Kimba Medical Supply v. Allstate Insurance

70 A.3d 725, 431 N.J. Super. 463
CourtNew Jersey Superior Court Appellate Division
DecidedJuly 5, 2013
StatusPublished
Cited by20 cases

This text of 70 A.3d 725 (Kimba Medical Supply v. Allstate 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
Kimba Medical Supply v. Allstate Insurance, 70 A.3d 725, 431 N.J. Super. 463 (N.J. Ct. App. 2013).

Opinion

The opinion of the court was delivered by

SABATINO, J.A.D.

These two companion1 appeals, both arising out of eases involving contested automobile personal injury protection (“PIP”) bene[467]*467fits, raise a common jurisdictional question. The common question concerns whether the trial court, under the New Jersey Alternative Procedure for Dispute Resolution Act (“APDRA”), N.J.S.A. 2A.-23A-1 to -19, and associated PIP regulations cross-referencing that statute, has the authority to remand unresolved factual questions to a dispute resolution professional (“DRP”) after that court has vacated or modified a DRP’s decision. The organization that contractually provides the State with DRPs who hear PIP matters, Forthright, insists that the trial court has no such power to remand any PIP cases. Consequently, Forthright does not want to proceed with the present cases a second time, despite remand orders from the trial court directing it to do so.

Exercising our supervisory appellate function, we reject Forthright’s interpretation of the law. We conclude that Sections 13 and 14 of the APDRA, N.J.S.A. 2A:23A-13 and -14, must be sensibly construed to authorize such remands to a DRP, in certain limited situations where a PIP arbitration award has been judicially vacated or modified. We therefore affirm the trial judges’ sound decisions to remand each of these two PIP cases to Forthright in the circumstances presented, so that open issues can be decided in that arbitral forum on an appropriate record. In addition, we affirm the trial judge’s separate ruling in A-1443-11 determining the PIP coverage limits that apply to the insured in that particular case.

I.

Pursuant to N.J.S.A. 39:6A-5.1(a) (“the PIP statute”), “[d]isputes between an insurer and a claimant as to whether benefits are due under the PIP statute may be resolved, at the election of either party, by binding arbitration or by civil litigation.” Riverside Chiropractic Grp. v. Mercury Ins. Co., 404 N.J.Super. 228, 235, 961 A.2d 21 (App.Div.2008). The Legislature has empowered [468]*468the Commissioner of Banking and Insurance to designate an organization to serve as an arbitration forum for such PIP disputes, where the parties have elected that procedure. N.J.S.A 39:6A-5.1(b). The organization that presently serves in that capacity is Forthright, otherwise known as the National Arbitration Forum (“NAF”). The submissions on appeal and the Department’s website indicate that over 50,000 PIP cases are filed with that arbitral forum each year.2

The Legislature has further authorized the Commissioner to adopt rules and regulations for the conduct of such PIP arbitration proceedings. N.J.S.A 39:6A-5.1(b). The Commissioner has duly adopted such regulations, which are codified at N.J.AC. 11:3-5.1 to -5.12. Among other things, the statute specifies that “[a]ll decisions of the [DRP] shall be in writing, ... shall state the issues in dispute, [and] the findings and conclusions on which the decision is based[.]” N.J.S.A 39:6A-5.1(c) (emphasis added); see also N.J.AC. ll:3-5.6(d) (mandating such findings and other requirements).

The PIP statute further declares that “[a]ll decisions of a [DRP] shall be binding.” N.J.S.A. 39:6A-5.1(c). However, both the Commissioner’s own regulations and ease law allow for a limited right of review of the DRP’s rulings in the Superior Court, following internal review procedures that may be available within the arbitral forum itself.

Most significantly, the Commissioner has incorporated aspects of the APDRA to govern PIP arbitrations in the designated forum. See N.J.AC. ll:3-5.6(g) (declaring that “[t]he final determination of the [DRP] shall be binding upon the parties, but subject to clarification/modification and/or appeal as provided by the rules of the dispute resolution organization, and/or vacation, modification or correction by the Superior Court in an action filed [469]*469pursuant to N.J.S.A. 2A:23A-13 for review of the award”). In that vein, we have held that “when [alternative [d]ispute [rjesolution is applied to PIP disputes, it must be conducted pursuant to the APDRA.” Riverside Chiropractic, supra, 404 N.J.Super. at 235, 961 A.2d 21 (citing Coalition for Quality Health Care v. N.J. Dep’t of Banking & Ins., 348 N.J.Super. 272, 312, 791 A.2d 1085 (App.Div.), certif. denied, 174 N.J. 194, 803 A.2d 1165 (2002)).

The APDRA’s mechanism for the limited review of decisions made by neutral DRPs,3 N.J.S.A. 2A:23A-13 (“Section 13”), which the Commissioner has adopted for PIP arbitrations, is at the heart of the present appeals. Because Section 13 is critical to our analysis, we initially present the relevant full portions of its text here for ease of reference:

Application to court for review of award[.]

a. A party to an alternative resolution proceeding shall commence a summary application in the Superior Court for its vacation, modification or correction within 45 days after the award is delivered to the applicant, or within 30 days after receipt of an award modified pursuant to subsection d. of [sjection 12 of this act, unless the parties shall extend the time in writing. The award of the umpire shall become final unless the action is commenced as required by this subsection.
b. In considering an application for vacation, modification or correction, a decision of the umpire on the facts shall be final if there is substantial evidence to support that decision; provided, however, that when the application to the court is to vacate the award pursuant to paragraph (1), (2), (3), or (4) of subsection c., the court shall make an independent determination of any facts relevant thereto de novo, upon such record as may exist or as it may determine in a summary expedited proceeding as provided for by mies adopted by the Supreme Court for the purpose of acting on such applications.
c. The award shall be vacated on the application of a party who either participated in the alternative resolution proceeding or was served with a notice of intention to have alternative resolution if the court finds that the rights of that party were prejudiced by:
(1) Corruption, fraud or misconduct in procuring the award;
(2) Partiality of an umpire appointed as a neutral;
(3) In making the award, the umpire’s exceeding their fsic] power or so imperfectly executing that power that a final and definite award was not made;
[470]*470(4) Failure to follow the procedures set forth in this act, unless the party applying to vacate the award continued with the proceeding with notice of the defect and without objection; or
(5) The umpire’s committing prejudicial error by erroneously applying law to the issues and facts presented for alternative resolution.

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Bluebook (online)
70 A.3d 725, 431 N.J. Super. 463, Counsel Stack Legal Research, https://law.counselstack.com/opinion/kimba-medical-supply-v-allstate-insurance-njsuperctappdiv-2013.