The Appellate Division has ruled against New Jersey Citizens United Reciprocal Exchange (“CURE”) earlier this month, ordering the auto insurance carrier to provide payment for a surgical procedure that should have been paid for under the customer’s Personal Injury Protection (PIP) insurance. This occurred after CURE refused to honor an Arbitrator’s award ordering them to pay.
CURE filed an appeal from the arbitration award that compelled them to pay for a billing dispute over a medical procedure performed on one of their customers as a result of an auto accident. CURE denied the injured victim’s claim after the insurance company’s paid “independent” doctor “found” the surgery to be medically unnecessary. The injured person underwent the surgery and filed a demand for payment, which was denied by CURE.
The injured person then followed their policy’s terms and filed an arbitration. Both parties submitted expert medical reports – CURE’s report concluded that the surgery was medically unnecessary, while the treating doctor that actually performed the surgery explained why the procedure medical necessity. At the end of the arbitration process, the arbitrator ruled in favor of the injured patient and entered an award for CURE to pay for the surgery.
Instead of paying the award, CURE filed court papers with the Law Division to vacate the award, claiming legal error. However, the trial court judge rejected CURE’s claims, finding that the insurance agency failed to provide authority for its argument that the insured was not permitted to submit their own medical report in rebuttal of CURE’s medical report. The trial court judge confirmed the decision rendered by the arbitrator.
Just this month, the trial judge’s decision was upheld by the Appellate Division.
This most recent appeal was CURE’s latest push to avoid paying for their insured’s surgery, which had already twice been deemed necessary by a medical professional following an auto accident.
“Over the course of years, time and time again, CURE has demonstrated a habit of being much more interested in collecting premiums than providing the benefits that customers pay for,” said Adam Rothenberg, a partner at Levinson Axelrod. “It does not seem to matter whether the person is making a claim against NJ CURE because they are the insured or someone who is seeking damages from a policy of insurance where the claim is against the insured.”
“It’s interesting that this is the third ruling by the court saying that CURE has to pay,” said Michael Fusco, a Levinson Axelrod attorney. “The arbitrator said ‘pay’—CURE said no. The Law Division judge said ‘pay’—CURE said no. It will be interesting to see if CURE listens to the Appellate Division’s ruling or decides to prolong their 0-3 losing streak all the way to the Supreme Court. Thankfully, the Supreme Court gets to decide which cases they hear.”
CURE has a history of denying insurance claims, forcing litigation which results in courts having to order payment of valid but denied claims. This can result in legal battles that take years, even though New Jersey law requires auto insurers to promptly provide their customers with PIP benefits. CURE employ similar tactics when it comes to bodily injury claims.
“People deserve to get the insurance paid for but CURE seems to do everything they can to prevent that from happening,” said Rothenberg. “The recent case is just an illustration of the type of behavior we have seen before.”
Levinson Axelrod has seen firsthand the effects of NJ CURE resisting to pay for coverage. If you are fighting to secure the coverage or benefits that you deserve, contact our New Jersey attorneys at Levinson Axelrod, P.A. today. We have decades of experience handling these types of cases, and will work with you to secure the legal outcome you need. Call us at (732) 440-3089 to speak with a member of our firm today, or send us your information through our online form to request a free case evaluation.