income continuation benefits to which she claimed entitlement under her personal automobile insurance policy. Following a nonjury trial in the Law Division, the court entered an order awarding plaintiff PIP income continuation benefits, counsel fees, and costs. Allstate appeals from that order, contending the trial court applied the wrong measure of damages to plaintiff's claim, and failed to consider offsets for disability payments plaintiff had received from her employer and from Social Security. We affirm.
When plaintiff was injured in an automobile accident on May 4, 1998, she was insured under a personal automobile insurance policy issued by Allstate (the 1998 policy). The 1998 policy provided PIP benefits as required by the Automobile Insurance Cost Reduction Act,
Plaintiff began working for the United States Postal Service in 1983 or 1984. She sustained injuries in an automobile accident in 1994. According to the PIP application plaintiff filed following the 1994 automobile accident, she was absent from work from January 7 through February 19, 1994. The Allstate automobile insurance policy that covered her for the 1994 accident (the 1994 policy) included a maximum weekly income continuation benefit of $500, subject to a limit of $52,000.
Plaintiff underwent neck surgery, described as a cervical diskectomy, on June 27, 1997.
The first time Allstate stopped paying income continuation benefits, plaintiff filed a "Demand for Arbitration" with the American Arbitration Association seeking, among other things, payment of income continuation benefits from "June 28, 1997-Present." Plaintiff filed her arbitration demand on December 1, 1998. The parties settled that dispute in January 1999, and plaintiff's attorney confirmed in a letter to Allstate's claim representative that: Allstate would pay $22,000, "which represents wage loss payment up to the date of her subsequent accident of May 4, 1998"; and "[a]ll wage loss payments, due and owing after the date of May 4, 1998, shall be processed under the claim for benefits for the May 4, 1998 accident." Allstate noted on the settlement check that the payment represented "lost income from 06-28-1997 through 05-04-1998 due to an accident on 01-07-94."
During the 2009 trial of the instant action, Allstate's claims representative testified about the January 1999 settlement. She explained, "we had decided in this case that we would settle the benefits up to the second accident and then let the — or the '98 accident and let the benefits continue through there as warranted"; but acknowledged her testimony was "only conjecture." The representative had no independent recollection, and had no access to "the file, to my notes, to anything that occurred...." Nevertheless, she also testified that Allstate agreed to pay plaintiff's post-May 4, 1998 income losses under the 1998 policy "primarily [as] a matter of administrative convenience"; but subsequently acknowledged that in order to pay plaintiff's claim under the 1998 policy, there would have to be a disability emanating from the date of loss, and that "administrative convenience" would have been an insufficient reason to process a claim under that policy.
Plaintiff's former attorney contradicted the adjuster's testimony concerning the 1999 settlement and explained that when she negotiated the settlement with Allstate, plaintiff had a projected return-to-work date and had not been declared permanently disabled. Allstate agreed to pay the post-May 1998 income losses under the 1998 policy. The attorney testified, "it was an agreement we both came to." The trial court determined that plaintiff's former attorney was "very credible," and though the Allstate adjuster was truthful, "she admittedly had no memory of the Plaintiff."
Allstate stopped making PIP payments to plaintiff a second time on August 16, 2001. Plaintiff instituted a PIP action in the Superior Court, Law Division, Camden County, which the parties settled after a non-binding arbitration but before trial. On September 10, 2002, plaintiff's counsel confirmed in a letter to Allstate's counsel that Allstate would "resume payment of my client's wage loss benefits and the payments shall be retroactive to August 16, 2001, the date upon which Allstate stopped paying [plaintiff's] benefits." Thereafter, Allstate paid the income continuation benefits to plaintiff with a check bearing the notation, "Due to an accident of 05-04-1998," and on October 1, 2002, the parties filed a stipulation dismissing the lawsuit with prejudice.
Allstate stopped paying plaintiff's income continuation benefits a third time in December 2002. To compel Allstate to resume payments, plaintiff filed a motion seeking to: set aside the stipulation of dismissal that had been filed in the Superior Court action; enforce the settlement agreement; and have a judgment entered against Allstate for attorney's fees and costs. In an order dated June 6, 2003, the court set aside the stipulation of dismissal and entered judgment against Allstate in the amount of $19,808 plus attorney's fees and costs of $2,655. On June 9, 2003, Allstate issued a check to plaintiff for income continuation benefits for the period of December 14, 2002 to June 6, 2003, and noted on the check that the payments were "Due to an accident of 05-04-1998."
When Allstate stopped making income continuation benefits a fourth time, plaintiff filed the action that is now before us. In the meantime, plaintiff had filed two disability claims.
