Kimba Medical Supply v. Allstate Insurance
431 N.J. Super. 463
| N.J. Super. Ct. App. Div. | 2013Background
- This appeal concerns the New Jersey APDRA-based remand authority in PIP disputes.
- Forthright argues trial courts cannot remand unresolved factual issues to Forthright’s DRP after an award is vacated or modified.
- Court holds Sections 13 and 14 of APDRA authorize remands to a DRP in limited circumstances when an arbitration award is vacated or modified.
- Two PIP matters, Pickell and Kimba, involved remands to Forthright to decide open issues (causation, coverage limits) on an appropriate record.
- Court harmonizes APDRA sections to permit remands and validates trial-court remand orders and, in Kimba, the Basic vs Standard coverage analysis.
- Record later remanded for DRP fact-finding to complete open issues as necessary.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Authority to remand to DRP after vacatur | Forthright: no remand power. | Court should remand to DRP under APDRA Sections 13–14. | Remand authority exists in limited cases. |
| Role of Section 13(c)(5) prejudicial error | Remand justified by prejudicial error in applying law. | Remand should be confined to trial court review. | Remand upheld under 13(c)(5) as prejudicial error. |
| Function of Section 14 after vacatur | Remand not authorized for unresolved issues. | Section 14 permits rehearing or remand after vacatur. | Section 14 supports remand/rehearing to resolve issues. |
| Open issues record adequacy in Pickell and Kimba | Trial court should decide unresolved issues de novo. | DRP record incomplete; remand appropriate. | Remand affirmed to complete DRP fact-finding. |
Key Cases Cited
- Mt. Hope Dev. Assocs. v. Mt. Hope Waterpower Project, L.P., 154 N.J. 141 (1998) (limited appellate review; supervisory authority over APDRA matters)
- Riverside Chiropractic Grp. v. Mercury Ins. Co., 404 N.J. Super. 228 (App.Div. 2008) (APDRA-based arbitration reviewed under narrow grounds)
- Allstate Ins. Co. v. Sabato, 380 N.J. Super. 463 (App.Div. 2005) (supervisory review of counsel fees in PIP arbitration)
- Neurology Pain Assocs., 418 N.J. Super. 246 (App.Div. 2011) (recognition that APDRA provisions implement broader insurance disputes)
- Weinstock v. Weinstock, 377 N.J. Super. 182 (App.Div. 2005) (APDRA review framework; deference to trial court findings)