Habick v. Liberty Mutual Fire Insurance

727 A.2d 51, 320 N.J. Super. 244, 1999 N.J. Super. LEXIS 110
CourtNew Jersey Superior Court Appellate Division
DecidedApril 1, 1999
StatusPublished
Cited by26 cases

This text of 727 A.2d 51 (Habick v. Liberty Mutual Fire Insurance) is published on Counsel Stack Legal Research, covering New Jersey Superior Court Appellate Division primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Habick v. Liberty Mutual Fire Insurance, 727 A.2d 51, 320 N.J. Super. 244, 1999 N.J. Super. LEXIS 110 (N.J. Ct. App. 1999).

Opinion

The opinion of the court was delivered by '

WECKER, J.A.D.

Plaintiff, Rosemarie Habick, appeals from Law Division orders denying her application to vacate or modify a PIP arbitrator’s determination that certain medical treatment was not required as a result of accident-related injuries, see N.J.S.A. 39:6A-4, and declaring that plaintiff would be bound by that ruling in her pending UM arbitration arising out of the same accident.1 We [246]*246conclude that the Law Division Judge erred only in denying modification of the award to exclude issues not before the arbitrator, and we otherwise affirm the orders appealed from.

After plaintiffs 1992 automobile accident, her PIP carrier, Liberty Mutual Fire Insurance Company, paid for treatment of a knee injury and a TMJ condition through 1995 and approved arthroscopic surgery on her right knee. When plaintiffs treating physician later recommended knee replacement in lieu of the arthroscopic procedure, Liberty denied payment on the basis of its own medical examiner’s report. Plaintiff then filed for arbitration of her PIP claim, as permitted by N.J.S.A. 39:6A-5h. Because the other driver was uninsured, plaintiff also filed for uninsured motorist coverage, and her UM arbitration was pending at the time she sought relief from the PIP arbitrator’s decision.2 The UM arbitrators adjourned any hearing pending the final outcome of the PIP arbitration.

The PIP arbitrator denied plaintiffs claim for further TMJ treatment as well as the knee replacement surgery, finding that neither treatment was warranted by a condition caused by the accident. In denying -plaintiffs demand, the arbitrator concluded:

It is my finding that Claimant sustained minor soft tissue injuries as a result of the underlying motor vehicle accident. This finding is based upon the information contained in the emergency room record as well as the information set forth in all medical records and medical examinations conducted by all doctors involved.
I believe that Claimant has pre-existing medical conditions that were not aggravated by the minor injuries she sustained in the October 2, 1992 accident.
I find the reports of [defendant’s orthopedic medicine expert] credible and I find the reports and testimony of [defendant’s dental medicine expert] credible.
[247]*247Frankly, it is difficult for me to attribute the requirement for bi-lateral total knee replacement to the underlying accident in light of the emergency room diagnosis of right knee contusion and the complete absence of complaints or objective evidence of left knee injury.
Additionally, Claimant had what I would describe as a significant pre-existing dental history. I find that a lapse of eleven months between accident and diagnosis of TMJ [is] supportive of the contention that had significant trauma occurred at the time of the accident a diagnosis would have and indeed should have been made much earlier.
For these reasons, the claim for benefits is denied.

In response to Habick’s request for clarification, based upon Liberty’s prior payments for treatment of knee and TMJ conditions and her own doctor’s report that Liberty had approved arthroscopic surgery on her right knee, the arbitrator responded in writing that he found “no evidence that Liberty Mutual in fact authorized arthroscopic surgery to claimant’s right knee.” The PIP arbitrator’s award does not refer to the pending UM arbitration.

Habick, obviously recognizing the potentially binding effect of the PIP arbitration upon her UM claim, filed a verified complaint in the Law Division seeking a judgment either vacating the award or, in the alternative, modifying the award to limit its scope to the issues submitted, and “to reflect that it be without prejudice to any claim plaintiff may have outside the scope of the PIP arbitration proceedings.”

There is no dispute that plaintiff suffered from osteoarthritis of both knees prior to the accident. Two factual issues were submitted to and decided by the PIP arbitrator, each of which is potentially before the UM arbitrators. The first is whether the accident aggravated the condition of plaintiffs right knee, thereby necessitating knee replacement surgery, or whether the deterioration of plaintiffs osteoarthritic knee instead reflected the natural progression of the disease and was unrelated to the accident. The second factual issue decided by the PIP arbitrator that is potentially before the UM arbitrator(s) is whether this accident was a proximate cause of Habick’s continuing TMJ symptoms. The PIP arbitrator ruled that it was not.

