In the Matter of the Arbitration between North Jersey Rehabilitation Center a/s/o Y.L. CLAIMANT(s), Forthright File No: NJ0903001250685 Insurance Claim File No: 040900064409-003 Claimant Counsel: Joseph M. Ariyan, Esquire, LLC v. Claimant Attorney File No: Respondent Counsel: Law Office of Patricia A. Palma Respondent Attorney File No: 040900064409DKPO Accident Date: 12/21/2007 High Point Insurance RESPONDENT(s). Award of Dispute Resolution Professional Dispute Resolution Professional: Joseph J. Riva, Esq. I, The Dispute Resolution Professional assigned to the above matter, pursuant to the authority granted under the Automobile Insurance Cost Reduction Act, N.J.S.A. 39:6A-5, et seq., the Administrative Code regulations, N.J.A.C. 11:3-5 et seq., and the Rules for the Arbitration of No-Fault Disputes in the State of New Jersey of Forthright, having considered the evidence submitted by the parties, hereby render the following Award: Hereinafter, the injured person(s) shall be referred to as: Patient An oral hearing was waived by the parties. An oral hearing was conducted on: 09/28/11 Hearing Information Claimant or claimant s counsel appeared in person. Respondent or respondent s counsel appeared in person. The following amendments and/or stipulations were made by the parties at the hearing: The amount of the claim was reduced to $26,180.34. NJ0903001250685 Page 1 of 11
Findings of Fact and Conclusions of Law This arbitration arises out of an automobile accident that occurred on 12/21/07. On that date, Patient (patient) was an insured of High Point Insurance (respondent) and eligible to receive personal injury protection (PIP) benefits when she suffered injuries because of the accident. Patient received medical care at North Jersey Rehabilitation Center (claimant). Claimant took an assignment of patient s claim for PIP benefits. After a dispute arose between respondent and claimant regarding those benefits, claimant commenced this proceeding, seeking reimbursement from respondent of $26,180.34 with interest for unpaid medical bills together with counsel fees and costs. The reimbursement claim is laid out in the Arbitration Summary submitted by claimant, which respondent does not challenge. The issues identified by the parties, confirmed by counsel at the arbitration hearing held on 09/28/11, and presented for my consideration are: (1) whether claimant is entitled to reimbursement of $1,368.86 for unpaid chiropractic treatment from 06/03/08 through 08/25/08; (2) whether the additional chiropractic treatment from 08/28/08 through 02/06/09 was medically necessary; (3) whether the acupuncture treatment from 06/03/08 through 07/11/08 was medically necessary; (4) whether the physical therapy (PT) from 08/26/08 through 09/20/08 was medically necessary; (5) whether the manipulations under anesthesia (MUAs) on 12/15/08, 12/17/08 and 12/18/08 were medically necessary; (6) whether claimant failed to abide by respondent s internal appeals process; and (7) counsel fees and costs. The parties did not present any other issues. They agreed that only the issues presented would be decided. Accordingly, I have not considered nor decided any other issues. The parties submitted a number of documents in support of their respective positions for my review, including: Claimant s 02/27/09 Demand for Arbitration with attachments, Claimant s 08/23/11 Arbitration Summary, Claimant s 09/24/11 submission with attached Exhibits A through F, Claimant s counsel s PIP Arbitration Attorney Fee Certification, and Respondent s 11/01/10 submission with attached Exhibits A through XX. I have carefully reviewed all of the parties submissions and considered the arguments of counsel advanced at the hearing. This is a consolidated case with N.J. Anesthesia Group/St. Joseph s a/s/o Y.L., N.J. 1251372 (Forthright, Nov. 9, 2011) and Saddle Brook Surgicenter a/s/o Y.L. v. High Point Ins. Co., N.J. 1270216 (Forthright, Nov. 9, 2011). As a starting point, I agree with claimant that respondent is obligated to make reimbursement of $1,368.86 for the unpaid dates of service from 06/03/08 through 08/25/08 as the medical necessity for the services patient received from claimant during that time frame is not disputed. More specifically, claimant is entitled to reimbursement of $1,116.73 the amounts reflected as outstanding in claimant s NJ0903001250685 Page 2 of 11
