PERSONAL SERVICE INSURANCE COMPANY VS. RELIEVUS A/S/O RACHEL SACKIE (L-3544-16, CAMDEN COUNTY AND STATEWIDE) , 455 N.J. Super. 508 ( 2018 )

NOT FOR PUBLICATION WITHOUT THE
APPROVAL OF THE APPELLATE DIVISION
SUPERIOR COURT OF NEW JERSEY
APPELLATE DIVISION
DOCKET NO. A-2393-16T2
PERSONAL SERVICE
INSURANCE COMPANY,
Plaintiff-Appellant, APPROVED FOR PUBLICATION
August 3, 2018
v.
APPELLATE DIVISION
RELIEVUS a/s/o
RACHEL SACKIE,
Defendant-Respondent.
______________________________
Argued March 20, 2018 – Decided August 3, 2018
Before Judges Fisher, Sumners and Moynihan.
On appeal from Superior Court of New Jersey,
Law Division, Camden County, Docket No. L-
3544-16.
Michael R. Eatroff argued the cause for
appellant (Methfessel & Werbel, attorneys;
Michael R. Eatroff, of counsel and on the
brief).
Bruce A. Wallace argued the cause for
respondent (Law Office of Bruce A. Wallace,
LLC; Bruce A. Wallace, on the brief).
The opinion of the court was delivered by
SUMNERS, J.A.D.
The question presented is whether a Law Division summary
action seeking to vacate an award by a dispute resolution
professional (DRP) as well as an appeal award of a three-member
DRP panel, which affirmed the DRP's decision, was timely made
within the forty-five-day time frame under N.J.S.A. 2A:23A-13(a),
when it was filed 159 days after the DRP's award, but forty-three
days after the DRP panel's award. The trial court dismissed the
summary action as untimely; finding it was not filed within forty-
five days after the DRP's award. We reverse and remand because
we conclude that, under the governing statutory and regulatory
guidelines, the summary action was timely filed within forty-five
days of the DRP panel's decision.
Since our decision turns on the timeliness of the application,
and not its merits, we need not dwell on the parties' underlying
dispute. Suffice it to say, Personal Service Insurance Company
(PSIC) terminated personal injury protection (PIP) benefits to its
insured, Rachel Sackie, on the basis that she did not attend an
independent medical exam. She then assigned her rights to her
medical provider, Relievus, to seek payment of her PIP benefits
on her behalf. Relievus filed a demand for arbitration with
Forthright1 and received a favorable DRP award on April 29, 2016.
Rather than initially pursuing its rights under N.J.S.A.
2A:23A-13(d)(1) and N.J.A.C. 11:3-5.6(f) to file a summary action
1
Forthright is the dispute resolution organization appointed by
the New Jersey Department of Banking and Insurance to administer
PIP benefits disputes. See N.J.S.A. 39:6A-5.1(b).
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with the court to vacate the DRP's award, PSIC filed an internal
appeal before a three-member DRP panel in accordance with
Forthright's procedures. The DRP panel rejected PSIC's appeal and
confirmed the DRP award. Forty-three days later, and 159 days
after the DRP award, PSIC sought summary action to vacate the
awards of both the DRP and DRP panel by filing a verified complaint
and order to show cause; contending the decisions violated the
laws governing PIP benefits.
The trial court dismissed PSIC's summary action and upheld
the DRP's award; determining that under N.J.S.A. 2A:23A-13(a), the
action was untimely because it was not filed within forty-five
days of the April 29 DRP award. The court reasoned that because
the forty-five-day time limit commenced when the DRP rendered his
decision, PSIC should not have waited after its unsuccessful appeal
to the DRP panel to file for summary action. The court stated:
. . . before the Superior Court matter was
filed, [PSIC] went to the [DRP] [p]anel within
Forthright. And, that was really [its] choice
. . . . [It] could have come to [the] Superior
Court and had that determination made in
regards to that or . . . appeal. I do not
find that [it has] the opportunity to [pursue]
the appeal and then, when [it did not] like
the appeal, come to Superior Court.
