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) v. ALLSTATE INSURANCE COMPANY (Respondent) AAA CASE NO.: INS. CO. CLAIMS NO.: DRP NAME: Maria I. Daniskas NATURE OF DISPUTE: Reasonable & necessary; income continuation 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 7/23/ ALL PARTIES APPEARED at the oral hearing(s) NO ONE appeared telephonically. 3. Claims in the Demand for Arbitration were made 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 Demand was amended to include the following bills: Otolaryncology Assoc. of Central Jersey $839.22; Morris Imaging Assoc II, P.A. $234.82; Pulmonary & Allergy Assoc. $950.45; Dr. Mark Widman of North Jersey Thoracic Surgical Assocs. $213; St. Barnabas Medical Center $19,091; and Dr. Kenneth Kopacz of Spine Care & Rehabilitation $59,855; and the bill of St. Barnabas Medical Center in the amount of $19,191. The bill of Dr. Friedman was amended to $3, The bill of Lab Corp. was amended to $ FINDINGS OF FACTS AND CONCLUSIONS OF LAW: The claimant, SD, seeks payment of unpaid medical bills for treatment relative to injuries sustained in a motor vehicle accident of 5/21/00. After the accident, claimant was treated

2 CASE NO. 18 Z at St. Clare s Hospital emergency room. Thereafter, he came under the care of Dr. Friedman and Dr. Lessing, as well as a physical therapist for injuries to his neck, left knee and right shoulder. He underwent right shoulder arthroscopic surgery to repair a rotator cuff on 4/24/02 which was performed by Dr. Lessing at St. Peter s Hospital. Due to the fact that his perioperative course was complicated by hemoptysis that was suspected to be secondary to pulmonary edema for an intubation injury, Dr. Friedman referred him to Mark Widmann, M.D., thoracic surgeon. It was recommended that he undergo x-rays and a CAT scan. He was also referred to a pulmonologist, Dr. Dimitry, for consultation. Dr. Dimitry opined that the bilateral infiltrates and hemoptysis was related to either trauma, aspiration with subsequent infection, noncardiogenic edema, or a combination of these factors. On 4/2/03, claimant underwent neck surgery for anterior cervical discectomy C5-C6 and C6-C7, anterior cervical interbody fusion C5-C6 and C6- C7, anterior plating with osteonics tether system and allograft bone fusion performed by Dr. Kopacz at St. Barnabas Medical Center. The surgery was performed after the EMG/NCV testing confirmed right C5-6 and C6-7 cervical radiculitis. The bulk of the claim relates to the 4/2/03 neck surgery. Claimant also seeks payment of unpaid bills relating to the prior shoulder surgery. Although the bills of St. Peter s Hospital and Dr. Lessing for that surgery have been paid, there are outstanding bills associated with the surgery, the resultant complications and follow-up care. Respondent submitted a series of peer reviews and IMEs, the most recent being that of David Rubinfeld, M.D. dated 12/11/02. The IME examiner diagnosed claimant with status post right shoulder surgery, as well as cervical radiculopathy, and concluded that claimant had not yet achieved maximum benefit from orthopaedic treatment. He recommended electrodiagnostic testing of the cervical spine and right upper extremities to clarify the presence or absence of radiculopathy. Claimant testified at the hearing that at the time of the accident he was employed as a chef at three (3) different restaurants: Charlie s; Sizzler s and Pazzo-Pazzo. Immediately after the accident, he missed one month of work. When he returned to work, he took a chef s job at the Hilton Hotel where he continued to work for eight months up until the April 2002 surgery. Post-surgery, he has not been able to return to work and Dr. Lessing has kept him out. Since his April 2003 surgery, he has been going to physical therapy. He has received State Disability payments, but no disability payments from any private plan. He never had any pulmonary problems prior to this accident. Currently, he is still under the care of Dr. Kopacz, a physical therapist and Dr. Dimitry. Claimant made a very credible, sympathetic witness. I find that the credible evidence demonstrates that all the unpaid services relative to the neck surgery were reasonable, medically necessary and causally related. Respondent s own orthopedist found that claimant had not reached maximum medical improvement and that electrodiagnostic testing was necessary to determine further treatment. That testing, performed subsequent to the IME, confirmed cervical radiculpathy. I further find that all the unpaid bills relative to the April 2002 surgery, its follow-up including the services of the thoracic surgeon and pulmonologist are reasonable, medically necessary

