Opinion
DOCKET NO. A-2334-13T1
04-08-2015
MAYHILL MEDICAL GROUP, ORTHOPEDIC ASSOCIATES REHAB, SADDLE BROOK SURGICENTER, NJ ANESTHESIA GROUP, GEORGE HERMAN, M.D. A/S/O EMMANUEL NUNEZ, Plaintiffs-Appellants, v. NEW JERSEY MANUFACTURERS INSURANCE GROUP, Defendant-Respondent.
Joseph A. Massood argued the cause for appellants (Massood & Bronsnick, LLC, attorneys; Mr. Massood and Sarah E. Turk, on the brief). Michael R. Speer argued the cause for respondent (Marshall Dennehey Warner Coleman & Goggin, attorneys; Mr. Speer, of counsel and on the brief; Gabriella R. Garofalo-Johnson, on the brief).
NOT FOR PUBLICATION WITHOUT THE APPROVAL OF THE APPELLATE DIVISION Before Judges Ostrer and Hayden. On appeal from Superior Court of New Jersey, Law Division, Passaic County, Docket No. L-4112-13. Joseph A. Massood argued the cause for appellants (Massood & Bronsnick, LLC, attorneys; Mr. Massood and Sarah E. Turk, on the brief). Michael R. Speer argued the cause for respondent (Marshall Dennehey Warner Coleman & Goggin, attorneys; Mr. Speer, of counsel and on the brief; Gabriella R. Garofalo-Johnson, on the brief). PER CURIAM
Plaintiffs Mayhill Medical Group, Orthopedic Associates Rehab, Saddle Brook Surgicenter, N.J. Anesthesia Group, and George Hermann, M.D. appeal from a Law Division order dismissing their complaint, which sought to vacate an arbitration award in favor of defendant New Jersey Manufacturers Insurance Group. For the reasons that follow, we dismiss the appeal.
The record establishes that defendant's insured, Emmanuel Nunez, was in a motor vehicle accident on January 19, 2011. Nunez injured his right knee and subsequently underwent arthroscopic knee surgery. Plaintiffs provided care and treatment to Nunez during and after his knee surgery. After defendant did not pay submitted bills for the care and treatment of Nunez, plaintiffs filed a demand for arbitration seeking payment. The dispute resolution professional (DRP) identified the primary issue in dispute to be whether Nunez's injury was causally related to the 2011 car accident or due to a previous car accident.
The DRP issued his written decision on September 6, 2013. The DRP noted that generally in PIP proceedings, plaintiffs bear the burden to prove "that the injured person was involved in an automobile accident [and] that the injured person suffered injuries that are causally related to that accident[.]" The DRP cited Bowe v. New Jersey Manufacturers Insurance Co., 367 N.J. Super. 128 (App. Div. 2004), for the principle that plaintiffs retain their burden where causation is disputed. The DRP found that the medical records and reports were confusing, incomplete, and that not one of the treating providers had ever clearly and directly asked Nunez about any previous injury to his right knee. The DRP determined that plaintiffs failed to meet their burden to prove that the knee surgery was causally related to the 2011 car accident or that it was medically necessary. The DRP found defendant's arguments more persuasive, reasoning that the findings in the various medical reports were consistent with "osteochondritis dissecan[,]" a condition typically associated with "repetitive trauma[.]" The DRP concluded that Nunez's right knee injury and subsequent surgery could have been due to a prior injury, the osteochondritis dissecan, or some combination of both, rather than relating solely to the 2011 car accident. Accordingly, the DRP entered an arbitration award in favor of defendant.
On October 17, 2013, pursuant to N.J.S.A. 2A:23A-13(a), plaintiffs filed a verified complaint seeking to vacate the award. Plaintiffs alleged that defendant committed misconduct under N.J.S.A. 2A:23A-13(c)(1) by breaching its duties to its insured in failing to conduct a computerized index bureau (CIB) search, and that, contrary to N.J.S.A. 2A:23A-13(c)(5), the DRP committed prejudicial error by erroneously applying the law to the issues and facts presented for alternative resolution. On December 20, 2013, the trial court denied plaintiffs' application.
