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 Insurance Company DRP NAME: Patrick W. Foley (Respondent) NATURE OF DISPUTE: Care Path, Diagnostic Test, Reasonable and Necessary 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 held on November 7, ALL PARTIES APPEARED at the oral hearing(s). 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). The claim of Blitz Chiropractic was amended to $17, for services rendered through October 18, The claim of Raritan Bay Medical center was withdrawn. The claimant's claim for income continuation benefits was amended to $3, FINDINGS OF FACTS AND CONCLUSIONS OF LAW: This arbitration arises as a result of an automobile accident that occurred on January 28, On that date the claimant was an insured of the respondent. The claimant suffered injuries in the automobile accident and came under the care of various medical providers, including, most significantly, the Blitz Chiropractic Center. This arbitration arises as a result of the respondent's refusal to pay medical benefits based on

2 CASE NO. 18 Z the respondent's position that benefits are unnecessary, unreasonable and/or rendered after the applicable cut-off date. In addition, the respondent has refused to honor the claimant's request for Income Continuation Benefits. From the claimant, the undersigned has the following documents: A copy of the police report herein; A copy of documentation concerning receipt of Temporary Disability Benefits from the State of New Jersey; A copy of records from Spinal and Head Trauma Associates concerning a pain management consultation rendered to the claimant herein; Copy of the Emergency Room records for treatment rendered to the claimant on the day of the accident; A copy of the report of Blitz Chiropractic Center dated October 22, 2002; and A copy of the MRI reports from MRIs of the claimant's lumbar and cervical spine conducted by Edison Imaging. The claimant and Dr. Blitz also testified at the hearing. From the respondent, the undersigned has the following documents: A copy of the Wage and Salary Verification provided by the claimant's former employer; Copy of the chiropractic IME report of Dr. Mark R. Dudick dated March 30, 2001; A copy of the follow-up chiropractic IME report of Dr. Mark R. Dudick dated May 18, 2001; A copy of the cut-off letter issued in this matter; A copy of the orthopedic IME report of Dr. John P. Nolan, Jr., MD dated April 16, 2001; Copy of a follow-up orthopedic IME report of Dr. John P. Nolan, Jr., MD dated November 26, 2001; Copy of a Peer Review Report dated April 12, 2001 from Dr. Mark Dudick; and Copy of various EOBs issued in this matter. The undersigned makes the following findings of fact: The claimant was involved in a significant motor vehicle accident in which he suffered injuries. Because of his injuries, he sought immediate care in the Emergency Room at Robert Wood Johnson University Hospital, where he was treated and released. Thereafter, approximately three (3) days after the accident he commenced a course of chiropractic treatment with Dr. Errol Blitz of the Blitz Chiropractic Center, that chiropractic therapy lasted until October 18, 2002, a period of some twenty-two (22) months. It would appear, from the most recent bill of Blitz Chiropractic Center, that all

3 CASE NO. 18 Z bills of Blitz Chiropractic Center were paid through April 16, 2001 with the remainder still remaining due and owing. With reference to the treatment of Dr. Blitz, the claimant testified that he had severe neck and lower back pain at the time he initially treated with Dr. Blitz. In addition, he suffered from disabling headaches. He testified that as time went on in the early months after his accident, he also suffered from pain radiating into his upper and lower extremities, with tingling and numbness. Dr. Blitz testified and indicated that he treated the claimant in an extremely conservative manner for approximately four (4) months, using essentially passive modalities of treatment. After approximately four (4) months, or into April of 2001, the claimant began complaining of radiating pain into his extremities and Dr. Blitz became concerned about the possibility of herniated or bulging discs in both the cervical and lumbar areas. Therefore, he requested pre-certification for cervical and lumbar MRIs, both of which were denied by the respondent. Nevertheless, the claimant underwent those MRIs in May of As to the cervical MRI, it revealed a small posterior central disc hernia ion at C6-7 and a disc bulge at L4-5 with a posterior element, as well as spondylosis at L4-5 and L5-S1. Dr. Blitz also referred the claimant to Spinal and Head Trauma Associates for pain management. The claimant was seen at that facility on several occasions where he received some trigger point injections, which the claimant said were of a limited benefit to him. Both Dr. Blitz and the claimant indicated that his condition improved during the summer of 2001 and he had some relief from both the radicular symptoms and the headaches that he suffered. The respondent's IME physicians, in large part, verified the complaints and subjective findings of the claimant and in March of 2001, Dr. Dudick authorized further treatment at two times per week for three weeks and then one time per week for three weeks, at which time he felt the claimant would reach maximum benefit. In May of 2001, he was re-examined by Dr. Dudick and he found that the claimant had received maximum benefit from chiropractic therapy. Dr. Nolan made essentially the same findings during his examinations in April and August. The claimant also presents bills from the Back Rehab Institute, University Radiology Group, Eckerd Pharmacy for pharmaceuticals, and Dr. James Boudwin, his family physician with whom he treated on two occasions. With regard to the claimant's claim for Income Continuation Benefits, the claimant alleges that he was disabled for a period of thirty (30) weeks. The claimant has shown proof that he had a standard policy of PIP insurance calling for payment of Income Continuation at $ per week. Therefore, the claimant's claim is for $3, The claimant has produced evidence of receipt of Temporary Disability from the State of New Jersey totaling $5, for the period of his alleged disability.

