A M E R I C A N A R B I T R A T I O N A S S O C I A T I O N NO-FAULT/ACCIDENT CLAIMS AWARD OF DISPUTE RESOLUTION PROFESSIONAL

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1 CASE NO. 18 Z A M E R I C A N A R B I T R A T I O N A S S O C I A T I O N NO-FAULT/ACCIDENT CLAIMS In the Matter of the Arbitration between (Claimant) AAA CASE NO.: 18 Z v. INS. CO. CLAIMS NO.: Allstate Insurance Company DRP NAME: Richard A. De Michele (Respondent) NATURE OF DISPUTE: Medical Expense Benefits AWARD OF DISPUTE RESOLUTION PROFESSIONAL I, THE UNDERSIGNED DISPUTE RESOLUTION PROFESSIONAL (DRP), designated by the American Arbitration Association under the Rules for the Arbitration of No-Fault Disputes in the State of New Jersey, adopted pursuant to the 1998 New Jersey Automobile Insurance Cost Reduction Act as governed by N.J.S.A. 39:6A-5, et. seq., and, I have been duly sworn and have considered such proofs and allegations as were submitted by the Parties. The Award is DETERMINED as follows: Injured Person(s) hereinafter referred to as: AF, SF, AB, AW, KW, NF. 1. ORAL HEARING held on September 24, Claimant APPEARED at the oral hearing(s). Respondent did not appear. NO ONE appeared telephonically. 3. Claims in the Demand for Arbitration were AMENDED and permitted by the DRP at the oral hearing (Amendments, if any, set forth below). STIPULATIONS were not made by the parties regarding the issues to be determined (Stipulations, if any, set forth below). See Rider A 4. FINDINGS OF FACTS AND CONCLUSIONS OF LAW: AF AF was involved in a motor vehicle accident on November 18, The effective date of insurance coverage was not provided by either counsel. Based on the date of the accident, AICRA will be considered as applicable. Subsequent to the motor vehicle accident, AF came under the care of the Eric M. Barbera, a chiropractic physician. During the course of treatment and on January 15, 2001, Dr. Barbera completed a series of computerized muscle, ROM and grip strength testing. On a mimographed sheet dated January 30,

2 CASE NO. 18 Z , AF s areas of complaint were checked off as follows: cervical pain, thoracic stiffness, lumbar pain and pain radiating through both arms. In reference to treatment, manipulation, ultrasound, heat and EMS was checked off on the form. Additional documentation consisted of a preliminary neurologic consultation report by Russell I. Abrams, M.D. that was not legible. On January 4, 2002, AF was evaluated by Lawrence I. Barr, an orthopedist. Dr. Barr reported that an MRI of the cervical spine showed a herniated disc at C5-C6 and C6-7. MRI of the right shoulder showed degenerative changes in the acromioclavicular joint, which was creating impingement on the supraspinatus tendon. It was reported that AF was still having persistent back pain, right shoulder pain and pain radiating down the right arm. Dr. Barr s impression was aggravation of chronic, traumatic cervical sprain and strain with cervical spondylosis and stenosis with discosteophyte complex at C5-C6 and C6-C7 and right upper radicular symptoms. He also reported aggravation of chronic, traumatic, lumbosacral sprain and strain and sprain and contusion of the right shoulder with impingement syndrome. An EMG study of the upper extremities was proposed. On March 12, 2002, Dr. Barbera ordered an electric heating pad, a cervical pillow, a portable TENS Unit and an obus foam pillow and a cock-up wrist splint. The durable medical equipment was supplied by Freedom Medical Supply, Inc. and C&H Medical Supply. SF Subsequent to the motor vehicle accident, SF came under the care of Eric Barbera, a chiropractic physician. The initial date of treatment is unknown. On February 19, 2002, Dr. Barbera conducted various tests. Spinal range of motion testing was also completed. There was no report by Dr. Barbera explaining the results of the testing. On March 12, 2002, Dr. Barbera prescribed a home whirlpool, an obus foam back support cushion, a muscle stimulator and a lumbosacral support. There was no medical report by Dr. Barbera to indicate the need for the prescribed durable medical equipment. The equipment was supplied by CNH Medical Supply Company. There was no report by Dr. Barry Korn, Dr. Russell Abrams or Dr. Lawrence Barr. NF On February 26, 2002, Dr. Barbera completed various symmetric tests, spinal range of motion tests, grip strength tests, and spinal ROM impairment testing. There was no report by Dr. Barbera indicating the results of the testing or what medical treatment was rendered to NF. AB AB was seen at Temple Pediatric Emergency Medical Association on November 18, Documentation from Temple Pediatric Emergency Medical Association was in the form of a bill in the amount of $ AW AW was seen at Temple Pediatric Emergency Medical Association on November 18, Documentation from Temple Pediatric Emergency Medical Association was in the form of a bill in the amount of $ Although given the opportunity, Respondent did not submit any arbitration submission addressing the above claims. Having heard the argument of counsel and having reviewed the submitted documentation, I find claimant AF has met her burden of proof and that the treatment rendered was medically necessary and reasonable. Miltner v. Safeco Insurance Company of America, 175 N.J. Super. 156 (Law. Div. 1980). In reference to SF, NF, AB and AW, I find claimants have not met their burden of proof. Miltner v. Safeco Insurance Company of America, 175 N.J. Super. 156 (Law. Div. 1980).