Arbitration Summary through 08/21/08 and, additionally, $72.45 for an office visit on 08/25/08 and $179.68 for 2 additional dates of service. The Payment Ledger submitted by respondent indicates that all treatment provided by claimant through 08/21/08 was properly processed and paid. Notably, however, respondent conceded at the hearing that the Ledger reflects codes that are not listed on claimant s Arbitration Summary. This brings me to the medical necessity of the additional chiropractic treatment from 08/28/08 through 02/06/09, the acupuncture treatment from 06/03/08 through 07/11/08, the PT from 08/26/08 through 09/20/08, and the MUAs on 12/15/08, 12/17/08 and 12/18/08. I start my analysis of this issue by stating the applicable regulatory provisions and legal principles. The regulatory definition of the phrase medical necessity is set forth in N.J.A.C. 11:3-4.2 and defined as follows: Medically necessary or medical necessity means that the medical treatment or diagnostic test is consistent with the clinically supported symptoms, diagnosis or indications of the injured person, and: 1. The treatment is the most appropriate level of service that is in accordance with the standards of good practice and standard professional treatment protocols including the Care Paths in the Appendix, as applicable; 2. The treatment of the injury is not primarily for the convenience of the injured person or provider; and 3. Does not include unnecessary testing or treatment. The phrase clinically supported is defined in N.J.A.C. 11:3-4.2 as follows: Clinically supported means that a health care provider prior to selecting, performing or ordering the administration of a treatment or diagnostic has: 1. Personally examined the patient to ensure that the proper medical indications exist to justify ordering the treatment or test; 2. Physically examined the patient including making an assessment of any current and/or historical subjective complaints, observations, objective findings, neurological indications and physical tests; 3. Considered any and all previously performed tests that relate to the injury and the results and which are relevant to the proposed treatment or test; and 4. Recorded and documented these observations, positive and negative findings and conclusions on the patient s medical records. NJ0903001250685 Page 3 of 11
The question of whether medical treatment is necessary is initially decided by the patient s treating physician, and an objectively reasonable belief in the utility of a treatment or diagnostic method based on credible and reliable evidence of its medical value is enough to qualify the expense for PIP purposes. Thermographic Diagnostics, Inc. v. Allstate Ins. Co., 125 N.J. 491, 512 (1991). The treating physician enjoys wide discretionary latitude in determining the extent of treatment needed for a particular patient in that it is not unusual to witness a genuine dichotomy of medical opinion as to the type and extent of treatment needed for a particular injury. Elkins v. N.J. Mfrs. Ins. Co., 244 N.J. Super. 695, 701 (1990); Miskofsky v. Ohio Cas. Ins. Co., 203 N.J. Super. 400, 410 (Law Div. 1984). As a result, when there is a conflict in the opinions of the medical experts regarding a patient s treatment or condition, the treating physician s objectively reasonable belief should be accorded greater weight. Mewes v. Union Bldg. & Constr. Co., 45 N.J. Super. 88, 94 (App. Div. 1957). Guided by these regulatory provisions and legal principles, I turn to an examination of the medical necessity issue in the following factual context. On 04/17/08, patient underwent a pain management independent medical examination (IME) performed by Dr. Boris Parkhina. Dr. Parkhina recorded patient s complaints and described her treatment history. He concluded that there were no positive findings in the cervical, thoracic or lumbar spinal regions. He also concluded that patient s initial complaints could possibly be caused by the 12/21/07 accident, but no permanent injuries resulted therefrom. He determined that patient had reached maximum medical improvement (MMI) and no further treatment was needed with regard to invasive pain management. On 05/05/08, respondent sent a letter to patient advising that Dr. Parkhina concluded that she had reached MMI from pain management treatment resulting from the accident and all pain management treatment would be terminated as of 05/16/08. Patient was subsequently seen by both Dr. William Yu and Hdong Im, LAC (acupuncturist) of claimant, North Jersey Rehabilitation Center, on 06/03/08. At that time, she complained of pain in the neck, radiation into both arms, pain in the mid-back, pain in the low back, and radiation into both legs, along with other symptoms. Dr. Yu indicated that patient had received little improvement with chiropractic treatment and he expected additional chiropractic treatment to last for another 4 to 6 weeks. On 06/03/08, Dr. Yu submitted a treatment plan requesting approval for chiropractic treatment at the rate of 3 times a week for 4 weeks. On 06/05/08, Dr. Yu submitted another treatment plan requesting approval for an MRI of the left shoulder and an MRI of the right shoulder. On 06/06/08, Medical Director, Dr. Thomas Cawley, reviewed Dr. Yu s request for additional chiropractic treatment. He noted that there was still positive neurologic and orthopedic testing, which might indicate a lack of response to treatment. Nevertheless, he determined that treatment at the rate of 3 times a week for 4 weeks should be approved as necessary with patient monitored for progression/persistence of neurologic deficits and a response to chiropractic treatment. As such, Dr. Cawley sent a Certification Letter to Dr. Yu that same day, advising that the requested treatment was approved. NJ0903001250685 Page 4 of 11
