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.: NEW JERSEY MANUFACTURERS COMPANY DRP NAME: Maria I. Daniskas (Respondent) NATURE OF DISPUTE: Reasonable & necessary; pre-certification 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: claimant. 1. ORAL HEARING was held on 9/17/02 and 11/1/ ALL PARTIES APPEARED at the oral hearing(s). NO ONE appeared telephonically. 3. Claims in the Demand for Arbitration were AMENDED at the oral hearing (Amendments, if any, set forth below). STIPULATIONS were made by the parties regarding the issues to be determined (Stipulations, if any, set forth below). The following claims were withdrawn as the amount claimed represent either copayments or deductibles: Emergency Medical Associates; Corvas Medical claim was withdrawn as the amount represents co-payment; Morris Imaging claim was withdrawn as the amount represents co-payment; Northern N.J. Orthopedic claim was withdrawn as the amount was paid by the respondent; Dr. Richman claim was withdrawn as the amount represents co-payment; bill for 7/28/00 was withdrawn as amount represents deductible; AHS Hospital claim was withdrawn as amount represents deductible; and Neuroscience Center/Dr. Ken Cerny claim was withdrawn as amount represents deductible.the following amounts were amended at the hearing: Advanced Musculoskeletal claim was amended down to $16 and the balance was withdrawn as it represents co-payment.

2 CASE NO. 18 Z The parties stipulated that the issue of the medical lien shall be determined by a subsequent proceeding through intercompany arbitration or other forum. 4. FINDINGS OF FACTS AND CONCLUSIONS OF LAW: Claimant is seeking payment of medical bills for injuries allegedly sustained in a motor vehicle accident of 7/28/00. Claimant submitted the following: Demand; bills; arbitration submissions dated 5/21/02, 3/12/02, 3/5/02, 2/15/02, 1/7/02, 12/21/01, 10/25/01, 10/18/01 10/2/01, 8/24/01, 7/25/01, 3/30/01; 10/4/01 letter from Matthew Lanum, D.C. (Bernards Sports Medicine & Physical Therapy) and pre-certification request; 10/1/01 report of Frank Cammisa, Jr., M.D.; initial and supplemental certification of services. Additionally, claimant testified at the hearing of 11/10/01. The arbitrator also heard the testimony of the claimant. Respondent submitted the following. Arbitration submissions dated 5/31/02, 5/17/01, 11/12/01, 11/1/01, 9/5/01; 8/3/01 MRO of Dr. Ceruiglia; and 8/1/01 MRO and 8/9/01 addendum of Dr. Lakin. Claimant was involved in a motor vehicle accident on 7/228/00. Immediately thereafter she reported to the investigating police officer of pain in her lower back and numbness in her right leg, but refused medical attention. Later that same day, she was taken by a family member to for complaints of neck and back pain, as well as numbness of her right leg. Thereafter, she began treating with orthpedist, Dr. Aurori, and began a course of physical therapy with Bernards Sports Medicine. MRI of the lumbar spine performed on 9/13/00 demonstrated right lateral disc herniation at L5- S1 with mild right foraminal stenosis and mild disc bulding at L4-L5. Claimant also underwent EMG/NCV testing with Dr. Geisse which were revealed abnormal results consistent with S1 root dysfunctioon.. She continued to experience symptoms and an unsatisfactory response to physical therapy. The consult was performed by Dr. Cohen, who recommended spinal surgery and causally related the lumbar disc to the accident. Thereafter, claimant obtained a second opinion by Dr. Cammisa, spinal surgeon at the Hospital for Special Surgery in New York City. Prior to the evaluation with Dr. Cammisa, and 2 1/2 months after the accident, claimant submitted to an orthopedic IME with Dr. Gross. Based on Dr. Gross' IME report, respondent terminated orthopedic benefits effective 11/7/00. Dr. Cammisa examined claimant on 12/4/00 and recommended conservative treatment, including epidural injections. Another MRI of the lumbar spine was performed on 4/29/01 which revealed disc degeneration at L5-S1 with facet arthrosis, L4-L5 disc degeneration and facet arthrosis with minimal anterolisthesis, moderate severe central canal stenosis, and no lumbar disc herniations. A 5/31/01 lumbar spine CAT scan revealed mild spinal stenosis at L4-L5, broad-based disc bulge and severe bilateral facet osteoarthritis and proliferative changes of the facet joints of L3-L4 and L5-S1. She was referred to Dr. Richmond at the Hospital for Special Surgery for those injections. As it

