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.: AAA Mid-Atlantic 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: MP. 1. ORAL HEARING held on July 23, 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). Washington Medical, P.A. $1, West Jersey Hospital $54.88 paid. Charles Wilkins, Jr., M.D., $65.00 Bloomfield Diagnostic $ FINDINGS OF FACTS AND CONCLUSIONS OF LAW: MP was involved in a motor vehicle accident on April 7, Insurance coverage in effect at time was for the period February 20, 2001 to February 20, Accordingly, AICRA is applicable. On the date of the accident, MP was taken by Ambulance to West Jersey Hospital where she was x-rayed, given medication and released. Subsequently she came under the care of Dominick Laganella who noted a pre-existing herniated disc by MRI dated April 30, Dr. Laganella prescribed a course of

2 CASE NO.18 Z physical therapy and referred MP to Dr. Charles Wilkins, an orthopedic surgeon and Dr. Denis Ribatsky, a TMJ specialist. Dr. Wilkins in a report dated July 18, 2001 noted that x-rays taken at West Jersey Hospital on the date of the accident which revealed degenerative discogenic change with no evidence of fracture or dislocation. His impression was that MP had suffered acute cervical and thoracolumbar sprain super imposed upon pre-existing degenerative discogenic change. He recommended physical therapy modalities. He also noted in his report that MP had at least on previous motor vehicle accident which involved spinal injuries and that she had undergone epidural steroid injections for herinated lumbar disc. Dr. Ribatsky in a report dated May 22, 2001 made a diagnosis of traumatic arthropathy, right and left temporomandibular joints. He found that the TMJ ligaments were stretched or torn and that the temp mandibular discs were displaced and lacked ligamentous support which caused recurrent episodes of myospasm. A course of treatment was prescribed along with various dental appliances. It was Dr. Ribatsky s opinion that the condition was the sole and direct result of the motor vehicle accident of April 7, It is alleged that MP s symptoms persisted and did not improve with physical therapy. She was thereafter seen by Dr. Heppenstal on August 1, 2001 at which time Dr. Heppenstal recommended surgery and performed a limited hemilaminectomy on September 7, 2001 at Pennsylvania Hospital. In a letter dated September 20, 2001 he reported that MP s post operative course was completely uneventful and she was discharged from the hospital the next day. In his letter dated September 20, 2001 he indicated I am happy to state that she has a fantastic result. He leg pain has completely resolved. She has very minimal low back discomfort. Between the time of the April 30, 1996 MRI indicating a herniated disc and the April 7, 2001 accident, MP had another motor vehicle accident on April 14, As a result of the April 14, 1997 accident she was seen by Dr. Michael Morone, who prescribed physical therapy and reported that her symptoms largely resolved with conservative treatment. Claimant argues that the e acciccident of April 7, 2001 exacerbated her condition and that her surgical bills were a direct result of the April 7, 2001 accident. An IME was conducted by Dr. Roy Gorin at Tri County Orthopaedic on August 17, History taken by Dr. Gorin on August 17, 2001 noted that MP was examined by Dr. Heppenstal at the University of Pennsylvania who suggested the need for an operative procedure. He also noted that MP was concerned that she had diminished reflex in her right leg and as a result she would require surgery on her back. He indicated routine task such as household chores, laundry, gardening, grocery shopping, driving and sleeping were limited. Under occupational history it was noted she had been on disability as a teacher since the accident and was unable to return to her occupational duties because of complaints of pain and disability. Imaging studies were not available for Dr. Gorin s review and he felt that this was important since MP had underlying pre-existing diagnosis of disc disease with radiculopathy as treated by Dr. Maslow in the past. He commented in his report that before making a determination of causality regarding this episode, previous EMG, previous pain management and previous office notes from Dr. Maslow would be of significance. Comparison of the 1996 MRI and the current MRI would be of benefit to. He also commented that MP had evidence of radiculopathy on the EMG and nerve conduction study performed by Dr. Masceri. He felt this suggest acute change and may be related to her motor vehicle accident. He also commented that surgical intervention regarding her lumbar spine at the time of his examination would not be recommended based on lack of appropriate information regarding her objective findings being available for review. A subsequent report completed by Dr. Gorin dated July 7, 2002 indicated that additional records were in fact reviewed. In his letter Dr. Gorin indicates that a review of the additional records suggests that the patient had a lumbar lamanectomy and has ongoing treatment for lumbar degenerative disc disease. He found that based on the records reviewed she appeared to be doing satisfactorily. He concluded in his letter by stating I anticipate a course consisting of physical therapy and symptomatic care to the point of maximum medical improvement following surgical decompression, based upon the patients clinical status, of approximately six to twelve weeks and that no additional treatment would be required. Although

