Opinion
DOCKET NO. A-3855-14T1
04-06-2016
AGIM ABDULAI AND RUFIJE ABDULAI, Plaintiffs, v. MATTHEW CASABONA, BUDGET TRUCK RENTAL, LLC AND CENTRE POINT FUNDING, LLC, Defendants. MERCURY INDEMNITY COMPANY OF AMERICA, Plaintiff-Respondent, v. BUDGET TRUCK RENTAL, LLC; CENTRE POINT FUNDING, LLC, Defendants, and ACADIA INSURANCE COMPANY, Defendant-Appellant.
Julia C. Talarick argued the cause for appellant (Coughlin Duffy LLP, attorneys; Ms. Talarick, of counsel and on the briefs; Kevin V. Small, on the briefs). Mariya Joldzic argued the cause for respondent (Law Offices of David C. Harper, attorneys; Lucia Macam, of counsel and on the brief; David C. Harper, on the brief).
NOT FOR PUBLICATION WITHOUT THE APPROVAL OF THE APPELLATE DIVISION Before Judges Messano and Carroll. On appeal from the Superior Court of New Jersey, Law Division, Essex County, Docket Nos. L-2733-13 and L-6205-13. Julia C. Talarick argued the cause for appellant (Coughlin Duffy LLP, attorneys; Ms. Talarick, of counsel and on the briefs; Kevin V. Small, on the briefs). Mariya Joldzic argued the cause for respondent (Law Offices of David C. Harper, attorneys; Lucia Macam, of counsel and on the brief; David C. Harper, on the brief). PER CURIAM
N.J.S.A. 39:6A-9.1 establishes a two-year statute of limitations within which an insurer that has provided personal injury protection (PIP) benefits must bring suit seeking reimbursement from a tortfeasor. Under the statute, the two-year period within which such action must be brought commences upon "the filing of the claim" for such benefits. Ibid. In New Jersey Manufacturers Insurance Group v. Holger Trucking Corporation, 417 N.J. Super. 393, 396 (App. Div. 2011), we were called upon to interpret "what is meant by 'the claim' as used in [the] context" of N.J.S.A. 39:6A-9.1. The precise issue presented in Holger was "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 . . . ." Id. at 394-95. We held "that 'the claim' referred to in N.J.S.A. 39:6A-9.1 is the submission of the claim form or application requested by the insurer." Id. at 401.
The present appeal involves a variation on the facts presented in Holger. Specifically, we address whether, for purposes of the statute, "the claim" is deemed "filed" when an insured or health care provider submits a generic form of PIP application, or rather whether it is an insured's submission of an application in the form requested by the insurer that controls. Consistent with Holger, we conclude that the "claim" is "filed" when the latter event occurs, absent unreasonable delay by the insurer.
I.
The underlying facts, with the exception of the source of the generic PIP claim form, are not in dispute. On June 26, 2011, Agim and Rufije Abdulai (collectively, the Abdulais) were injured in an automobile accident when their vehicle was allegedly struck in the rear by a vehicle owned or insured by Budget Truck Rental, LLC (Budget), and driven by Matthew Casabona. The next day, notice of the Abdulais' injuries was reported to their automobile insurer, Mercury Indemnity Company of America (Mercury), which created a file for the Abdulai's PIP claims and assigned them a claim number.
On June 29, 2011, Sara Granstrom, a Mercury adjustor, mailed a three-page PIP application (the "Mercury application") to Agim Abdulai's attorney and requested that it be completed and returned. On August 3, 2011, as requested, counsel returned the Abdulais' completed Mercury applications, along with the police accident report. Mercury received its completed PIP claim forms on August 15.
In the interim, on July 11, 2011, Mercury received single-page PIP applications (the "generic application") dated June 28, 2011, purportedly signed by the Abdulais. While Mercury contends that the "generic forms [were] submitted by a treating provider within the provider's initial treatment notification," the record is unclear as to their precise origin.
On July 22, 2011, another Mercury adjustor, Kevin Bachalis, sent a letter to Casabona's excess liability insurer, Acadia Insurance Company (Acadia), notifying Acadia of Mercury's intention to seek reimbursement for PIP benefits paid on behalf of the Abdulais. Thereafter, on August 2, 2013, Mercury filed its complaint in this action against Budget, Centre Point Funding, LLC, and Acadia, seeking reimbursement of $91,701.38 in PIP benefits Mercury paid on the Abdulais' behalf.