3 CASE NO. 18 Z was burdensome to travel to New York City for those injections, claimant sought that treatment with a local pain specialist, Dr. Winnie. As claimant did not obtain relief after four (4) epidural injections, claimant was referred to Dr. Cammisa for surgery. Surgery was performed on 8/10/01 at the Hospital for Special Surgery and she was released on 8/17/01. Dr. Cammisa has related claimant s conditions to the accident. On 8/22/01, claimant was transported by ambulance to Union Hospital for complications related to blood clots. Thereafter, she was diagnosed with blood clots which required hospitalization at. In his follow-up report, Dr. Cammisa related claimant s post-operative admissions to the surgery as they are possible postoperative risks following spinal surgery. Respondent submitted the 11/2/00 IME report of Dr Gross who opined that claimant had "most probably" reached maximum benefit from active orthopedic and physical therapy treatment. Additionally, he opined that invasive treatments are not indicated. Respondent also submitted addendum reports of Dr. Gross dated 12/14/00, 1/4/01 and 1/12/01. Based upon review of additional documentation, he upheld his initial opinion and added that he opined that the risks for any invasive treatments would be increased. He further stated that, although he did not recall whether he reviewed the actual MRI films, he did not dispute the test results. Rather, he found no objective findings on examination which would confirm a clinical herniated disc. Respondent also submitted a MRO dated 8/3/01 by Sal Ceruiglia, D.O., Board Certified Anesthesiologist on the issue of the medical necessity of epidural injections administered on 3/14/01, 3/27/01 and 4/10/01. Dr. Ceruiglia opined that since there is no documentation of any pre-existing conditions, the injuries are related to the subject motor vehicle accident. Additionally, the doctor stated that since the claimant did not respond to all the non-invasive modalities with pain relief and considering the MRI studies as well as the clinical findings, the epidural steroid injections were necessary and appropriate. Additionally, respondent submitted a 8/1/01 MRO and 8/9/01 addendum by Dr. Lakin. In his initial report he concluded that claimant has degenerative disc disease of the lumbosacral spine and that the disease is not associated with the accident. He further opined that surgery is not indicated as related to the accident, and that claimant has a significant pre-existing condition of a previous motor vehicle accident of 12/29/91. Based upon a review of the police report, and records of Dr Aurori, Dr. Cohen and Dr. Cammisa, Dr. Lakin upheld his opinion that surgery is not related to the motor vehicle accident. Claimant testified that she had no prior problems with either her legs or lower back, nor had any chiropractic or orthopedic care to those parts of her body prior to the subject accident. Injuries sustained in the prior 1991 accident were limited to her head and neck. She testified that she had not been involved in any intervening accidents or mishaps, nor suffered any injuries since the subject accident. Relative to her hospitalization in August 2001, claimant testified that while staying with her sister for one week in Roselle, New Jersey, she had an episode where she was unable to breathe. She contacted her physician who advised her to go the hospital. She was transported via ambulance to Union Hospital

4 CASE NO. 18 Z where she was examined and then released. Her sister took her home, whereupon her husband telephoned Dr Cammisa who instructed her to go back to an emergency room. The doctor's office faxed her records to her husband so that they could take them to emergency room for their review. She was admitted for approximately five (5) days and then released. Thereafter, she returned to the hospital and admitted for three (3) weeks. She is still under the care of Dr Cammisa for orthopedic care and Dr. Gerhardt for pulmonary care. Based on the review of the extensive medical records and the testimony of the claimant, the arbitrator finds that the claimant has proved by a preponderance of the evidence that all the treatment at issue was reasonable, medically necessary and causally related. Accordingly, the claim is awarded in its entirety. The claimant s proofs were compelling. The arbitrator found the claimant credible and convincing. The MRO of Dr. Ceruiglia was favorable to claimant. The arbitrator found the claimant s proofs overcame the presumption of correctness of Dr. Lakin s MRO. Claimant s treating physicians found that the claimant s condition was causally related, as did respondent s own expert Dr. Ceruiglia, who rendered the favorable MRO. Respondent also raised the issue that the various providers did not request pre-certification of post PIP termination treatment. The arbitrator finds that since orthopedic benefits were terminated 11/7/00, it is irrelevant that pre-certification was not requested thereafter. Moreover, the services rendered in conjunction with the August 2001 hospitalization were performed on an emergent basis. The claimant also seeks payment of a medical lien in the amount of $14, to Primary Recoveries' for payment of PIP medical expenses made to various providers on behalf of Blue Cross/Blue Shield. Respondent objects to this claim on the basis that the arbitrator lacks authority to determine whether or not a PIP carrier must reimburse a health carrier for payment of PIP medical expenses. The arbitrator agrees. The actual amounts to be reimbursed by respondent shall be the subject of intercompany arbitration. Claimant submitted a certification of services in the amount of $7,595.91, calculated on the basis of $180 per hour. Respondent argues that the rate and hours expended are excessive. Pursuant to AAA Rule 30, the arbitrator finds that the amount claimed is reasonable. Additionally, the claimant has requested that the bills be paid at a rate of interest in the amount of 3.5% rate commencing on the 61 st day after the bills were submitted. The arbitrator awards the interest to be calculated by the respondent according to claimant's calculation. 5. MEDICAL EXPENSE BENEFITS: Awarded Provider Amount Claimed Amount Awarded Payable to Advanced Musculature $16 $16* Claimant & Provider