On 06/10/08, Medical Director, Dr. Alan Stern, reviewed Dr. Yu s request for bilateral shoulder MRIs. He noted that patient had treated with a pain management specialist for quite some time and currently had achieved MMI. He indicated that he was unable to approve the request for bilateral shoulder MRIs because all documented findings were spinal related with no specific shoulder testing performed. He noted that shoulder instability could not be diagnosed from the documented tests and, therefore, the shoulder MRIs were not clinically supported as medically necessary. On 06/10/08, Dr. Stern sent a Denial Letter to Dr. Yu with regard to the request for bilateral shoulder MRIs. Despite the denial, bilateral shoulder MRIs was performed on 06/25/08 at Cliffside Park Imaging and Diagnostic Center. Only tendonitis was revealed but the glenohumeral joint in each shoulder was found to be intact. On 06/30/08, Dr. Yu re-examined patient whose complaints had not improved. He noted that she was at a point in therapy where he was expecting good progress. He encouraged patient to undergo another 4 to 6 weeks of treatment. He submitted a treatment plan on that date requesting approval for an additional 12 sessions of chiropractic treatment as well as an MRI of the left knee and an MRI of the right knee. Patient also saw the acupuncturist, Dr. Im, on 06/30/08, complaining of pain in the head, neck and low back. On that day, Dr. Im submitted a treatment plan requesting approval for acupuncture therapy. On 07/07/08, Medical Director, Dr. Robert Krotenberg, reviewed the request. Dr. Krotenberg noted that patient had neck and back pain for which she had a full course of conservative care far in excess of the Care Path guidelines. He also noted that she had already had a course of acupuncture by another provider but remained symptomatic. He indicated that she had been found to have reached MMI as a result of an IME. He determined that patient had reached MMI and additional acupuncture would unlikely result in long term benefits for her and, therefore, the treatment should be denied. On 07/07/08, Dr. Krotenberg sent a Denial Letter to Dr. Im with regard to the request for acupuncture treatment advising that patient had reached MMI for such treatment. Dr. Im did not appeal the denial. Instead, he submitted additional similar treatment plans on 07/28/08 and 08/18/08. In the meantime, on 07/02/08, Dr. Cawley reviewed Dr. Yu s request for additional chiropractic treatment and MRIs. Dr. Cawley noted that as regards the knee complaints, Dr. Yu did not mention the specific anatomical region either in his report or treatment plan. He noted that patient continued to have neck and low back pain with weakness in all 4 extremities and bilateral knee pain. He determined that additional chiropractic therapy at the rate of 3 times per week for 4 weeks should be approved and that a discharge plan with a total number of visits to date should be supplied by Dr. Yu. He determined that the bilateral knee MRIs should be denied as no specific examination of the knee had been performed or documented. On 07/02/08, Dr. Cawley sent a Certification Letter to Dr. Yu advising that 12 chiropractic visits were approved with a request for a total number of visits to date and a discharge plan. Also, on 07/02/08, Dr. Cawley sent a Denial Letter to Dr. Yu advising that the requested bilateral knee MRIs were denied as inconsistent with the Care Paths and not clinically supported as medically necessary. Despite the denial, NJ0903001250685 Page 5 of 11
patient had MRIs of the right and left knees performed on 07/10/08 at Cliffside Park Imaging and Diagnostic Center. On 07/28/08, Dr. Yu again re-examined patient who voiced similar complaints as previously noted. On that date, Dr. Yu submitted another treatment plan, again requesting approval for 12 sessions of chiropractic treatment. On 07/31/08, respondent faxed to Dr. Yu a Certification Letter approving the requested PT and again requesting a copy of a discharge plan and the number of chiropractic visits completed to date. On 08/25/08, patient was again seen by Dr. Yu and complained of similar complaints as previously noted. On that date, Dr. Yu submitted another treatment plan, again requesting 12 sessions of chiropractic therapy. This treatment plan was reviewed on 08/28/08 by Medical Director, Dr. Timothy Hayes, who noted that patient commenced chiropractic treatment on 06/30/08. He also noted that she had undergone 2 trials of chiropractic care and the most recent report of 08/25/08 was reviewed. Dr. Hayes stated that Dr. Yu is notorious for submitting identical reports with little change and, in this case, he compared the initial examination of 06/30/08 to the most recent one and patient s complaints were identical