SELECTIVE INSURANCE COMPANY OF AMERICA, ET AL. V. HUDSONEAST PAIN MANAGEMENT OSTEOPATHIC MEDICINE AND PHYSICAL THERAPY, ET AL. A-0433-09T1 10-07-10
We hold that a private automobile insurer providing PIP coverage is not entitled to declaratory relief compelling expansive discovery from assignee health care providers in its internal investigation of suspected insurance fraud. Neither the PIP statute's limited discovery provision, N.J.S.A. 39:6A- 13(g), nor the cooperation clause of the insurance policies in which medical providers are assigned the rights of the insureds, support the imposition of a corresponding duty on the assignees to produce extensive documentation beyond that authorized in the PIP statute.
We also found no entitlement to the requested information under the umbrella of statutory schemes mandating that insurance carriers investigate putative fraud. Such discovery may be appropriate in an insurer's private cause of action under the Insurance Fraud Protection Act (N.J.S.A. 17:33A-1 to -30), seeking to recover compensatory damages for violations by medical providers of statutes or regulations governing their profession. Here, however, the insurer filed a declaratory judgment action exclusively for the purpose of obtaining information to further its investigation, alleging no violation of governing law and seeking no compensatory damages as a result thereof.