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Bailey v. Garden State Hospitalization Plan

New Jersey Superior Court, Appellate Division


May 16, 1996

CHRISTINA BAILEY, PLAINTIFF-RESPONDENT,
v.
GARDEN STATE HOSPITALIZATION PLAN, DEFENDANT-APPELLANT, AND PRUDENTIAL INSURANCE COMPANY AND STATE OF NEW JERSEY, DIVISION OF MEDICAL ASSISTANCE AND HEALTH, DEFENDANTS-RESPONDENTS.

On appeal from the Superior Court of New Jersey, Law Division, Middlesex County, whose decision is reported at Before Judges King, Kleiner and Humphreys.

PER CURIAM

Garden State Hospital Plan appeals from orders of December 14, 1994 and March 16, 1994 in the Law Division adjudicating its obligation to pay certain medical expenses of plaintiff Christina Bailey. Garden State contends on appeal that: (1) the Judge "erred in requiring a secondary health care provider to pay benefits prior to the exhaustion of all applicable personal injury protection benefits," (2) the "plaintiff has failed to meet her burden of proof," and (3) the Judge "erred in granting plaintiff benefits not available under the plan of insurance." We affirm the ruling on the coverage dispute for the reasons given by Judge Longhi in his published opinion, 280 N.J. Super. 206 (Law Div. 1994). See N.J.A.C. 11:3-37.9.

We also affirm the Judge's ruling that plaintiff's first admission at Kessler Rehabilitation Institute from May 10 to June 8, 1994 was primarily for medical treatment rather than rehabilitative purposes, for the reasons given by Judge Longhi at the Conclusion of the factual hearing on this issue. This Conclusion was essentially a factual determination based on ample credible evidence in the record. Rova Farms Resort v. Investors Ins. Co., 65 N.J. 474, 483-84, 323 A.2d 495 (1974).

Nothing which we have ruled upon in affirming Judge Longhi's decision as to plaintiff's eligibility for Garden State's coverage should be construed to deprive Garden State of its right to review the expenses which may have been paid to date by the PIP carrier Prudential Insurance company and to resist its contribution toward those payments on the ground that such payments were not "reasonable and necessary" in the circumstances, if such ground indeed exists. See N.J.A.C. 11:3-37.2. *fn1

Affirmed.


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