and the findings were almost identical. There was no improvement throughout the 2 trials of chiropractic treatment. He determined that the additional requested treatment should be denied as patient had plateaued and there was no clinical support for the treatment. On 08/28/08, Dr. Hayes sent a Denial Letter to Dr. Yu with regard to the requested additional chiropractic treatment advising that it was not clinically supported. On 09/22/08, Dr. Yu again re-examined patient who had similar continuing complaints as previously noted. On that date, Dr. Yu submitted another treatment plan again requesting approval for 12 sessions of additional chiropractic therapy. On 09/25/08, this treatment plan was reviewed by Dr. Cawley who reiterated that additional treatment would be passive in nature and not consistent with the Care Paths. Because clinical improvement was not apparent after several months of passive therapy, he determined that the additional treatment requested should be denied. On 09/25/08, Dr. Cawley sent a Denial Letter to Dr. Yu. Dr. Yu examined patient again on 10/20/08 and the same complaints were noted. He submitted another treatment plan on 10/20/08 again requesting approval for 12 sessions of additional chiropractic therapy. Dr. Cawley reviewed this request on 10/23/08 and again noted that treatment had become passive with no clinical improvement after several months of chiropractic therapy. He again determined that the request should be denied. On 10/23/08, Dr. Cawley sent another Denial Letter to Dr. Yu with regard to the requested treatment. Dr. Yu examined patient again on 11/17/08, again noting similar complaints and findings. On that date, Dr. Yu submitted another treatment plan requesting an additional 12 sessions of chiropractic therapy. NJ0903001250685 Page 6 of 11
Dr. Cawley reviewed this request on 11/20/08 and again noted that there was no clinical improvement with passive therapy which had gone on for several months and, therefore, the request should be denied. On 11/20/08, Dr. Cawley sent a Denial Letter to Dr. Yu. On 12/8/08, Dr. Yu again saw patient who continued to voice similar complaints. On that same date, he submitted a treatment plan requesting approval for MUAs of the spine and hip. On 12/10/08, Dr. Cawley reviewed the request for MUAs. He noted that chiropractic treatment commenced on 06/03/08 and that a re-evaluation of 12/08/08 was submitted. He noted that patient continued to complain of neck and back pain with radiation into all 4 extremities. The symptoms remained unchanged from the initial evaluation back on 06/03/08. He noted that there were multiple positive cervical and lumbar provocative maneuvers bilaterally but no neurologic assessment was performed. He determined that the requested MUAs should be denied as spinal manipulation is no longer the treatment of choice. A plateau had been reached after several months of passive therapy. On 12/10/08, Dr. Cawley sent a Denial Letter to Dr. Yu advising that the requested MUAs were denied as inconsistent with the Care Paths and not clinically supported. On 12/15/08, Dr. Yu again re-examined patient who had continuing similar complaints as previously noted. On that day, Dr. Yu submitted another treatment plan, again requesting approval for additional chiropractic therapy for 12 sessions. Despite the multiple denials of continuing chiropractic care which had become passive and the denials of the requested MUAs, Dr. Yu administered MUAs of the cervical, thoracic and lumbar spine on 12/15/08, 12/17/08 and 12/18/08. On 12/18/08, respondent faxed a letter to Dr. Yu in response to the treatment plan requesting additional chiropractic therapy which was submitted on 12/15/08. Respondent advised Dr. Yu that the treatment had been previously denied by respondent and chiropractic treatment remained denied. No appeals of the denied chiropractic therapy had ever been filed by claimant. On 01/12/09, Dr. Yu again re-examined patient who had continuing similar complaints. On 01/12/09, Dr. Yu submitted another treatment plan again requesting 12 sessions of chiropractic therapy. On 01/15/09, respondent faxed a Final Notification Letter to Dr. Yu acknowledging receipt of the latest treatment plan but advising that it could not be considered because the 30-day time frame within which to appeal had expired. On 02/25/09, Dr. Yu submitted what purports to be an appeal of the treatment which had been denied. The appeal consisted of one sentence which was unsupported by any medical documentation whatsoever and submitted well beyond the 30-day appeal time frame. On 03/03/09, respondent faxed another Final Notice Letter to Dr. Yu acknowledging receipt of the appeal but advising that the 30-day time frame for filing appeals had expired. On 06/05/09, an orthopedic IME was performed by Dr. Alan Miller. Dr. Miller noted that patient continued to complain of pain in the neck, back, right shoulder and bilateral knees. He described patient s treatment in great detail and conducted a thorough clinical examination. Dr. Miller concluded NJ0903001250685 Page 7 of 11
