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

Transcription

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 OF NEW JERSEY DRP NAME: Margaret Knuetter (Respondent) NATURE OF DISPUTE: Causation, 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: SK. 1. ORAL HEARING held on 1/15/ ALL PARTIES APPEARED at the oral hearing(s). NO ONE appeared telephonically. 3. Claims in the Demand for Arbitration were NOT AMENDED 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). 4. FINDINGS OF FACTS AND CONCLUSIONS OF LAW: This is a claim for payment of bills incurred by SK after an auto accident of 8/19/01. The sole issue is whether the treatment rendered after that accident was caused by the accident. At oral hearings, claimant SKS testified and the following documents were submitted: NJ Police report of 8/19/01 Correspondence to SK from respondent dated 9/28/01 PIP application Correspondence regarding Aetna US Healthcare lien

2 CASE NO. 18 Z Bills from the following providers: Matthew France, MD, DOS 1/21/02 through 4/4/02 Lawrence Gelber, MD, DOS 9/19/01 Carl Giordano, MD, DOs 10/3/01 through 9/24/02 Morristown Memorial Hospital, DOS 1/21/02 through 1/22/02 John Lapchak,MD, DOS 1/21/02 Morristown Pathology Assoc, DOS 1/15/02 to 1/21/02 Phillip Rubenfeld, MD, DOS 9/25/01 to 10/25/02 Robert Fried,MD, DOS 5/1/02 to 7/18/02 HealthSouth Holdings, DOS 4/2/02 to 5/24/02 with treatment notes Roxbury Open MRI,DOS 10/19/01 Arash Emani and Steven Dorsky, MD 9/14/01 to 9/21/01 Tri County MRI, DOS 9/19/01 Fox Chiropractic 8/22/01 to 10/12/01 Pre-certification requests Certification of Dr. Giordano, dated 12/14/01 and report dated 8/26/03. Dr. Giordano states that he initially saw SK on 2/1/00 with complaints of back pain radiating down right leg His initial diagnosis was neuritis. A review of the MRI films of the low back yielded an impression of right L5-S1 disc protusion. Subsequent to the auto accident, he saw SK on 10/3/01 with complaints of right lower extremity sciatica. He compared the MRI films of 9/19/02 and found that there was a right L5-S1 herniation larger than before. On 1/21/02 he performed a right L5-S1 microsurgical discectomy. He concludes that the motor vehicle accident caused a prior herniation to worsen and ultimately require surgery. Reports of Dr. Giordano, dated 10/3/01, 11/1/01 Report of Lawrence Gelber, MD, dated 9/19/01 re MRI of lumbar spine with findings of early degenerative disc changes at L5-S1 with a broad based disc herniation extending more to the right than the left of midline with associated mass effect on the ventral contour of the dural sac and the emerging right S1 root. Similar findings were present on a prior study of 10/22/99. Certification of Michael Fox, DC, dated 3/13/02. Dr. Fox states that between July and August 10,2001 SK was under his care for low back pain radiating into the right leg (acute neuritis/ radiculitis). At his last treatment before the accident, he noted that he was progressing well and responding to treatment. After the accident, he was seen on 8/20 but did not mention the accident until he was leaving. Another appointment was scheduled for 8/22 at which time the diagnosis was segmental somatic dysfunction of L5 with neuritis, radiculitis, low back. He continued to treat him to 10/12/01 with fair progress. Office records and bills are attached Records of New Jersey Pain Management, (Dr. Philip Rubinfeld) with operative report of 10/19/01(epidural steroid injection ), 4/17/00, 3/17/00, 2/25/00. Narrative report of Dr. Rubinfeld, dated 2/24/00 Report of Tri County MRI re study of 10/22/99 with findings of early degenerative disc changes, a mild generalized annular bulge, a small focal central disc protrusions and mild hypertrophic degenerative interfacet joint changes at L5-S1 bilaterally. Office records of Robert Fried, MD Records of Steven Dorsky, MD and Arash Enami, MD

3 CASE NO. 18 Z Report of Marc Cohen, MD, dated 12/14/01(below) SK testified that he had been under the care of a chiropractor prior to the accident. He said he used to get pain down his leg when he sat in a chair for about 30 minutes. He said that at the time of the accident he felt a jolt and was "shook up a little". He did not feel anything until he got back into his car when he felt a sharp increase in pain dwon the leg. He said that when he went to the chiropractor the next day, he told them of the accident. He had to hold onto the wall because he was having difficulty walking. He had initially injured his back some years ago when he was playing squash and treated with a chiropractor at that time. Respondent submitted the following: Police report MRI of Dr. Gelber, dated 10/22/99 (above) and 9/19/01 (above) Report of Marc Cohen, MD, dated 12/14/01. Dr. Cohen examined SK and reviewed records submitted. It was his opinion that the MRI's of 2001 were unchanged from the 1999 films and that the accident of 8/19/01 obviously did not cause any new change in his back problems. He opined that he was not in need of surgical intervention. Addendum to report of Dr. Cohen, dated 11/10/03. Dr. Cohen states that he again reviewed both sets of MRI films and agreed with Dr. Gelber that they were unchanged in 2001 from the pre-accident films. He concluded that the surgery was the result of a preexisting condition and degenerative conditions and not the auto accident. Report of Maria Addesa, DC, dated 10/11/01. Dr. Addesa examined SK on that date and her impression was of lumbalgia. She concluded that there was no direct relationship between the accident and his injuries. She found that he had reached maximum improvement and needed no further treatment. Estimate of damage to SK's car - total $ representing $ to replace a face bar chrome on rear of the vehicle. Picture of rear of SK's vehicle Report of Richard Harding, of Biodynamic Research Corporation, dated 10/23/03 with CV attached. Mr. Harding prepared a low impact analysis report and concluded that the post-collision clinical course of persistent lower extremity symptomatology leading to surgical intervention was inconsistent with the injury causation potential of this minor motor vehicle collision. This was supported by biomechanical and pathological literature, citations given. Transcript of EUO of SK. SK states that he experienced back pain around August 1999 after playing squash for a few years. He was having spasms which were starting to go down his leg. He went to his primary care physician who sent him for physical therapy for about 6 weeks at which point he said he was feeling better. He next saw Dr. Emani around June or July 2001 because his back started hurting again. He also had seen Dr. Dorsky who prescribed the MRI and physical therapy. He said he saw him again in January 2000 to get some extra sessions of physical therapy. He underwent the sessions of epidural injections in He said in May or June of 2001 he started getting spasms again in his back and a friend recommended Dr. Fox I have reviewed the submissions of the parties and heard the testimony of the claimant. I have a great deal of difficulty in finding that an accident that caused such minor damage to claimant's substantial vehicle (Toyota 4 Runner) could precipitate such physical changes in the condition of SK's back. He had a pre-existing condition for a number of

4 CASE NO. 18 Z years, that had gone into remission once, but had recurred 3 or 4 months prior to this accident. He was actively treating with the chiropractor at the time of the accident. Even his own expert who did both MRI studies admitted that the later set were similar to the earlier studies. I therefore conclude that the injury and resu

5 CASE NO. 18 Z This Award is in FULL SATISFACTION of all Claims submitted to this arbitration. 2/11/04 Date Margaret Knuetter, Esq.