SUPERIOR COURT OF NEW JERSEY
APPELLATE DIVISION
A-3805-94T2
CHRISTINA BAILEY,
Plaintiff-Respondent,
v.
GARDEN STATE HOSPITALIZATION
PLAN,
Defendant-Appellant,
and
PRUDENTIAL INSURANCE COMPANY
and STATE OF NEW JERSEY,
DIVISION OF MEDICAL ASSISTANCE
AND HEALTH,
Defendants-Respondents.
______________________________________
Argued: April 24, 1996 - Decided: May 16, 1996
Before Judges King, Kleiner and Humphreys.
On appeal from the Superior Court of New
Jersey, Law Division, Middlesex County, whose
decision is reported at
280 N.J. Super. 206
(Law Div. 1994).
Clark W. Convery argued the cause for
appellant (Convery, Convery & Shihar,
attorneys).
Edward J. Ramp argued the cause for respondent
Bailey (Ramp & Renaud, attorneys; Ann L.
Renaud, of counsel; Carol F. Gerity, on the
brief).
Respondent, Division of Medical Assistance and
Health Services, did not participate in the
appeal.
PER CURIAM
Garden State Hospital Plan appeals from orders of December 14,
1994 and March 16, 1994 in the Law Division adjudicating its
obligation to pay certain medical expenses of plaintiff Christina
Bailey. Garden State contends on appeal that: (1) the judge "erred
in requiring a secondary health care provider to pay benefits prior
to the exhaustion of all applicable personal injury protection
benefits," (2) the "plaintiff has failed to meet her burden of
proof," and (3) the judge "erred in granting plaintiff benefits not
available under the plan of insurance." We affirm the ruling on
the coverage dispute for the reasons given by Judge Longhi in his
published opinion,
280 N.J. Super. 206 (Law Div. 1994). See
N.J.A.C. 11:3-37.9.
We also affirm the judge's ruling that plaintiff's first
admission at Kessler Rehabilitation Institute from May 10 to June
8, 1994 was primarily for medical treatment rather than
rehabilitative purposes, for the reasons given by Judge Longhi at
the conclusion of the factual hearing on this issue. This
conclusion was essentially a factual determination based on ample
credible evidence in the record. Rova Farms Resort v. Investors
Ins. Co.,
65 N.J. 474, 483-84 (1974).
Nothing which we have ruled upon in affirming Judge Longhi's
decision as to plaintiff's eligibility for Garden State's coverage
should be construed to deprive Garden State of its right to review
the expenses which may have been paid to date by the PIP carrier
Prudential Insurance company and to resist its contribution toward
those payments on the ground that such payments were not
"reasonable and necessary" in the circumstances, if such ground
indeed exists. See N.J.A.C. 11:3-37.2.See footnote 1
Affirmed.
Footnote: 1 N.J.A.C. 11:3-37.2 states in pertinent part:
"Medical expenses" means expenses for medical, surgical and dental treatment, professional nursing services, hospital expenses, rehabilitation services, diagnostic services, ambulance services, prosthetic devices, medications and other reasonable and necessary expenses resulting from the treatment prescribed by persons licensed to practice medicine and surgery, dentistry, psychology or chiropractic in accordance with this State's laws, or by persons similarly licensed in other states or nations, or any nonmedical remedial treatment rendered in accordance with a recognized religious method of healing.