In New Jersey Healthcare Coalition, et. al. v. New Jersey Department of Banking and Insurance, Docket Nos. A-1038-12T2, A-1445-12T2, A-1636-12T2 and A-1792-12T2 (App. Div. Mar. 31, 2015),  the court rejected the latest challenges filed by numerous medical provider groups as well as the New Jersey Association for Justice to the 2012 revised personal injury protection (PIP) regulations adopted by the New Jersey Department of Banking and Insurance (Department) in 2012. In the four separate appeals consolidated by the court,  the appellants disputed the regulations insofar as they limit certain reimbursable medical procedures and the facilities where they can be performed, set allowable fees health care providers may charge for specified procedures,  include of a number of acupuncture procedures within the daily fee cap, provide for on-the-papers determinations of PIP disputes below $1,000, outline standards for the award of counsel fees at PIP arbitrations, and other, related issues.

Noting the standard of review on appeal providing administrative regulations a presumption of validity and reasonableness, and recognizing the deference accorded the special expertise of agencies to understand the technical and policy issues within their jurisdiction, the court rejected the challenges as “fundamentally disagreements” with the policy choices made by the Legislature and implemented by the Executive.  In rejecting the appellants’ arguments, the court stated further that “[t]he majority of appellants’ issues are a rehash of contentions we have considered and rejected in prior cases, ”  finding no merit in them overall, subject to certain clarifications by the Department which narrow the scope of the issues and warrant publication of the court’s opinion in the context of “the future application” of the regulations.

More specifically, in applying the regulations, the Department conceded that: (1) an award of counsel fees in PIP arbitrations should be consistent with the Court’s holding in Rendine v. Pantzer, 141 N.J. 292 (1995); (2) dispute resolution professionals may provide for an award of counsel fees directly to a medical provider’s attorney;  and (3) an assignment of benefits under a policy which includes an assignment of duties to the medical provider may not circumvent the discovery limitations set forth by the Court in Selective Ins. Co. of America v. Hudson East Pain Management, 210 N.J. 597 (2012).

Emphasizing the Department’s commitments to monitor the impacts of the regulations, the court also noted that “after virtually every major amendment to the regulations appellants have warned of dire consequences for accident victims, whom they allege would be stripped of access to medical treatment by virtue of regulatory restrictions. Yet, the reported opinions do not reflect that they have documented those consequences.”

The court’s decision affirming the regulations may be reviewed here

For more information, please contact Susan Stryker.

Note Bressler, Amery & Ross, P.C. represented Insurance Council of New Jersey and The Property Casualty Association of America, who intervened in the appeals in support of the regulations.


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