that patient had sustained sprains of the cervical spine, lumbar spine, right shoulder and bilateral knees all of which had resolved. He determined that the injuries were causally related to the 12/21/07 accident but there were no permanent injuries resulting therefrom and no need for any further diagnostic testing or treatment of any kind whatsoever. On 06/18/09, respondent sent a letter to patient advising that Dr. Miller had concluded that she had reached MMI from orthopedic treatment and that all treatment would be terminated as of 07/02/09. On 10/29/09, Dr. Cawley undertook a peer review of the medical necessity of the MUAs, which had been performed and also of the chiropractic treatment provided on 73 dates from 08/26/08 through 02/04/09. Dr. Cawley concluded that the MUAs were not clinically supported as medically necessary and were properly denied by respondent. He also determined that all chiropractic care prior to 08/26/08 was medically necessary but the 73 dates of service beyond that date were not clinically supported as medically necessary. Where there is a dispute as to PIP benefits, the burden rests on the claimant to establish by a preponderance of the evidence; that is, the greater weight of the credible evidence, that the services for which PIP payment is sought were reasonable, medically necessary and causally related to an automobile accident. Miltner v. Safeco Ins. Co. of Am., 175 N.J. Super. 156 (Law Div. 1980). While it is true the treating physician s opinion is not automatically accorded conclusive weight, Black & Decker Disability Plan v. Nord, 123 S. Ct. 1965 (2003), (relating to ERISA Plans), it is accorded an appropriate measure of deference. Having considered the arguments advanced by counsel in light of the record and applicable legal framework, I conclude that the additional chiropractic treatment from 08/28/08 through 02/06/09 was properly denied by respondent as not medically necessary and in excess of the Care Paths. A review of claimant s written notes demonstrate no significant changes in patient s condition that would justify continued conservative care. Accordingly, I deny the additional amount of reimbursement sought as reflected in claimant s Arbitration Summary. I further conclude that the PT from 08/26/08 through 09/20/08 was properly denied by respondent as not medically necessary. Accordingly, I deny the reimbursement claim of $1,104.32 for the PT from 08/26/08 through 09/20/08. In light of the conclusion reached by Dr. Cawley as a result of his 10/29/09 peer review; namely, that all chiropractic care prior to 08/26/08 was medically necessary, I conclude that the contemporaneous acupuncture from 06/03/08 through 07/11/08 was medically necessary. Accordingly, I award claimant $2,530.09 for the acupuncture treatment. Finally, I conclude that the MUAs performed on 12/15/08, 12/17/08 and 12/18/08 were not medically necessary. The treating records point out that patient had reached a plateau after 3 months of chiropractic treatment. Based on a comparison of the examinations, I find that the chiropractic treatment did not result in any significant improvement. The proofs show that patient s complaints did not improve after the MUAs were performed and actually worsened, which confirms that patient was not a candidate for the MUAs, and I so find. NJ0903001250685 Page 8 of 11
Moreover, the National Academy Of Manipulation Under Anesthesia Physicians (NAMUAP) protocols identify the conditions that provide clinical justification for MUAs. The proofs presented here fall short of demonstrating that patient s condition satisfied the protocols. In fact, the records reveal that patient was not responding to chiropractic treatment as her condition was chronic. Notably, the protocols do not state that MUAs are appropriate where a patient s condition has become chronic. Rather, they state that MUAs may be useful where the chronicity of the problem and/or the presence of fibrous adhesions render conservative manipulations incomplete. Here, however, there is no indication from Dr. Yu that his manipulations were incomplete. Indeed, the records simply do not reveal that he was having difficulty manipulating patient due to pain or adhesions. MUA is designed to relax the patient so that the chiropractor can achieve a proper manipulation of the joint that he/she otherwise would not be able to do because of pain or adhesions or muscle splinting. The mere failure to respond to conservative care is not a basis to perform MUA. Based upon the proofs presented, I conclude that there was no need to perform the MUAs. Beyond that, Dr. Yu failed to follow the protocols in performing the second and third MUAs. The protocols state that if the patient gains 80% or more biomechanical function during the first procedure and retains at least 80% of functional improvement during the post MUA evaluation, then serial MUA is