On appeal from the Superior Court of New Jersey, Mercer County, Law Division, Docket No. L-3173-08.
The opinion of the court was delivered by: Fisher, J.A.D.
NOT FOR PUBLICATION WITHOUT THE APPROVAL OF THE APPELLATE DIVISION
Argued September 29, 2010 - Decided Before Judges Fisher, Sapp-Peterson and Simonelli.
The opinion of the court was delivered by
N.J.S.A. 39:6A-9.1 requires that an insurer, which has provided personal injury protection (PIP) benefits, must commence suit for reimbursement from a tortfeasor within two years of "the filing of the claim." The parties dispute whether the claim is filed when an insured or health care provider first requests reimbursement for PIP benefits or when the insured submits a claim form requested by the insurer -- a determination critical to the survival of this action. After closely examining this difficult issue, we conclude the Legislature most likely intended that the "claim" is "filed" when the latter event occurs.
The facts are not in dispute. Garrison Lange was injured in an automobile accident in Sayreville on December 1, 2006, when his vehicle was struck by a vehicle owned by Holger Trucking Company and driven by a Holger employee. That day, Lange contacted his automobile insurer, plaintiff New Jersey Manufacturers Insurance Group (NJM), advising of the accident and claiming he had sustained neck and back injuries. On that same day, NJM created a file for Lange's PIP claim and assigned it a file number.
On December 4, 2006, Michael Feher, an NJM adjuster, mailed Lange a PIP application to be completed and returned. That same day, Lange was first treated by Dr. Edward Palluzzi, a chiropractor. On December 6, 2006, Dr. Palluzzi submitted medical bills to NJM for treatment rendered on December 4 and 5, 2006. NJM received Dr. Palluzzi's bills on December 8, 2006.
On December 8, 2006, Dr. Palluzzi sent NJM a letter of medical necessity, which referenced the file number NJM had assigned to Lange's PIP file, asserting that Lange's right and left shoulders required adjustment. Dr. Palluzzi requested NJM's approval of a one-month treatment plan, which was authorized by Feher on December 11, 2006. Dr. Palluzzi forwarded additional bills for treatment rendered on December 8 and 11, 2006, which were received by NJM on December 20, 2006.
On December 20, 2006, as requested, Lange sent NJM a completed PIP application, which NJM received on December 26, 2006.
On December 24, 2008, NJM filed its complaint in this action against Holger and its insurer, ARI Insurance Companies, seeking reimbursement of $53,323.29 in PIP benefits NJM paid on Lange's behalf. Because NJM's suit was filed more than two years after Lange first advised NJM of the accident and more than two years after NJM opened a file, assigned it a number, received medical bills and treatment plans regarding Lange's treatment, and approved Lange's treatment plan, Holger and ARI (defendants) moved for summary judgment based on N.J.S.A. 39:6A-9.1, which states in pertinent part:
An insurer . . . paying [PIP] benefits . . . or medical expense benefits . . . as a result of an accident occurring within this State, shall, within two years of the filing of the claim, have the right to recover the amount of payments from any tortfeasor who was not, at the time of the accident, required to maintain [PIP] protection or medical expense benefits coverage at the time of the accident. [Emphasis added.]
NJM countered that the suit was timely filed because it did not receive Lange's formal PIP application until December 26, 2006, slightly less than two years before the filing of this suit. The trial judge agreed with NJM's proposed construction of the statute and denied defendants' motion. We affirm.
N.J.S.A. 39:6A-9.1 does not expressly define what is meant by "the claim" as used in this context. We have in the past broadly defined "claim" as "'a challenging request, a demand of a right, a calling upon another for something due, a demand for benefits or payment, a privilege to something, a title to something in the possession of another. . . .'" Burlington Cnty. Abstract Co. v. QMA Assocs., 167 N.J. Super. 398, 404 (App. Div.) (quoting Lamberton v. Travelers Indem. Co., 325 A.2d 104, 107 (Del. Super. Ct. 1974), aff'd, 346 A.2d 167 (Del. 1975)), certif. denied, 81 N.J. 280 (1979). The statutory framework for the rendering of PIP benefits, however, fully recognizes that an insured or health care provider may provide many such claims, and, as a result, there is significant uncertainty about which of the many demands for payment that might be submitted in a given case -- or were submitted here --constitutes "the" claim that commenced the limitation period prescribed by N.J.S.A. 39:6A-9.1. For example, Dr. Palluzzi's various bills may be viewed as "claims," because they were submitted with the intent that NJM provide payment within the brief time frame contained in N.J.S.A. 39:6A-5(g). In addition, NJM requested Lange's submission of a completed ...