Selective Insurance v. Hudson East Pain Management Osteopathic Medicine
210 N.J. 597
N.J.2012Background
- Selective Insurance sought PIP payments from defendants who had assigned their PIP benefits to the providers treated for injuries from auto accidents.
- Selective requested data on ownership, billing practices, and regulatory compliance based on the insureds’ cooperation clause and its assessment of potential fraud.
- The trial court ordered defendants to respond to discovery requests; the Appellate Division reversed, limiting discovery under the PIP statute.
- The question presented is whether an insurer can compel a health care provider, as assignee of PIP benefits, to furnish information beyond patient records.
- The court analyzed the cooperation clause, the PIP discovery statute, and the assignor-assignee relationship, using de novo contract interpretation principles.
- The Court ultimately affirmed the Appellate Division, holding that an assignee cannot be required to provide information beyond what the insured's cooperation clause and statute permit, and that broad discovery requests exceed statutory scope.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Can an assignee be compelled to supply broad information by discovery? | Selective: assignee obligated by policy cooperation terms. | Hudson E. Pain Mgmt: assignment does not impose those duties on assignee. | No; assignee bears no broader duties than assignor. |
| Does the PIP discovery statute authorize broad data beyond patient history and treatment? | Statutory framework supports extensive discovery to prevent fraud. | Statute restricts discovery to patient history, condition, treatment, dates, costs. | No; statutory limits control scope of discovery. |
| May a declaratory judgment action authorize discovery beyond statutory limits? | Declaratory relief permits broad discovery to prevent fraud. | Declaratory judgment cannot expand statutory discovery beyond what the statute allows. | No; limited by statutory framework. |
Key Cases Cited
- Mayo v. City Nat’l Bank & Trust Co., 56 N.J. 111 (1970) (rights of assignee limited to assignor’s rights)
- Gen. Accident Ins. Co. v. N.Y. Marine & Gen. Ins. Co., 320 N.J. Super. 546 (App. Div. 1999) (assignee cannot exceed assignor’s rights or duties)
- Sealed Air Carp. v. Royal Indem. Co., 404 N.J. Super. 363 (App. Div. 2008) (insurance contract interpretation and cooperation principles)
- Adron, Inc. v. Home Ins. Co., 292 N.J. Super. 463 (App. Div. 1996) (interpretation of insurance contract is a question of law)
- Kieffer v. Best Buy, 205 N.J. 213 (2011) (contract interpretation and policy language de novo review)
- Longobardi v. Chubb Ins. Co. of N.J., 121 N.J. 530 (1990) (read insurance coverage provisions broadly; ambiguities resolved in insured’s favor)