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Travelers Insurance Company of New Jersey v. South Jersey Health & Wellness Center

April 3, 2012

TRAVELERS INSURANCE COMPANY OF NEW JERSEY, PLAINTIFF-APPELLANT,
v.
SOUTH JERSEY HEALTH & WELLNESS CENTER, A/S/O JOSEPHINE RICKERT, DEFENDANT-RESPONDENT.



On appeal from the Superior Court of New Jersey, Law Division, Camden County, Docket No. L-2970-11.

Per curiam.

NOT FOR PUBLICATION WITHOUT THE APPROVAL OF THE APPELLATE DIVISION

Argued March 20, 2012

Before Judges Fisher, Nugent and Maven.

Plaintiff Travelers Insurance Company of New Jersey filed this appeal, seeking our review of a trial court order that confirmed a decision rendered by a dispute resolution professional (DRP) pursuant to the Alternative Procedure for Dispute Resolution Act (APDRA), N.J.S.A. 2A:23A-1 to -19. The DRP applied an equitable estoppel theory in rejecting Travelers' defense to certain portions of defendant South Jersey Health and Wellness Center's claim, and the Law Division judge confirmed the award by dismissing the complaint. Because N.J.S.A. 2A:23A-18(b) bars any "further appeal or review" of such a trial court order, we dismiss the appeal.

The record reveals that Josephine Rickert was injured in an accident in Atlantic City on August 24, 2008. At the time, Rickert was covered by a Travelers' automobile insurance policy that contained $250,000 in personal injury protection (PIP) coverage and $10,000 in extended medical expense benefits (MedPay) coverage. Because Rickert was injured while a passenger on a jitney -- a commercial vehicle -- the PIP coverage did not apply and only the Med-Pay coverage was available to pay her medical expenses. Rickert was treated by South Jersey, which understood from Travelers' responses at times and silence at others that Travelers was handling the matter as a PIP claim. A dispute arose as to the payment of South Jersey's bills beyond the $10,000 Med-Pay limit, and South Jersey, which had obtained authorization from Rickert, demanded arbitration pursuant to APDRA.

The arbitration association appointed a DRP, who received documentary evidence and heard the arguments of counsel. A few weeks later, the DRP rendered a written decision, awarding South Jersey a portion of its claim because Travelers failed to communicate its view that South Jersey's bills were covered by Med-Pay, not PIP.

Travelers thereafter commenced this action, seeking the vacation of the DRP award. On the return date of an order to show cause, Travelers argued that the DRP's determination was erroneous within the meaning of N.J.S.A. 2A:23A-13(c)(5), which permits a judge to vacate, modify or correct an arbitration award if the arbitrator "committed prejudicial error by erroneously applying law to the issues and facts presented." After hearing counsel's argument, Judge Francis J. Orlando concluded, in a thorough and thoughtful opinion, that the DRP had not committed prejudicial error. As a result, Judge Orlando dismissed Travelers' complaint.

Travelers appealed, arguing:

I. APPEALS FROM LAW DIVISION DETERMINATIONS UNDER N.J.S.A. 2A:23A-13(c)(5) ARE COGNIZABLE IN SITUATIONS SUCH AS THIS WHERE THE ARBITRATION AWARD IN ISSUE CONSTITUTES A REFORMATION OF AN INSURANCE POLICY.

II. THERE WAS NO BASIS TO INVOKE THE DOCTRINE OF ESTOPPEL TO REFORM THE POLICY OF INSURANCE BECAUSE THE ELEMENTS OF ESTOPPEL WERE NOT PROVEN.

In responding, South Jersey argued that Travelers' appeal was filed out of time, that there is no merit to Travelers' criticism of either the DRP's determination or Judge Orlando's decision, and that this court lacks jurisdiction to review Judge Orlando's decision. We reject South Jersey's argument that the appeal was untimely but conclude, as South Jersey has forcefully and correctly urged, that we lack appellate jurisdiction.

Whether we have jurisdiction to hear this appeal turns on the meaning and scope of N.J.S.A. 2A:23A-18(b), which states:

Upon the granting of an order confirming, modifying or correcting an award, a judgment or decree shall be entered by the court in conformity therewith and be enforced as any other judgment or decree. There shall be no further ...


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