The First Published Appellate Division Decisions of October

Today, and on two days last week, the Appellate Division issued its first published opinions since September 29. Here are summaries of those decisions.

Meyers v. State Health Benefit Commission, 474 N.J. Super. 1 (App. Div. 2022). This opinion by Judge Smith today dealt concisely with an appeal from a decision of the State Health Benefits Commission that ordered health insurance benefits to be deducted from plaintiff’s monthly retirement payments. The Appellate Division affirmed that order because the statutory regime was clear that such deductions were required. Plaintiff argued that certain conduct of the New Jersey Division of Pension and Benefits, which the Division characterized as “mistakes,” created an equitable estoppel that precluded the deductions. The Appellate Division did not agree.

Desai v. New Jersey Manufacturers Ins. Co., 473 N.J. Super. 582 (App. Div. 2022). [Disclosure: I have represented New Jersey Manufacturers in certain matters, but I had no involvement in this case]. Judge Mawla’s opinion in this case addressed an appeal by a provider from an arbitration award regarding reimbursement for nerve tests performed on plaintiff’s patient. The case centered on the meaning of N.J.A.C. 11:3-29.4(e), which addresses the limits of insurer’s liability in various circumstances, as to which there had been a split of authority. Applying de novo review, the Appellate Division reversed, finding that the regulation and the interpretation of it by the Department of Banking and Insurance, made clear that plaintiff’s view of the matter was the correct one.

C.L. v. Division of Medical Assistance & Health Services, 473 N.J. Super. 591 (App. Div. 2022). Judge Marczyk wrote this opinion for the Appellate Division. The issue was whether the defendant Division properly denied plaintiff’s request for Medicaid benefits due to excess resources. The “excess resource” at issue was an annuity whose terms provided that, after a ten-day rescission period, it was irrevocable, plaintiff could not liquidate or transfer it, and that it had “no cash or loan value.” But because there was language that the issuer of the annuity could modify or waive the annuity’s terms, and that had been done in another case involving the same annuity held by a different person, in unique factual circumstances, an Administrative Law Judge ruled that the annuity was a liquid asset that disqualified plaintiff from Medicaid benefits. The Appellate Division disagreed. The plain language of the annuity stating that it was irrevocable and that plaintiff could not liquidate it meant that the annuity could not count as a resource. The denial of benefits was thus reversed.