3 CASE NO. 18 Z Based on my review of the Certification of Legal Services rendered and in accordance with Rule 29, I am awarding the sum of $1, in counsel fees. This award of counsel fees is consonant with the amount in issue and with Rule 1.5 of the Rules of Professional Conduct. 5. MEDICAL EXPENSE BENEFITS: Awarded Provider Amount Claimed Amount Awarded Payable to See Rider B Explanations of the application of the medical fee schedule, deductibles, co-payments, or other particular calculations of Amounts Awarded, are set forth below. Award is subject to fee schedule, co-payments and deductibles. 6. INCOME CONTINUATION BENEFITS: Not In Issue 7. ESSENTIAL SERVICES BENEFITS: Not In Issue 8. DEATH BENEFITS: Not In Issue 9. FUNERAL EXPENSE BENEFITS: Not In Issue 10. I find that the CLAIMANT did prevail, and I award the following COSTS/ATTORNEYS FEES under N.J.S.A. 39:6A-5.2 and INTEREST under N.J.S.A. 39:6A-5h. (A) Other COSTS as follows: (payable to counsel of record for CLAIMANT unless otherwise indicated): $ (B) ATTORNEYS FEES as follows: (payable to counsel of record for CLAIMANT unless otherwise indicated): $1,406.00

4 CASE NO. 18 Z (C) INTEREST is as follows: Not In Issue $0.00 Claimant did not submit documents supporting interest, therefore no interest is awarded. This Award is in FULL SATISFACTION of all Claims submitted to this arbitration. November 11, 2003 Date Richard A. De Michele, Esq.

5 CASE NO. 18 Z RIDER A AMENDMENTS SF Dr. Eric Barbera $ AF Temple University Hospital $ Dr. Eric Barbera, D.C. $ AB Temple University Physicians $ Temple University Children s Medical Center $ NF Dr. Eric Barbera $490.00

6 CASE NO. 18 Z RIDER B AF Provider Amount Claimed Amount Awarded Payable To Dr. Russell Abrams $ $ Dr.Russell Abrams Dr. Lawrence Barr $ $ Dr. Lawrence Barr Diagnostic Imaging $ $ Diagnostic Imaging C&H Medical Supply $1, $1, C&H Medical Supply Freedom Medical $1, $1, Freedom Medical Supply Supply Temple Univ. Hosp. $ $ Temple Univ. Hosp. Dr. Eric Barbera,D.C. $ $ Dr. Eric Barbera,D.C.