Justia New Jersey Supreme Court Opinion Summaries

A "discrete, narrow legal question" came before the Supreme Court: is a health care provider who has received an assignment of personal injury protection (PIP) benefits from an insured obligated upon request to furnish to the insurer broad information with respect to the provider’s ownership structure, billing practices, and regulatory compliance? Plaintiffs in this matter consist of six “Selective Insurance Company” entities. Individuals insured by Selective sought medical treatment from defendants for injuries received in automobile accidents. Those insureds assigned to defendants the benefits to which they were entitled under their PIP coverage, giving defendants the contractual right to seek PIP reimbursement under those policies. In reviewing claims submitted for payment, Selective detected what it considered to be suspicious patterns in both the treatments defendants had provided and the corporate links among the treating entities. Selective requested that defendant supply to it a variety of data with respect to their ownership, structure, billing practices, and compliance with certain regulations. In support of its request, Selective cited the provision within the insureds’ insurance policies requiring the insureds to cooperate with Selective in the investigation of any claim under the policy. When defendants refused to supply the material Selective sought, Selective sued, alleging that defendants' failure to supply the information was a breach of they duty to cooperate and a violation of the PIP discovery statute. After hearing oral argument, the trial court denied defendants’ motion to dismiss and granted Selective the relief it had requested by directing defendants to respond to Selective’s discovery requests. Defendants thereafter moved for reconsideration, but the trial court denied that motion, together with defendants’ request for a stay. Upon review of the matter, the Supreme Court held that an insured had no duty to provide information to plaintiff with respect to the ownership structure, billing practices, or referral methods of the medical providers from whom he or she sought treatment for his or her injuries. Because an insured had no obligation to supply that information to plaintiff, the assignment of benefits executed by an insured could not serve to impose that duty on the providers. View "Selective Insurance Company of America v. Hudson East Pain Management" on Justia Law

Plaintiffs Memorial Properties, LLC (Memorial) and Mount Hebron Cemetery Association (Mt. Hebron) are respectively the manager and owner of Liberty Grove Memorial Gardens. Mt. Hebron was sued in 2007 and 2008 in seven lawsuits in the Superior Court of New Jersey and the Supreme Court of New York by family members of decedents whose remains were sent by funeral directors to Liberty Grove for cremation in 2003, 2004 and 2005. The New Jersey and New York plaintiffs alleged that prior to being sent to Liberty Grove, the decedents’ bodies were unlawfully dissected, and that tissue, bone and organs were removed for commercial sale. The families contended that they did not discover the illegal harvesting scheme until 2006, when law enforcement officials who investigated and prosecuted the perpetrators advised them that their relatives’ body parts had been illegally harvested. Memorial and Mt. Hebron contended that they received the decedents’ remains in closed containers and were unaware that the remains had been tampered with before being turned over to the crematory. Memorial and Mt. Hebron were not prosecuted as a result of the criminal investigation of the illegal harvesting. This appeal arose from Memorial’s and Mt. Hebron’s pursuit of a defense and indemnification with respect to the New Jersey and New York litigation, under two insurance policies. The first policy, issued by Assurance Company of America (Assurance), provided coverage for the year 2003 for claims arising from damage to human remains and bodily injury, including mental anguish. The second, issued by Maryland Casualty Company (Maryland), provided analogous coverage for the year 2006, but contained an "improper handling" exclusionary clause, barring coverage for bodily injury or property damage arising from specified acts and omissions including "[f]ailure to bury, cremate or properly dispose of a 'deceased body.'" In 2008, Memorial and Mt. Hebron demanded that Assurance and Maryland defend and indemnify them. Assurance declined coverage on the ground that the occurrences were outside of the policy period, invoking plaintiffs' claims that they learned of the harvesting scheme in 2006. Maryland declined coverage, citing the "improper handling" exclusionary clause in its 2006 policy. Memorial and Mt. Hebron filed a declaratory judgment action on May 14, 2008, naming as defendants Assurance, Maryland and Zurich North American Insurance Company (Zurich), and demanding defense and indemnification. Assurance and Maryland cross-moved for summary judgment. The trial court denied the summary judgment motion filed by Memorial and Mt. Hebron, but granted defendant insurers' cross-motion for summary judgment, identifying the year 2006 as the time frame of the "occurrence" in the two cases for which the insureds sought coverage. The Appellate Division affirmed both of the trial court’s orders granting the summary judgment motions filed by Assurance and Maryland. After its review, the New Jersey Supreme Court concluded that neither the Assurance policy nor the Maryland policy required the insurer to defend or indemnify Memorial and Mt. Hebron for claims asserted in the New Jersey and New York litigation. The Court affirmed the Appellate Division's ruling. View "Memorial Properties, LLC v. Zurich American Insurance Co." on Justia Law

