Under the New Jersey scheme, disputes that arise from claims for automobile personal injury protection coverage are submitted for resolution through an arbitration system. The current arbitration system is administered by the National Arbitration Forum. While many medical treatments have been assigned fixed allowable charges under the New Jersey Administrative Code, there are numerous medical procedures for which costs must be reimbursed on a "usual, customary and reasonable" ("UCR") basis. The conflict between medical providers and insurance carriers as to what exactly constitutes "usual, customary and reasonable" is perpetual.
 
In a recent matter reviewed by the New Jersey Appellate Division, the court denied the relief sought by New Jersey Manufacturers Insurance Company ("NJM") in challenging the UCR calculation of a private surgical center.
 
NJM globally denied all claims by the surgical center pending receipt by the carrier of a set of complete billing and payment histories for one year for each service for which it was requesting reimbursement, this included a schedule of all charges submitted to, and payments received from, all public and private sources, such as other automobile insurance carriers, health insurers, worker's compensation organizations, Medicare, etc. The medical provider complained that the request was oppressive and refused to provide the documents.
 
Relying upon a statute allowing for discovery in the arbitration setting, (N.J.S.A. 39:6A-13(g)), the carrier then instituted suit requesting an order compelling these materials. It argued that without such billing histories, they were placed at a disadvantage in competently disputing the UCR figures which were being advanced by the medical provider.
 
Although this seems like a reasoned argument, neither the trial court nor the Appellate Division was sympathetic to the position of the carrier. Upon application of the medical provider, the action seeking to enforce the discovery was dismissed. NJM appealed and was, again, unsuccessful at the appellate level.
 
The Appellate Court suggested that the underlying legislation did not allow for the Superior Court to intervene and grant an application for the "sprawling" discovery sought by NJM. It did not dispute the relevancy of some of the materials requested but suggested that any relief had to be accomplished on a "case-by-case" basis and that the decisions regarding allowable discovery would rest in the hands of the dispute resolution professionals (arbitrators). It noted that if such discretion were to be improperly utilized, then the aggrieved party would be allowed to seek intervention through the courts. Unstated, however, is that the standard for review of an arbitrator's decision is quite stringent.
 
The court also suggested that the statutory arbitration scheme was intended to avoid the type of expansive discovery which would be expected in a matter litigated in the Superior Court.
 
The opinion is interesting in that it does not seem to be critical of the substantive positions advanced by either of the parties, but rather rests its decision solely on what appears to be a technical, procedural basis, coupled with the generalized reluctance of the Superior Court to enmesh itself in the arbitration process.
 
The matter is entitled New Jersey Manufacturers Insurance Company v. Bergen Ambulatory Surgery Center and was decided on October 7, 2009.