The court furthered remarked, PSIC "does not get two opportunities
[to] appeal." The court denied PSIC's reconsideration motion;
determining that PSIC did not establish the decision was based on
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a palpably incorrect or irrational basis, or fail to consider
probative, competent evidence.2
PSIC now appeals arguing that we have jurisdiction to decide
that its application to vacate the DRP panel's award was timely
under N.J.S.A. 2A:23A-13(a). If we decide that it acted timely,
PSIC contends we should not remand but take original jurisdiction
and vacate the DRP award on the merits. Should we reverse and
remand, PSIC argues another court should decide the matter because
the deciding court is biased against its claim.
Initially, we address the parties' arguments regarding our
jurisdiction to resolve this appeal. In doing so, we briefly
discuss the law governing resolution of PIP benefits
disagreements.
Disputes between an insurer and a claimant over PIP benefits
"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 (App. Div. 2008).
In accordance with our PIP statutes, guidelines have been adopted
2
PSIC notes that its request for oral argument was denied.
However, under Rule 1:6-2, the trial court has the discretion to
dispense with oral argument on substantive issues where the record
provides all that is necessary to make a decision on the issue
presented. See Raspantini v. Arocho, 364 N.J. Super. 528, 531-32
(App. Div. 2003). Such was the case here.
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regarding the conduct of PIP arbitration. In that vein, N.J.S.A.
2A:23A-13(a), the key statute here, provides in pertinent part:
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, . . . 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.
The key regulation involved in this matter, N.J.A.C. 11:3-5.6(g)
provides:
The final determination of the dispute
resolution professional 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 pursuant to N.J.S.A.
2A:23A-13 for review of the award.
[(Emphasis added.)]
To avoid delay in resolving disputes, N.J.S.A. 2A:23A-18(b),
requires that after a trial court's review of the decision,
"[t]here shall be no further appeal or review of the judgment or
decree." Nonetheless, our "case law has clarified that our
appellate courts retain the discretion to exercise supervisory
authority over such trial court rulings for reasons of public
policy." Kimba Med. Supply v. Allstate Ins. Co., 431 N.J. Super.
463, 470 (App. Div. 2013). Thus, "N.J.S.A. 2A:23A-18(b) 'does not
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bar our review of . . . the judge's dismissal of the action on
timeliness grounds[,]'" and "we have the 'authority to examine
. . . the order dismissing the complaint as untimely.'" Citizens
United Reciprocal Exch. v. N. NJ Orthopedic Specialists, 445 N.J.
Super. 371, 376 (App. Div. 2016) (first and third alteration in
original). Accordingly, we will determine whether the court erred
in dismissing PSIC's action on the basis that it was untimely
under N.J.S.A. 2A:23A-13(a) and N.J.A.C. 11:3-5.6(g).
In determining the timeliness of PSIC's summary action, we
acknowledge that even though disputes resolved by a DRP are binding
under N.J.S.A. 39:6A-5.1(c), "both the Commissioner [of Banking
and Insurance]'s own regulations and case 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." Kimba Med. Supply, 431 N.J. Super.
at 468 (emphasis added) (holding that "a trial court possesses the
inherent authority to refer certain PIP arbitration cases back to
the DRP or alternative dispute resolution forum, in instances
where additional fact-finding or other decision-making on
unresolved material issues is necessary").
In challenging the DRP award, PSIC followed Forthright's
internal appeal process that allowed it to appeal to a DRP panel.
After exhausting that process, the insurer filed its summary action
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under N.J.S.A. 2A:23A-13(a) to vacate the awards of both the DRP
and the DRP panel. In essence, PSIC argues that the statute's
forty-five-day period to file its action to vacate the DRP award
was tolled when it took advantage of the internal appeal process.
We agree with Relievus that there is no specific language in
N.J.S.A. 2A:23A-13(a) that provides for such tolling. Yet, on the
other hand, PSIC also appeals – and did so within the forty-five-
day period – the DRP panel's award. So to say the appeal of the
DRP was untimely, while the appeal of the DRP panel was timely,
allows for an incongruous result.