The trial court rejected both of plaintiffs' arguments. The court reasoned that corruption, fraud or misconduct under N.J.S.A. 2A:23A-13(c)(1) focuses on the actions of the DRP, not defendant. The court noted that there was no evidence in the record demonstrating that the DRP committed misconduct and thus, it was irrelevant whether defendant engaged in misconduct by not running a CIB search. Additionally, the court concluded that the DRP made "a reasoned decision" and "properly cited to plaintiffs' bearing of the burden of proof and applied the burden to the facts as the arbitrator interpreted them." This appeal followed.
On appeal, plaintiffs reiterate the arguments raised below and contend that appellate review is required because the trial court failed to exercise its supervisory function. We find plaintiffs' arguments unpersuasive.
The resolution of disputes between automobile insurers and claimants as to whether benefits are due may be resolved through binding arbitration. N.J.S.A. 39:6A-5.1(a). Such arbitrations must be conducted through the procedures set forth in the Alternative Procedure for Dispute Resolution Act (APDRA or Act), N.J.S.A. 2A:23A-1 to -30. The Act provides for very limited judicial review of arbitration awards. Trial courts can vacate an award only in circumscribed instances that cause the rights of a party to be prejudiced. N.J.S.A. 2A:23A-13(c). Judicial scrutiny by the trial court is designed to be the final level of appellate review. N.J.S.A. 2A:23A-18(b). Under APDRA, after adjudication by the trial court, "[t]here shall be no further appeal or review of the judgment or decree." Ibid.
Consequently, the general rule is that a plaintiff has no right to appeal from a trial judge's order in an APDRA case. Morel v. State Farm Ins. Co., 396 N.J. Super. 472, 475 (App. Div. 2007). The statute limits the role of appellate review to determine "whether the trial judge acted within APDRA's bounds." Fort Lee Surgery Ctr., Inc. v. Proformance Ins. Co., 412 N.J. Super. 99, 103 (App. Div. 2010). If so, then the appeal must be dismissed, even if the trial judge's evaluation was imperfect or if the appellate court "might have decided the merits differently." Id. at 104; see Mt. Hope Dev. Assocs. v. Mt. Hope Waterpower Project, L.P., 154 N.J. 141, 152-53 (1998) (affirming dismissal where trial court affirmed arbitration award and no rare circumstances compelled review); see also N.J. Citizens Underwriting Reciprocal Exch. v. Kieran Collins, D.C., LLC, 399 N.J. Super. 40, 49-50 (App. Div.) (dismissing auto accident coverage appeal where trial judge modified arbitrator's award and thoroughly explained the legal errors therein), certif. denied, 196 N.J. 344 (2008).
However, "'in rare circumstances, a court may vacate an arbitration award for public policy reasons.'" Riverside Chiropractic Grp. v. Mercury Ins. Co., 404 N.J. Super. 228, 239 (App. Div. 2008) (quoting In re Tretina Printing, Inc. v. Fitzpatrick & Assocs., Inc., 135 N.J. 349, 364 (1994)). "These circumstances arise in areas where the courts have 'a nondelegable, special supervisory function.'" Ibid. (quoting Mt. Hope, supra, 154 N.J. at 152). Appellate review may also be available when needed to effectuate the supervisory function of the Appellate Division. Morel, supra, 396 N.J. Super. at 476.
We agree with the trial court that "[c]orruption, fraud or misconduct in procuring the award" under N.J.S.A. 2A:23A-13(c)(1) pertains to corruption of the arbitration process and that the DRP did not err in applying the law to the facts and issues before him. The trial court acted within APDRA's bounds and adequately explained the basis for its decision. This case implicates no compelling public policy issue that warrants appellate review. Because the trial court complied with the Act, we have no jurisdiction to review the court's decision, even if "we might have decided the merits differently." Fort Lee, supra, 412 N.J. Super. at 102.
Dismissed.
I hereby certify that the foregoing is a true copy of the original on file in my office.
CLERK OF THE APPELLATE DIVISION