Plaintiff applied for disability benefits through her employer in January 1998, and for Social Security disability benefits in February 1999. She received disability benefits through her employer. While receiving those benefits, plaintiff periodically submitted disability insurance claim forms, which were admitted into evidence at trial. Those forms confirmed that plaintiff anticipated returning to work following the 1994 accident. On one of the forms dated January 23, 1998, in response to the question, "[W]hen does the doctor think you can go back [to work]," plaintiff wrote "5/4/98." Plaintiff testified that the date was based on her discussions with her doctor. Although the target return-to-work date changed, plaintiff testified that she always planned to return to work.
Plaintiff's claim for Social Security disability benefits was initially rejected, but she was ultimately awarded benefits after an administrative hearing. The administrative law judge determined that plaintiff was "entitled to a period of disability beginning on June 27, 1997, and to disability insurance benefits... and the claimant's disability has continued through at least the date of this decision." The decision was dated December 29, 1999.
Plaintiff commenced the present action for PIP benefits on June 3, 2005. Following a three-day trial in November and December 2009, the trial court issued a written decision on January 28, 2010, and thereafter reduced the decision to an order awarding plaintiff "[w]eekly income continuation benefits from June 9, 2003 to the present in the amount of $605.24 (352 weeks)," plus attorney's fees and costs.
In its written decision, the trial court concluded that Allstate was barred by the doctrines of res judicata and equitable estoppel from relitigating the "parties' settlement on the issue of whether Plaintiff was an `income producer' at the time of the May 4, 1998 accident." The court explained: "This is not to say that if Plaintiff did not continue to qualify as `disabled,' the Defendant could not then challenge her entitlement to benefits." Citing
The trial court also rejected Allstate's "invitation" to recalculate plaintiff's income continuation benefits by taking "into consideration monies received through a disability plan and Social Security." The trial court reasoned that the parties "resolved" in the previous litigation "not only the issue of Plaintiff's status as an income producer but also the appropriate rate of payment, (although Defendant is also equitably estopped from raising the same issues in this litigation)." The trial court further reasoned that the disability benefits upon which Allstate's proposed recalculation was premised were known or should have been known to Allstate "at the time of the confirmation of the settlement memorialized by [plaintiff's attorney's] letter of September 10, 2002, nearly seven and a half years ago. The only issue that would remain open would be Plaintiff's continued disability, which would be subject to medical corroboration."
Allstate appealed from the order memorializing the trial court's decision.
Allstate raises the following issue on appeal:
Allstate's argument is twofold. First, Allstate argues that the "income" plaintiff was receiving as of her May 1998 accident was the disability benefit that she received through her employer, and the weekly disability payment should therefore have been the measure of damages for her PIP income continuation claim.
Our review of a trial court's fact-finding is narrowly circumscribed. "Findings by the trial judge are considered binding on appeal when supported by adequate, substantial and credible evidence."
We conclude the trial court correctly determined that Allstate is barred as a matter of law from challenging the amount of the weekly income continuation benefits plaintiff is entitled to receive under the 1998 policy. The evidence plaintiff produced at trial, including the testimony of Allstate's representative, established that when Allstate first began processing plaintiff's income claims under the 1998 policy, Allstate paid plaintiff's weekly income continuation benefit based on her pre-accident salary. There is nothing in the record before us to suggest that Allstate raised the issue during the arbitration or in the first lawsuit. Rather, it appears that Allstate raised the argument for the first time after the close of its proofs in the 2009 trial.
Allstate had the opportunity to contest the amount of plaintiff's weekly benefit after plaintiff filed an arbitration demand with the American Arbitration Association on December 1, 1998;
The trial court implicitly determined that Allstate should have raised the issue in previous proceedings. If Allstate did not raise its claim in previous proceedings, it did so at its own peril.
The twin goals underlying the entire controversy doctrine — judicial administration and fairness to litigants,
Even if the trial court was not implicitly referring to
Moreover, Allstate's argument as to the measure of damages is incorrect. "The measure of the income loss referred to in
Allstate relies upon
Here, plaintiff presented proofs that she intended to return to work after her 1997 surgery, that her job remained available, and that her return-to-work date was based upon, among other things, the advice of her doctor.
We also reject the second prong of Allstate's argument. Allstate argues that the court should have offset plaintiff's income loss by the amount of her disability and Social Security benefits. Allstate was required to pay PIP benefits to which plaintiff was entitled, "without regard to collateral sources, except that benefits, collectible under workers' compensation insurance, employees' temporary disability benefits statutes, Medicare provided under federal law, and benefits, in fact collected, that are provided under federal law to active and retired military personnel shall be deducted from the benefits collectible...."
Allstate's reliance upon
Affirmed.