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PALISADES INSURANCE COMPANY VS. HORIZON BLUE CROSS BLUE SHIELD OF NEW JERSEY (L-6136-19, MIDDLESEX COUNTY AND STATEWIDE)
Plaintiff Palisades Insurance Company appeals from a February 28, 2020 order granting defendant Horizon Blue Cross Blue Shield of New Jersey's motion for summary judgment and dismissing its complaint with prejudice. Plaintiff is an automobile insurance company that provides mandatory personal injury protection (PIP) benefits for medical expenses arising out of injuries sustained during car accidents. Pursuant to N.J.S.A. 39:6A-4.3(d), plaintiff allows its customers to designate their health insurer as primary for payment of car-accident-injury-related expenses, which election results in a premium reduction. The insureds named in plaintiff's complaint each elected to have defendant act as the primary payor. Despite the designation, plaintiff received and paid the claims, before they were properly submitted to defendant. On appeal, plaintiff asserts that it has a right to be reimbursed for the medical expenses it voluntarily paid under a theory of subrogation.
After reviewing the provisions of the New Jersey Automobile Reparations Reform Act (No-Fault Act), N.J.S.A. 39:6A-1 to -35, the Coordination of Benefits scheme (COB), N.J.A.C. 11:3-37.1 to -37.14, and case law, the court concluded that no cause of action for subrogation exists to allow a PIP carrier to pursue reimbursement from a health insurer for claims mistakenly paid out of turn. Plaintiff's remedies are to deny the claim upon receipt, recover payments from the medical providers, request that the insureds submit their claims to defendant and pursue an appeal if coverage is denied, or obtain an assignment of rights and pursue the appeals on the insureds' behalf. In addition, when a health carrier is exempt from providing benefits, the COB regulations allow the PIP carrier to recoup the amount of the reduced premium from its insured. None of these remedies were pursued by plaintiff in this case.
The court also concluded that further discovery would be futile, as the sought-after information is not capable of overcoming the legal obstacle faced by defendants: the absence of a legal right of subrogation to recoup payments mistakenly made out of turn.
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