Since we are required to interpret a statute and regulation
governing PIP disputes, "[a]s with all issues of statutory
construction, our review in this matter is de novo." Cashin v.
Bello, 223 N.J. 328, 335 (2015). We therefore look to our Supreme
Court, which summarized the canons of statutory and regulation3
construction as follows:
In construing any statute, we must give words
"their ordinary meaning and significance,"
recognizing that generally the statutory
language is "the best indicator of [the
Legislature's] intent." DiProspero v. Penn,
183 N.J. 477, 492 (2005) (citations omitted);
see also N.J.S.A. 1:1-1 (stating that
customarily "words and phrases shall be read
and construed with their context, and shall
3
"We interpret a regulation in the same manner that we would
interpret a statute." US Bank, N.A. v. Hough, 210 N.J. 187, 199
(2012).
7 A-2393-16T2
. . . be given their generally accepted
meaning"). Each statutory provision must be
viewed not in isolation but "in relation to
other constituent parts so that a sensible
meaning may be given to the whole of the
legislative scheme." Wilson ex rel. Manzano
v. City of Jersey City, 209 N.J. 558, 572
(2012) (citing Kimmelman v. Henkels & McCoy,
Inc., 108 N.J. 123, 129 (1987)). We will not
presume that the Legislature intended a result
different from what is indicated by the plain
language or add a qualification to a statute
that the Legislature chose to omit.
DiProspero, 183 N.J. at 493.
On the other hand, if a plain reading of the
statutory language is ambiguous, suggesting
"more than one plausible interpretation," or
leads to an absurd result, then we may look
to extrinsic evidence, such as legislative
history, committee reports, and
contemporaneous construction in search of the
Legislature's intent. Id. at 492-93 (citing
Cherry Hill Manor Assocs. v. Faugno, 182 N.J.
64, 75 (2004); Hubbard ex rel. Hubbard v.
Reed, 168 N.J. 387, 392-93 (2001)).
[Tumpson v. Farina, 218 N.J. 450, 467-68
(2014) (alterations in original).]
From N.J.S.A. 2A:23A-13(a) and N.J.A.C. 11:3-5.6(g), we glean
that the intent of Legislature and the Commissioner is to allow
for resolution of PIP benefits disputes outside of the courts, and
if dissatisfied with the result, under limited circumstances,
relief can be sought from the courts. In fact, the language of
N.J.A.C. 11:3-5.6(g) suggests an insurer or claimant can challenge
a DRP award by appealing under "the rules of the dispute resolution
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organization, and/or vacation, modification or correction by the
Superior Court in . . . [a summary] action" under N.J.S.A. 2A:23A-
13(a) (emphasis added). We do not envision, as the trial court
did without analyzing the relevant law, that the application of
these laws gives an insurer or claimant a second opportunity to
appeal that is inconsistent with the intent of these laws. Neither
the statute nor regulation provide that a party to a PIP benefits
dispute must choose between an internal appeal process or filing
a summary action to challenge a DRP award. Absent a directive to
the contrary, it makes sense that either party can pursue the
internal appeals process under Forthright's rules, and retain the
right thereafter to seek summary relief in our courts. A different
ruling might encourage a party to file a summary action within
forty-five days of a DRP award and request a stay of that action
while simultaneously pursuing an internal appeal before a DRP
panel. Under such a scenario, we see no value to the dispute
resolution tribunal or the courts.
In sum, we do not see that the intent behind N.J.S.A. 2A:23A-
13(a) and N.J.A.C. 11:3-5.6(g) is to close the door to our courts
when PSIC filed its summary action after it was rebuffed in
Forthright's internal appeal process.
Accordingly, we remand and, being mindful of our limited role
in the appeal of dispute resolution awards, we decline to exercise
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original jurisdiction and leave the details of the merits analysis
to the court. However, because the manner in which the court
expressed its opinion regarding PSIC's ability to seek summary
action to vacate the DRP award suggests a predisposition against
the insurer's position, we are constrained to remand to a different
court to determine the merits on remand.
Reversed and remanded. We do not retain jurisdiction.
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