In another Personal Injury Protection (PIP) case before the National Arbitration Forum, Richard W. Fogarty successfully defended a claim for Allstate New Jersey Insurance Company against two orthopedic surgeons who performed cervical spine surgery, including a spinal fusion, on an Allstate insured following a motor vehicle accident. The surgeons billed $42,000 for the procedure. Mr. Fogarty challenged the medical necessity of the surgery, the reasonableness of the bills and whether the surgery was the result of the claimed accident or a second and subsequent accident.
On the causal relationship issue, Mr. Fogarty argued that doctors failed to demonstrate, as required by Bowe v. NJM, 367 N.J. Super. 128 (App. Div. 2004), that the surgery was related to the present accident, referring to several medical records which recorded that that doctors believed that the surgery was necessitated by the subsequent accident. The arbitrator agreed with Mr. Fogarty and denied the claim in a decision available on the NAF website, www.njadrforum.com, File No. NJ1153391.