3 CASE NO. 18 Z and causally related. The proofs demonstrate that the following unpaid bills were reasonable, medically necessary and causally related: Dr. Friedman for services rendered from 5/23/00 through 4/15/00; Medical Associates of New Brunswick for pre-operative ECG on 4/13/02; Dr. Ahmad (St. Peter s University Hospital Ambulatory Care Group) for services rendered in connection with shoulder surgery on 4/24/02; Dr. Lessing for follow-up visits of 9/30/02 and 12/19/02; balance of Lab Corp. bill in the amount of $440; Morris Imaging Assoc. II, P.A. for treatment on 2/20/03; Pulmonary & Allergy Assoc. for treatment rendered on 2/21/03 and 3/26/03; Dr. Mark Widman; Morris Medical Group for services rendered from 5/22/02 through 5/28/02; Dr. Miller for services performed on 1/28/02; University Radiology for pre-operative testing performed on 4/13/02; Anesthesiology Consultants for surgery of 4/24/02; MRI of West Morris, P.A. for scans performed on 12/19/01 and 11/11/02; Otolaryngology Assocs. Of Central Jersey for treatment rendered in St. Peter s Hospital after 4/26/02 surgery; St. Barnabas Medical Center for hospitalization for surgery on 4/2 through 4/3/03; and Dr. Kopacz of Spine Care & Rehabilitation for spinal surgery. I find that the claimant has shown by a preponderance of the evidence that the he is entitled to 47 1/7 weeks at $100 per week for a total of $4, Claimant has submitted a disability note from his treating physician, Dr. Lessing, board certified orthopedic surgeon, certifying that claimant must remain out of work and is not due to return to work until the earliest, April 1, Claimant eventually underwent cervical spine surgery on 4/2/03 and his period of disability has been extended. He applied for permanent disability benefits with Social Security. Claimant has submitted a notification from the State of New Jersey Department of Labor indicating that he has been paid for twenty-six weeks, the maximum period of time payable on the Temporary Disability Claim. As respondent is entitled to a credit for such payments, he is only demanded and is awarded payments of $100 per week from 10/30/02 through 9/24/03, the date of claimant s last post-hearing submission. Claimant has submitted a certification of services claiming attorney s fees in the amount of $4,710, and costs of $ for filing fee, postage, photocopying and courier. Pursuant to AAA Rule 30, I find the fee claimed is reasonable. Claimant is awarded $325 for reimbursement of the filing fee, $2.58 postage and $150 copying costs. Inasmuch as no interest calculation is submitted, interest is deemed waived. 5. MEDICAL EXPENSE BENEFITS: Awarded Provider Amount Claimed Amount Awarded Payable to Dr. Friedman $3, $3, Claimant & provider Medical Associates $16.41 $16.41 Claimant & provider of New Brunswick St. Peter s $2,970 $2,970 Claimant & provider

4 CASE NO. 18 Z University Hospital Ambulatory Care Group (Dr. Ahmad) Dr. Lessing $ $ Claimant & provider Lab Corp. $440 $440 Claimant & provider Morris Imaging Assoc. II, P.A. $ $ Claimant & provider Pulmonary & Allergy Assoc. $ $ Claimant & provider North Jersey Thoracic Surgical Assocs. (Dr. Widman) $213 $213 Claimant & provider St. Barnabas Medical Center $19,091 $19,091 Claimant & provider Spine Care & Rehabilitation(Dr. Kopacz) $59,855 $59,855 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, copayments and deductibles, as well as any prior payments. 6. INCOME CONTINUATION BENEFITS: Awarded $4, 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, $2.58 postage and $150 photocopying costs (B) ATTORNEYS FEES as follows: (payable to counsel of record for CLAIMANT unless otherwise indicated): $4,710 (C) INTEREST is as follows: Waived by Claimant

5 CASE NO. 18 Z This Award is in FULL SATISFACTION of all Claims submitted to this arbitration. 10/23/03 Date Maria I. Daniskas, Esq.