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The Definition of “Payment” When Calculating The Statute of Limitations in PIP Arbitration Matters
The purpose of this post is to help assist those with questions they have concerning their business or medical practice. The Callagy Law team is knowledgeable in many law practice areas and will frequently post topics ranging from Medical Revenue Recovery, PIP, Workers Compensation, and Commercial Insurance. We hope to have this blog shed a light on many common questions.
The question of what constitutes payment for the purpose of calculating the Statute of Limitations in a PIP Claim for Benefits was recently addressed by our office in the Context of a PIP Arbitration filed on behalf of one of our Medical Provider’s.
The issue our Provider faced, as presented by CURE Insurance, was whether the Provider’s Claim was barred by the application of the 2 year statute of limitations period in connection to the filing of a PIP Arbitration Matter.
In relation to the calculation of the Statute of Limitations time period when filing a PIP Claim for Benefits, N.J.S.A. 39:6A-13.1(a) states:
Every action for the payment of benefits payable under a standard automobile insurance policy pursuant to sections 4 and 10 of P.L. 1972, c. 70 (c. 39:6A-4 and 39:6A-10), medical expense benefits payable under a basic automobile insurance policy pursuant to section 4 of P.L. 1998, c. 21 (c. 39:6A-3.1) or benefits payable under a special automobile insurance policy pursuant to section 45 of P.L. 2003, c. 89 (c. 39:6A-3.3), except an action by a decedent’s estate, shall be commenced not later than two years after the injured person or survivor suffers a loss or incurs an expense and either knows or in the exercise of reasonable diligence should know that the loss or expense was caused by the accident, or not later than four years after the accident whichever is earlier, provided, however, that if benefits have been paid before then an action for further benefits may be commenced not later than two years after the last payment of benefits.
(emphasis added).
Specifically, the facts of our matter showed that while there were no actual pip benefits paid by CURE, it was undisputed that CURE received the Provider’s Bill and processed the bill, applying the eligible amount (as determined by CURE) to the patient’s policy deductible.
Our office relied on the case of George C. Everett v. State Farm Indemnity Co., 358 N.J. Super. 400 (App. Div. 2002), wherein the Appellate Division found that the term “last payment of benefits” as used in N.J.S.A. 39:6A-13.1(a) is consistent with and includes the adjustment of a bill and application of that bill to the patient’s deductible.
Specifically, our office highlighted that in Everett, 358 N.J. Super. at 379, the Court found:
“since the bill was an expense caused by the accident, we conclude that the process of adjusting the bill to the fee schedule and applying the balance to the deductible constituted a ‘last payment of benefits’ under the Act, making the plaintiff’s complaint, which was filed within two years of that date, timely.”
Our office maintained that based on the determination of the Court in Everett, even though the adjustment/ processing of the Provider’s bill in this matter resulted in no more than a credit against the patient’s deductible, this was considered a benefit to the insured and therefore the date of processing of the bill sets the statute of limitations period once again.
In considering the above arguments, DRP Gary T. Lesser, Esq., in NJ-1644666 determined that based upon the Everett matter, the two-year statute of limitations commenced anew with the processing the bill and application of the payment against the patient’s deductible. As such, the Statute of Limitations period did not expire prior to the Provider’s filing of the PIP Demand for Arbitration. Therefore, as a result, the Provider had standing to Proceed with the underlying PIP Claim for Benefits.
We hope you found the information provided in this article helpful to various questions you may have had concerning the healthcare industry. For information pertaining to our services for medical providers, please click here. Please note, Callagy Law has recovered over $200,000,000 for medical providers, and that number grows daily. Our team of knowledgeable PIP Arbitration attorneys are ready to help you. Please free to reach out to Sean Callagy of Callagy Law at any time for questions you may have concerning personal and business matters. Callagy Law offices are located conveniently in Paramus, NJ. Beyond the scope of information, Sean Callagy has developed multiple areas of our healthcare legal practice and business coaching. Feel free to connect with us on Facebook, Twitter or LinkedIn! Additionally you can subscribe to our daily videos on YouTube.
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