unnecessary. If the patient achieves less than a 50% improvement, then a subsequent MUA would not be useful. Unquestionably, the protocols require that a post-mua evaluation be done. There is no record of any post-mua evaluation being done here. In fact, the 3 procedures were performed within 4 days, which suggests that Dr. Yu proceeded to perform a second and third MUA without even considering if they were needed. Under these circumstances, I deny the reimbursement claim as regards the MUAs. Accordingly, respondent s argument that claimant excessively billed for cervical, lumbar and thoracic MUA on each date is moot. On a final note, I reject respondent s argument that claimant is barred from recovery for failing to abide by its internal appeals process given Dr. Cawley s 10/29/09 peer review. Turning to counsel fees and costs, claimant s counsel seeks counsel fees in the amount of $1,920 together with costs of $368.75. Respondent s counsel objects to such an award with particular opposition to both the total number of hours billed and the hourly billing rates. It is respondent counsel s position that the counsel fee requested is excessive and not consonant with the amount at issue and, moreover, that respondent is not obligated to pay for the services rendered by the paralegal, law clerk and secretary. In N.J. Coalition of Health Care Professionals, Inc. v. N.J. Dep t of Banking & Ins., 323 N.J. Super. 207 (App. Div. 1999), the court noted that an award of counsel fees to an insured who successfully obtains an arbitration award against an insurance carrier for payment of PIP benefits... has been the statutory and historical jurisprudence of our State. The courts have construed Rule 4:42-9(a)(6), which allows for an award of counsel fees in an action upon a liability or indemnity policy of insurance in favor of a NJ0903001250685 Page 9 of 11
successful claimant, to permit an award of attorney's fees and judicial actions brought under the PIP statute. I find the claimant was successful and is entitled to an award of counsel fees. In Enright v. Lubow, 215 N.J. Super. 306 (App. Div. 1987), the court identified the factors to be considered in deciding whether to award attorney s fees, including the insurer's good faith in refusing to pay the claim, the excessiveness of plaintiff's demands, the bona fides of the parties, the insurer's justification in litigating the issues, the insurer's conduct as it contributes substantially to the need for litigation, the general conduct of the parties, and the totality of the circumstances. As the court pointed out in Scullion v. State Farm Ins. Co., 345 N.J. Super. 431 (App. Div. 2001), while the Enright factors are to be considered in making the threshold determination as to whether to award counsel fees, many of those factors are equally applicable in determining the amount of counsel fees to be awarded. The court in Scullion clearly suggests that the proper determination of the amount of counsel fees to be awarded requires a line by line analysis of the various certifications of services to determine whether hours expended by counsel or excessive for what appeared to be routine efforts. I have carefully reviewed the Attorney Fee Certification submitted by claimant s counsel. I have also carefully considered the arguments advanced by counsel. I am mindful of the fact that any amount awarded as counsel fees must be consonant with the amount at issue. I am also mindful of the fact that the claimant was only partially successful in this action. I find that an award of counsel fees in the amount of $1,200 is consonant with the amount at issue and consistent with the requisites of R.P.C. 1.5 as well as with the degree of effort, expertise and experience required for a successful prosecution of this claim. I also award costs in an amount of $225.00, representing the filing fee. I deny the photocopying costs of $132.00 and the postage costs of $11.75. Therefore, the DRP ORDERS: NJ0903001250685 Page 10 of 11
1. Medical Expense Benefits: Awarded: Disposition of Claims Submitted Medical Provider Amount Claimed Amount Awarded Payable To North Jersey Rehabilitation Center $26,180.34 $3,898.95 North Jersey Rehabilitation Center 2. Income Continuation Benefits: Not in issue 3. Essential Services Benefits: Not in issue 4. Death or Funeral Expense Benefits: Not in issue 5. Interest: I find that the Claimant did prevail. Interest is awarded pursuant to N.J.S.A. 39:6A-5h.: Interest shall be calculated by respondent Attorney s Fees and Costs I find that the Claimant did not prevail and I award no costs and fees. I find that the Claimant prevailed and I award the following costs and fees (payable to Claimant s attorney unless otherwise indicated) pursuant to N.J.S.A. 39:6A-5.2g: Costs: $ 225.00 Attorney s Fees: $ 1,200 THIS AWARD is rendered in full satisfaction of all claims and issues presented in the arbitration proceeding. Entered in the State of New Jersey Date: 11/09/11 NJ0903001250685 Page 11 of 11