The Limitations Period for PIP Benefits Appeals From Decisions of Dispute Resolution Professionals

Personal Service Ins. Co. v. Relievus, 455 N.J. Super. 508 (App. Div. 2018).  This opinion, issued by Judge Sumners today for a unanimous panel, concerned “whether a Law Division summary action seeking to vacate an award by a dispute resolution professional (DRP) as well as an appeal award of a three-member DRP panel, which affirmed the DRP’s decision, was timely made within the forty-five-day time frame under N.J.S.A. 2A:23A-13(a), when it was filed 159 days after the DRP’s award, but forty-three days after the DRP panel’s award.”  The Law Division found the filing untimely, but the Appellate Division reversed and remanded for further proceedings.

Recognizing that the issue involved the interpretation of a stature and regulation governing personal injury protection (“PIP”) disputes, Judge Sumners applied de novo review.  He first concluded that the Appellate Division had jurisdiction to hear the appeal, despite N.J.S.A. 2A:23A-18(b), which states that after a trial court’s review of a DRP’s decision, “there shall be no further appeal or review of the judgment or decree.”  Judge Sumners cited prior Appellate Division authority that permitted that court to review an order dismissing a complaint as untimely.

Here, plaintiff followed the procedures of the DRP, which afforded the right to appeal to a DRP panel.  Its filing in the Superior Court came within 45 days of the DRP panel’s decision, but far beyond 45 days from the original DRP ruling.  Judge Sumners found it “an incongruous result” to say that plaintiff’s filing was timely as to the panel decision, but untimely as to the DRP ruling.

The panel proceeded to apply basic principles of statutory interpretation, which Judge Sumners rightly noted apply to regulations as well as statutes themselves.  “From N.J.S.A. 2A:23A-13(a) and N.J.A.C. 11:3-5.6(g), we glean that the intent of Legislature and the Commissioner [of the Department of Banking and Insurance] is to allow for resolution of PIP benefits disputes outside of the courts, and if dissatisfied with the result, under limited circumstances, relief can be sought from the courts.  In fact, the language of N.J.A.C. 11:3-5.6(g) suggests an insurer or claimant can challenge a DRP award by appealing under ‘the rules of the dispute resolution organization, and/or vacation, modification or correction by the Superior Court” (emphasis by Judge Sumners).

Judge Sumners continued by noting that “[n]either the statute nor regulation provide that a party to a PIP benefits dispute must choose between an internal appeal process or filing a summary action to challenge a DRP award.  Absent a directive to the contrary, it makes sense that either party can pursue the internal appeals process under [the alternative dispute resolution provider’s] rules, and retain the right thereafter to seek summary relief in our courts.”  There was simply no legislative intent to “close the door to our courts” in these  circumstances.