Plaintiff Selective Insurance Company of America declined to pay Defendant Arthur Rothman, MD's claims for needle electromyography (EMG) tests performed by his physician assistant (PA). Defendant took the insurance company to arbitration and won. Subsequently, he filed a complaint in the Law Division to confirm the arbitration award. He also initiated a proceeding in the Chancery Division to secure a declaration that PAs are authorized to perform EMGs. That complaint was transferred to the Law Division. In a consolidated opinion, the trial court affirmed the arbitration award and ruled that PAs are authorized to perform EMGs. The Appellate Division reversed, and Defendant appealed. Upon review, the Supreme Court concluded that PAs are not authorized to perform EMG tests, finding that needle EMG tests performed by physician assistants were not in the promulgated lists of authorized procedures from the Board of Medical Examiners. View "Selective Insurance Company of America v. Rothman" on Justia Law

In this case, the Supreme Court was called to determine whether the heirs of an uninsured motorist killed in an automobile accident had a rightful claim under the Wrongful Death Act or whether N.J.S.A. 39:6A-4.5(a) extinguished that claim, as it did the survival action. In 2005, Lawrence Aronberg was driving southbound on the New Jersey Turnpike when a tractor trailer careened into the rear of his car, killing him. The truck was operated by Wendell Tolbert and owned by Fleetwood Taggart (Fleetwood Trucking). On the day of the fatal accident, Aronberg, then thirty-four years old, was an uninsured motorist. Just three weeks earlier, Allstate New Jersey Insurance Company (Allstate) had cancelled Aronberg’s automobile insurance policy because of his failure to keep his premiums current. Plaintiff Sheila Aronberg, as General Administratrix of her son’s Estate, filed a survivorship and wrongful death action against defendants Tolbert and Fleetwood Trucking. The “Survivor’s Act” permits an appointed representative to file any personal cause of action that decedent could have brought had he lived. In contrast, the “Wrongful Death Act” provides to decedent’s heirs a right of recovery for pecuniary damages for their direct losses as a result of their relative’s death due to the tortious conduct of another. The trial court held that because the decedent did not carry insurance at the time of the accident, his estate could not recoup on its survival claim per N.J.S.A. 39:6A-4.5(a), but could recoup on the wrongful death action. The court found that the Wrongful Death Act granted heirs an independent right of recovery, regardless of the decedent’s failure to procure insurance. The Appellate Division granted defendants’ motion for leave to appeal and in a split decision affirmed. Upon review, the Supreme Court held when an uninsured motorist’s cause of action is barred by the uninsured motorist statute, an heir has no right of recovery under the Wrongful Death Act. View "Aronberg v. Tolbert" on Justia Law

Plaintiff Denise Perrelli appealed a trial court decision in favor of Defendants Bridget and Paul Pastorelle. Plaintiff believed the last time she sent her car insurance company a check for coverage was in 2005. She believed she had coverage on August 4, 2006, the day she got into an accident with Defendants. Geovanni Velverde, a friend, was driving at the time of the accident. He died of his injuries, and Plaintiff suffered serious injuries. Plaintiff sued Defendants alleging that her injuries were caused by Defendants' negligence. Defendants moved for summary judgment, arguing that as an uninsured motorist, Plaintiff had no right to sue. Upon careful consideration of the arguments and the applicable legal authority, the Supreme Court affirmed the lower court's decision. The Court found that under the state's "No Fault Act," a person injured while a passenger in her on uninsured vehicle was barred from suing for her injuries.