It appears that Budget and Centre Point Funding, LLC, undertook a common defense, and that Mercury settled with Budget, leaving Mercury and Acadia as the sole remaining parties to this insurance coverage dispute.
On January 31, 2014, Acadia filed a motion for summary judgment on the basis that Mercury's complaint was filed outside the two-year statute of limitations on actions for reimbursement of PIP benefits set by N.J.S.A. 39:6A-9.1. In support of its motion, Acadia argued that the Abdulais' "claim" for purposes of setting the start date for the statute of limitations was Mercury's receipt of the generic application on July 11, 2011. In response, Mercury argued that the statute of limitations did not begin to run until August 15, 2011, when Mercury received the claim forms it requested from its insureds.
On February 28, 2014, the court issued an order denying Acadia's motion for summary judgment. In his oral opinion, the motion judge relied on our holding in Holger, supra, 417 N.J. Super. at 401, that "'the claim' referred to in N.J.S.A. 39:6A-9.1 is the submission of the claim form or application requested by the insurer." Therefore, since Mercury filed its action for reimbursement within two years of August 15, 2011, the date it received the completed claim form from its insureds, the complaint was timely. It is from that order that Acadia now appeals.
The matter became final when Mercury and Acadia entered into a consent order on March 13, 2015, in which they agreed to arbitrate all their respective claims and defenses, with the exception of the statute of limitations. The parties further agreed to stay the arbitration pending this appeal.
II.
We begin with the standard of review that governs our analysis. "An appellate court reviews an order granting [or denying] summary judgment in accordance with the same standard as the motion judge." Bhagat v. Bhagat, 217 N.J. 22, 38 (2014) (citing W.J.A. v. D.A., 210 N.J. 229, 237-38 (2012); Henry v. N.J. Dep't of Human Servs., 204 N.J. 320, 330 (2010)). We "identify whether there are genuine issues of material fact and, if not, whether the moving party is entitled to summary judgment as a matter of law." Ibid. (citing Brill v. Guardian Life Ins. Co. of Am., 142 N.J. 520, 540 (1995); R. 4:46-2(c)).
[A] determination whether there exists a "genuine issue" of material fact that precludes summary judgment requires the motion judge to consider whether the competent evidential materials presented, when viewed in the light most favorable to the non-moving party, are sufficient to permit a rational factfinder to resolve the alleged disputed issue in favor of the non-moving party.
[Brill, supra, 142 N.J. at 540.]
We then decide "whether the motion judge's application of the law was correct." Atl. Mut. Ins. Co. v. Hillside Bottling Co., 387 N.J. Super. 224, 231 (App. Div.), certif. denied, 189 N.J. 104 (2006). In this regard, "[w]e review the law de novo and owe no deference to the trial court . . . if [it has] wrongly interpreted a statute." Zabilowicz v. Kelsey, 200 N.J. 507, 512 (2009). Similarly, determining the date upon which a statute of limitations begins to run is an issue of law, subject to plenary review. Town of Kearny v. Brandt, 214 N.J. 76, 91 (2013).
N.J.S.A. 39:6A-9.1(a) provides in relevant part:
An insurer . . . paying . . . personal injury protection benefits . . . [or] medical expense benefits . . . 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 personal injury protection or medical expense benefits coverage . . . under the laws of this State . . . .The statute does not provide a definition for the date that triggers "the filing of the claim." In Holger, supra, 417 N.J. Super. at 395-96. plaintiff (NJM) filed a complaint seeking reimbursement more than two years after its insured 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 and approved the treatment plan. However, the complaint was filed within two years of the date that NJM received its insured's formal PIP application. Id. at 396. We reviewed the competing arguments as to whether the complaint was timely filed in light of established principles of statutory interpretation and concluded, "it is the submission of the PIP claim form that triggers the two-year limitations period contained in N. J.S.A. 39:6A-9.1." Id. at 400.
[(Emphasis added).]
We considered various communications among an insured, an insurance carrier and healthcare providers to determine which could be considered the triggering event for the statute of limitations. Id. at 398-400. We rejected a healthcare provider's last request for payment, since an injured person may require ongoing treatment over an indefinite period, and rejected a first request for payment, because this could be construed as the insured's first telephone call to the insurance company or a doctor's first bill. Id. at 398-399. We determined that each of these options created uncertainty as to which, among several communications, might trigger the two-year period. Ibid.
