The Cumberland County Court granted State Farm a preliminary injunction, dismissing Vera’s claim with prejudice.
But in a per curiam opinion from the New Jersey Superior Court, Appellate Division, the order was reversed and sent back for future proceedings, New Jersey Law Journal reported. The court also stated that the “file does not adequately explain the circumstances surrounding the alleged delay in the prosecution of the plaintiff and that State Farm was not entitled to an interim injunction over the current file.”
According to the court’s ruling, Vera suffered injuries to his right shoulder in a car accident on September 10, 2016. His policy at State Farm included protection against personal injury. He was later evaluated by orthopedic surgeon Dr. Gregory Gallick, who recommended an MRI to properly assess the injury. State Farm, however, had initially refused permission, but eventually approved the test, which was conducted in November of that year.
Vera had another meeting with Dr. Gallick to discuss the MRI results, and the doctor suggested physical therapy, but also recommended that Vera undergo surgery. In January 2017, a doctor selected by State Farm examined him – the surgery was finally approved and took place on February 23, 2017.
According to the advisory, Gallick’s surgery revealed a complete rupture of the biceps tendon, which the doctor said was due to the delay in performing the MRI and surgery.
“The delay in the authorization of [State Farm] has clearly led to an even further deterioration of [plaintiff’s] status,” Gallick said in the letter. “Clear, [State Farm] to tow [its] feet regarding authorization for the MRI and after that authorization for surgery is gone [plaintiff] with a greater injury to his right shoulder than would have been present if [State Farm] had given the right authorization at the right time.”
Vera filed a claim against State Farm later in 2018, the advisory said, alleging that the company “arbitrarily and erratically violated its contractual obligations”. In addition to attorney’s fees, the plaintiff also claimed damages and punitive damages. But the court ruled that the claims were for “wrongful denial of PIP benefits and that NJSA 39:6A-5(h) limited the remedies for a successful claim for a denial of, or delay in the approval of, benefits to collecting of interest and attorney’s fees.” Since Vera’s claim did not include interest or attorney fees, the court ruled that the damages and punitive claims were time barred by law.
The recent appeals court ruling noted that Vera will have to provide evidence to file a claim for damages from State Farm’s delayed approval.
“The Plaintiff has not established those facts for us in the file,” according to the advice. “For example, he did not provide us with a copy of his policy. Nor has he shown that Dr. Gallick required pre-authorization to perform the MRI. He also has not shown that State Farm acted unreasonably by having its own doctor examine Plaintiff before Plaintiff was operated on.”
The opinion also noted that while Vera has not established the elements of a bad faith claim, “the file also does not show that the plaintiff cannot prove the claim.”
“Therefore, State Farm was not entitled to an interim injunction,” the opinion concluded.