3 CASE NO.18 Z treatment employed would be based upon chronic radicular complaints associated with two previous surgical procedures and the effected site. In addition to medical benefits a claim for essential services and lost wage benefits was also filed by Claimant. The claim for essential services is for twenty-three days from September 24, 2001 through October 26, 2002 while MP was recuperating from surgery. Her wage loss claim is for the same period of time. In addition a claim was made for a home spa prescribed by Dr. Laganella. Having heard the argument of counsel and having reviewed the submitted documentation, I find Claimant has met its burden of proof and that the surgery performed by Dr. Heppenstal and the related medical expenses were medically necessary and reasonable. Miltner v. Safeco Insurance Company of America, 175 N.J. Super. 156 (Law Div. 1980). Mewes v. Union Building and Construction Company, 45 N.J. Super. 89 (App. Div. 1957). It is to be noted that at the time of Dr. Gorin s IME on August 17, 2001 that Dr. Gorin lacked various medical documentation as indicated in his IME report. With reference to the pre-surgery medical expenses, I find that Claimant has met her burden of proof and that the services so rendered were medically necessary and reasonable. This would include Washington Medical, P.A., Denis Ribatsky, D.D.S. and Bloomfield Diagnostic. I find that the wage loss claim is supported by the medical documentation and in particular the letter by Dr. Heppenstal dated August 17, 2001 wherein he indicates MP would be disabled from active employment for approximately six to eight weeks following the surgery. I also find that the claim for essential services is supported by the medical documentation and the proofs submitted. It is to be noted that Respondent made no argument or submitted any documentary proof to deny the claim. In reference to the claim for a home spa, I find that Claimant has not met her burden of proof and that the home spa was not medically necessary. It is to be noted that home spa was purchased April 30, Dr. Laganella s letter dated February 13, 2002 lists MP s diagnosis; as status post lumbar disc surgery; lumbar radiculopathy; and lumbar disc disease. In his letter of February 13, 2002 he recommended that MP purchase a home spa. No interest calculation or factual basis to support an award of interest has been submitted. Pursuant to Rule 29 I am awarding the sum of $1, as counsel fees. This award of counsel fees is consonant with the amount in issue and with Rule 1.5 of the Rules of Professional.

4 CASE NO.18 Z MEDICAL EXPENSE BENEFITS: Awarded Provider Amount Claimed Amount Awarded Payable to Gloucester Township EMS $38.24 $38.24 Gloucester Township EMS Washington Medical, P.A. $1, $1, Washington Medical, P.A. Dennis Ribatsky $ $ Dennis Ribatsky Charles Wilkins, Jr., M.D. $65.00 $65.00 Charles Wilkins, Jr., M.D. Bloomfield $45.00 $45.00 Bloomfield Diagnostic Diagnostic University of Pennsylvania Medical Center $ $ University of Pennsylvania Medical Center Society Hill Anesthesia $1, $1, Society Hill Anesthesia PA Cardiology $70.00 $70.00 PA Cardiology Associates Found Pennsylvania Hospital Associates Found $13, $13, Pennsylvania Hospital Explanations of the application of the medical fee schedule, deductibles, co-payments, or other particular calculations of Amounts Awarded, are set forth below. Award of Benefits is subject to prior payments, 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

5 CASE NO.18 Z 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: Awarded in the amount of $0.00. This Award is in FULL SATISFACTION of all Claims submitted to this arbitration. November 22, 2002 Date Richard A. De Michele, Esq.