[248]*248In denying relief to Habick from the PIP arbitration award, the Law Division Judge wrote:

the arbitrator found that Liberty was not responsible for any additional treatment---- [T]he arbitrator gave a factual basis for reaching his conclusion. It is based on those findings that the plaintiff seeks to overturn the arbitrator’s award.
The court has reviewed the submissions of counsel and the findings of the arbitrator and can find no evidence that this arbitrator in the instant case exceeded his power. There is nothing in the record before the court to reflect that [the arbitrator], who had the benefit of the testimony of the plaintiff and her witnesses as well as all relevant medical evidence, made a finding that was with a gross, unmistakable or manifest disregard to the applicable law of this state.
[emphasis added.]

The judge also denied plaintiffs motion for reconsideration, writing with respect to the binding effect of the PIP arbitration:

As to whether the findings of [the PIP arbitrator] are binding on the U.M. arbitrator, the court finds in the affirmative. The plaintiff in her P.I.P. arbitration submitted all facets of her case most favorable to her position for the arbitrator’s consideration. A finding was made by the arbitrator and since there are no new facts to be considered by the U.M. arbitrator, the decision of [the arbitrator] is binding on all issues he ruled on in presenting his findings.

I.

There are two separate questions before us. The first question is whether the judge erred in refusing to vacate or modify the arbitration award. We are aware of no reported case addressing the standard of review applicable to a motion to vacate a PIP arbitration award (or opposition to confirming that award).

There can be little doubt that arbitration is a favored means of dispute resolution. See, e.g., United States Auto. Ass’n v. Turck, 156 N.J. 480, 486, 721 A.2d 1 (1998). The Arbitration Act, N.J.S.A. 2A:24-1 et seq., enacted in 1923, provides narrow grounds for vacating an arbitration award:

The court shall vacate the award in any of the following cases:
a. Where the award was procured by corruption, fraud or undue means;
b. Where there was either evident partiality or corruption in the arbitrators, or any thereof;
c.

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Krivulka v. Lerner/krivulka
Court of Appeals of Arizona, 2024
Timothy McHale v. Taylored Services LLC
705 F. App'x 99 (Third Circuit, 2017)
New Jersey Healthcare Coalition v. Nj Dep't of Banking and Insurance
111 A.3d 716 (New Jersey Superior Court App Division, 2015)
Cole v. JERSEY CITY MED. CENTER
39 A.3d 909 (New Jersey Superior Court App Division, 2012)
Lopez v. Patel
969 A.2d 510 (New Jersey Superior Court App Division, 2009)
Bardis v. First Trenton Ins. Co.
936 A.2d 476 (New Jersey Superior Court App Division, 2007)
Bardis v. First Trenton Insurance
936 A.2d 476 (New Jersey Superior Court App Division, 2007)
Selective Insurance v. National Continental Insurance
895 A.2d 1218 (New Jersey Superior Court App Division, 2006)
Allstate Ins. Co. v. Sabato
882 A.2d 972 (New Jersey Superior Court App Division, 2005)
Wilde v. O'LEARY
866 A.2d 205 (New Jersey Superior Court App Division, 2005)
Panniel v. Diaz
871 A.2d 156 (New Jersey Superior Court App Division, 2004)
Wylie v. Hamilton
838 A.2d 514 (New Jersey Superior Court App Division, 2004)
David v. Government Employees Ins. Co.
821 A.2d 564 (New Jersey Superior Court App Division, 2003)
Empire Fire & Marine Insurance v. GSA Insurance
808 A.2d 98 (New Jersey Superior Court App Division, 2002)
Liberty Mut. Ins. Co. v. Open MRI of Morris & Essex, LP
813 A.2d 621 (New Jersey Superior Court App Division, 2002)

Cite This Page — Counsel Stack

Bluebook (online)
727 A.2d 51, 320 N.J. Super. 244, 1999 N.J. Super. LEXIS 110, Counsel Stack Legal Research, https://law.counselstack.com/opinion/habick-v-liberty-mutual-fire-insurance-njsuperctappdiv-1999.