5 CASE NO. 18 Z Affiliates & Gastro (8/30/01 to 8/31/01) Affiliates & Gastro (9/4/01 to 9/11/01) AHS Hospital (8/29/01) AHS Hospital (10/10/01) AHS Hospital (11/6/01) Ambulance Services Atlantic Healthcare (2/2/01) Atlantic Healthcare (3/13/01) Bernards Sports Med (8/16/00 to 10/16/00) Bioelectron (11/21/01) Dr. Cammisa (12/4/00) Dr. Cammisa (8/16/01) Dr. Cammisa (5/4/01 to 8/10/01) Cardiovascular Care (8/23/01 to 9/4/01) Richard Claps, M.D. Richard Devereux (7/31/01) East River Medical Anesthesiology Emergency Medical Assoc. Harvey Gerhard, M.D. (9/1/01, 9/7/01, 11/5/01) Hospital Center for Special Surgery (5/31/01 Hospital Center for Special Surgery $260 $260+# Claimant $945 $945+# Claimant $45 $45+# Claimant $ $ # Claimant $ $ # Claimant $295 $295+ Claimant & Provider $142 $142* Claimant & Provider $867 $867* Claimant & Provider $ $727.89* Claimant & Provider $4,695 $4,695* Claimant & Provider $475 $475* Claimant & Provider $74.28 $74.28* Claimant & Provider $60,146 $60,146# Claimant $943. $943* Claimant & Provider $28 $28+# Claimant $450 $450+# Claimant $4,490 $4,490* Claimant & Provider $473 $473* Claimant & Provider $775 $775* Claimant & Provider $ $ # Claimant $35, $35,965.09* Claimant & Provider

6 CASE NO. 18 Z (8/10/01) Hospital Center for $350 $350+ Claimant & Provider Special Surgery (11/6/01) MEDCO $30.28 $30.28+# Claimant (6/6/01) MEDCO $10.35 $10.35+# Claimant (11/21/01) Mid Atlantic $535 $535+# Claimant Cardiology (9/2/01 9/3/01) Mid Atlantic $330 $330+# Claimant Cardiology (9/4/01 9/6/01) Morris Imaging $10 $10* Claimant & provider (8/31/01 9/3/01) Morris Imaging $ $211.50# Claimant (8/29/01) Morris Imaging $39 $39# Claimant (8/30/01) Morris Imaging $39 $39# Claimant (9/2/01) $1,715 $1,715* Claimant & provider (3/27/01, 4/10/01) $ $127.80* Claimant & provider (2/2/01) $ $780.32* Claimant & provider (3/13/01) $ $511.22* Claimant & provider (4/10/01) $12, $12,071.19* Claimant & provider (8/24/01 8/27/01) $45 $45* Claimant & provider (8/30/01) $40, $40,090.74* Claimant & provider (8/30/01 9/17/01) Dr. Penek $943 $943+ Claimant & provider (8/23/01 9/4/01) Dr. Penek $350 $350# Claimant

7 CASE NO. 18 Z (8/30/01) Prescriptions/Pharm acy Bills 6/18/01 11/8/01) Prescriptions/Pharm acy Bills (8/19/01) Prescriptions/Pharm acy Bills (8/27/01) Prescriptions/Pharm acy Bills (9/17/01) Pulmonary & Allergy Associates (8/30/01) John Rossman (9/19/01) Nigel Sharrock, M.D. (8/11/01, 8/12/01) Somerset Hills PT (12/17/01 2/23/01)# Elliot Stein, M.D./ Union Hospital Family Health (823/01) Union Hospital Union Hospital Ambulance Dr. Richard Winne (2/2/01 3/27/01) Dr. Richard Winne (3/27/01 4/10/01) $ $ Claimant & provider $9.28 $9.28+ Claimant & provider $3.91 $3.91+ Claimant & provider $ $ Claimant & provider $ $ Claimant & provider $ $ # Claimant $ $700.00* Claimant & provider $3, $3,540.00# Claimant $68.00 $68.00* Claimant & provider $1, $1,915.60# Claimant $ $ Claimant & provider $1, $1,386.00* Claimant & provider $1, $1,152.00* Claimant & provider Explanations of the application of the medical fee schedule, deductibles, co-payments, or other particular calculations of Amounts Awarded, are set forth below. *Subject to the application of fee schedule, copayment and deductible. +Only health care EOB available. Bill to be obtained.

8 CASE NO. 18 Z #Subject of medical lien. By consent of parties, the exact amounts awarded shall be determined by a subsequent proceeding through intercompany arbitration or other forum. 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): $325 filing fee, $66.91 photocopying charges (B) ATTORNEYS FEES as follows: (payable to counsel of record for CLAIMANT unless otherwise indicated): $7, (C) INTEREST is as follows: To be awarded by respondent based on claimant s calculation set forth in #4. This Award is in FULL SATISFACTION of all Claims submitted to this arbitration. 11/14/02 Date Maria I. Daniskas, Esq.