In concluding "it is the submission of the PIP claim form that triggers the two-year limitations period contained in N. J.S.A. 39:6A-9.1," we specifically referenced the PIP application form. Id. at 400. In so holding, we recognized that insurance policies do not always require an insured seeking benefits to submit this form, and stated that as a result, "the event [we had] assumed to be the triggering event . . . may be something that, in many cases, may never occur." Id. at 401. However, we concluded that
because nothing else would sensibly constitute a logical event for the commencement of the limitation period, we conclude that "the claim" referred to in N.J.S.A. 39:6A-9.1 is the submission of the claim form or application requested by the insurer.
[Ibid.]
On appeal, Acadia argues that the trial court erred in holding that the submission of the Mercury application, rather than the earlier generic application, triggered the commencement of the two-year statute of limitations period. It contends that the essential holding in Holger is that "the claim," as referenced in N.J.S.A. 39:6A-9.1, equates to the filing of a PIP claim form with the insurer. Acadia asserts that the fact that the claim form in Holger happened to have been "requested by the insurer" constituted mere dicta and that the quoted language was not essential to the court's interpretation of the statute. Here, because the two application forms submitted to Mercury contained "substantively identical information," Acadia submits that the earlier generic application should have constituted the PIP claim form that triggered the statute of limitations period. We disagree.
While the generic and Mercury applications are in many respects similar in scope, the Mercury application contains somewhat more detailed and varied information. Notably, unlike the single-page generic form, Mercury's application includes a HIPAA authorization that enables it "to obtain additional treatment records, which are critical in determining causality of injuries/treatment."
Mercury's three-page application form also seeks added detail with respect to all household vehicles and insurance policies. According to Mercury, this information "is critical in determining primacy of coverage, potential subrogation rights, [and] potential fraudulent claims and underwriting issues . . . ." Mercury also seeks family physician information that it asserts is "likewise important to the issue of causality, which would again require the Mercury form's HIPAA authorization."
In adopting Mercury's position, we do so with the recognition that an insurer should be entitled to rely on information that it deems accurate and necessary for the proper processing of an application for PIP benefits. This information should be submitted in the form of a "single document" requested by the insured. See Holger, supra, 417 N.J. Super. at 401. In contrast, the PIP insurer should not be constrained by an incomplete or inadequate claim form submitted by an insured or third-party provider whose sole interest is in seeking payment for injuries incurred or services performed.
Additionally, Mercury was entitled to rely on our decision in Holger as establishing the proper triggering date for the two-year period within which it was required to seek reimbursement. We reject Acadia's argument that the motion judge relied on language in Holger that was mere dicta. Rather, we squarely held "that 'the claim' referred to in N.J.S.A. 39:6A-9.1 is the submission of the claim form or application requested by the insurer." Id. at 401 (emphasis added). It is this document that we determined sets the accrual date for purposes of the statute of limitations, notwithstanding prior actual notice on the part of the PIP insurer. As we further noted in Holger, "the Legislature is fully capable of correcting the statute's ambiguity if it believes we have erroneously interpreted the statute." Id. at 402. To date it has not seen fit to do so.
On January 28, 2011, some two weeks after Holger was decided, N.J.S.A. 39:6A-9.1 was amended to provide that recovery by an insurer is subject to any claim by the injured party and shall be paid only after satisfaction of the injured party's claim. This amendment did not affect the statutory provision regarding "the filing of the claim" that is at issue in this appeal. --------
Acadia properly argues that PIP insurers can subvert the intent of the statute and thereby receive an unfair advantage by allowing a claim to languish, despite actual notice and notification to the tortfeasor's insurer, before belatedly requesting an official claim form from their insured. Essential to our decision here is that Mercury did not engage in any such dilatory conduct. Rather, within three days of the accident, Mercury mailed out the PIP application that the Abdulais then completed and promptly returned.
Summarizing, in the absence of any unreasonable delay by Mercury, we conclude that its receipt of the completed application on August 15, 2011, constituted the filing of "the claim" under N.J.S.A. 39:6A-9.1. Consequently, commencement of this action by Mercury within two years of that date was timely.
Affirmed. I hereby certify that the foregoing is a true copy of the original on file in my office.
CLERK OF THE APPELLATE DIVISION