4 CASE NO. 18 Z The undersigned makes the following conclusions of law: The claimant in this matter was a credible witness. He suffered significant and disabling injuries that were treated aggressively by Dr. Blitz. Dr. Blitz treated this patient for twenty-two (22) months with an intense unremitting course of chiropractic therapy. The undersigned has had the opportunity to review the records of Dr. Blitz and Spinal and Head Trauma Associates, as well as the reports of the respondent's IME physicians. I find that the intense, unremitting and non-varied approach chosen by Dr. Blitz was not proper. I also find, however, that the respondent's cut-off of benefits was premature. I find that a portion of Dr. Blitz's treatment that was not paid by the respondent was reasonable, necessary and causally related to the accident. I find that Dr. Blitz should be paid for eight (8) visits per month from the date of last payment, which I have accepted as April 16, 2001 through October 31, This course of treatment is more in line with the care paths, and while it exceeds the care paths, it does so modestly to reflect the significant injuries suffered by the claimant. I also note that the claimant had the benefit of pain management consultation with Spinal and Head Trauma Associates and I find that this extension of treatment is appropriate given the nature and extent of his injuries. The undersigned has calculated Dr. Blitz's bill from the period from April 16, 2001 through October 31, 2001 and I have calculated the payment for the first eight-(8) visits of each month. I, therefore, find that the total due and owing Dr. Blitz is $5,377.00, which is rendered subject to the New Jersey Medical Fee Schedule, as well as any remaining deductible and co-pay. With regard to the MRIs performed at Edison Imaging in this matter, it is the conclusion of the undersigned that these MRIs were requested by Dr. Blitz during the course of treatment, as extended herein. Based upon the testimony of both Dr. Blitz and the claimant, after several months, the claimant suffered from radiating symptoms into his upper and lower extremities. Dr. Blitz made a determination that diagnostic testing was required in order to implement a proper treatment plan for the claimant. After the MRIs were conducted and reviewed by Dr. Blitz, he altered the treatment plan to include traction and other more aggressive modalities to treat the herniations and bulges located in the MRIs. Therefore, the finding herein is that the MRIs, as ordered and performed, were reasonable and necessary and these bills shall be paid subject to the New Jersey Medical Fee Schedule, as well as remaining deductible and co-pay. As to the other remaining bills, namely those of the Back Rehab Institute, University Radiology Group, Eckerd Pharmacy and James Boudwin, the undersigned finds all of them to be rendered in the early part of treatment herein. Accordingly, they are found to be reasonable, necessary and they shall be paid by the respondent, subject to the New Jersey Medical Fee Schedule as well as any remaining deductible and co-pay. Concerning all of these claims for medical benefits, no claim for interest was presented and interest is, therefore, deemed waived.

5 CASE NO. 18 Z With reference to the claimant's request for Income Continuation Benefits, the finding herein is that the claimant was disabled for approximately thirty (30) weeks, he would be entitled to Income Continuation of $ per week, or $3, Sufficient proof has also been shown that the claimant received a total of $5, in disability benefits and, therefore, the disability benefits offset the Income Continuation Benefits and the claimant is not entitled to any payment of Income Continuation Benefits. See Tillman v. Allstate Ins. Co., 154 NJ Super. 206 (Ch. Div. 1977). With regard to the claimant's application for attorney's fees and costs, it is the determination of the undersigned that the claimant is entitled to an award of fees and costs in the instant matter. The undersigned has examined the Affidavit of Services filed by the attorney for the claimant, wherein he sets forth 9.9 hours at $ per hour. The respondent has objected to the hourly rate, indicating that same is excessive. The undersigned has reviewed the Affidavit and finds same to be excessive as to the hourly rate, however, the number of hours does seem to be consistent with the work performed in this matter, which included an Examination Under Oath as well as a fairly lengthy hearing. Accordingly, the claimant's attorney is awarded a fee of $1, (9.9 $175 p/h) plus costs of $ MEDICAL EXPENSE BENEFITS: Awarded Provider Amount Claimed Amount Awarded Payable to Blitz Chiropractic $17, $5, Provider* The Back Rehab $ $ Provider* Institute Edison Imaging $2, $2, Provider* Associates University $ $ Provider* Radiology Group Eckerd Drugs $ $ Claimant* James Boudwin, MD $ $ Provider* *Subject to the New Jersey Medical Fee Schedule, as well as any remaining deductible and co-pay. 6. INCOME CONTINUATION BENEFITS: Claimed and not Awarded 7. ESSENTIAL SERVICES BENEFITS: Not In Issue 8. DEATH BENEFITS: Not In Issue

6 CASE NO. 18 Z 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, (C) INTEREST is as follows: waived per the Claimant. This Award is in FULL SATISFACTION of all Claims submitted to this arbitration. February 14, 2003 Date Patrick W. Foley, Esq.