Citizens United Reciprocal Exchange v. Neurological Surgery Spine Specialists

New Jersey Superior Court Appellate Division·Decided December 22, 2025·No. A-3972-23·Unpublished

Opinion

NOT FOR PUBLICATION WITHOUT THE APPROVAL OF THE APPELLATE DIVISION This opinion shall not "constitute precedent or be binding upon any court." Although it is posted on the internet, this opinion is binding only on the parties in the case and its use in other cases is limited. R. 1:36-3.

SUPERIOR COURT OF NEW JERSEY APPELLATE DIVISION

DOCKET NO. A-3972-23

CITIZENS UNITED RECIPROCAL EXCHANGE,

Plaintiff-Appellant, v.

NEUROLOGICAL SURGERY SPINE SPECIALISTS a/s/o RASHEEDA ROBINSON,

Defendant-Respondent.

Submitted November 20, 2025 – Decided December 22, 2025 Before Judges Mawla and Marczyk.

On appeal from the Superior Court of New Jersey, Law Division, Mercer County, Docket No. L-1008-22.

Brennan & Sponder, attorneys for appellant (Stewart M. Martinez, of counsel and on the briefs).

Law Offices of Lora B. Glick, LLC, attorney for respondent (Lora B. Glick, of counsel and on the brief).

PER CURIAM

Plaintiff Citizens United Reciprocal Exchange (CURE) appeals from the July 2, 2024 trial court order denying its application to vacate the arbitration award entered in favor of defendant Neurological Surgery Spine Specialists a/s/o Rasheeda Robinson (NSSS) under the Alternative Procedure for Dispute Resolution Act (APDRA), N.J.S.A. 2A:23A-1 to -30. Based on our review of the record and applicable legal principles, we dismiss for lack of jurisdiction.

I.

On August 11, 2016, Robinson was injured in an automobile accident when another vehicle rear-ended the car she was driving, which was owned by a CURE-insured individual, while she was stopped at a red light. Later that day, Robinson sought medical treatment at Jersey City Medical Center, reporting severe neck pain radiating up the left side of her face and lower back pai n. She was given medication for her pain and discharged that same day.

In the months that followed, Robinson underwent various diagnostic procedures and medical treatments for her ongoing neck and back pain. An MRI of her cervical spine from January 2017 showed disc herniations at the C3-C4 and C4-C5 levels, and disc bulges at the C5-C6 and C6-C7 levels. Thereafter, Robinson attended physical therapy for cervical and lumbar myelopathy and radiculopathy between January and February 2017, then again from November

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2017 to April 2018, during which time she "complain[ed] of constant cervical spine pain and stiffness . . . radiating down to [her] left hand." In June 2018, a second MRI of Robinson's cervical spine again showed disc herniations at the C3-C4 and C4-C5 levels, as well as the C5-C6 and C6-C7 levels, with a "small to moderate-sized paracentral disc extrusion" at C4-C5 that "contact[ed] the right ventral aspect of the spinal cord." An electromyography from July 2018 "revealed evidence of chronic ongoing right C5 radiculopathy."

In November 2019, Robinson presented to an urgent care facility with complaints of "neck pain and vomiting," for which she was prescribed a steroid and pain medication. Later that month, she was treated at Newark Beth Israel Hospital for "neck pain radiating to [her] head" and underwent a third MRI of her cervical spine, which an interpreting radiologist found showed disc herniations at the C3-C4, C4-C5, and C6-C7 levels, as well as disc bulges at the C5-C6 and C7-T1 levels.

Notably, on November 26, 2019, Robinson consulted Dr. John R. Cifelli of NSSS for a neurological assessment, who, after examining her and reviewing her medical history, referred her to Dr. Jose Colon at the Newark Rehabilitation Center for a cervical epidural steroid injection. That December, Dr. Colon conducted a physical examination of Robinson and determined "her symptoms

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[we]re consistent with C3-4 and C4-5 [level] disc derangement and radiculopathy." He noted Robinson complained of "neck pain radiating to both upper extremities," rating the pain a "9/10 [o]n a scale of 0-10." On Dr. Colon's advice, Robinson received a cervical epidural steroid injection in January 2020, but she reported no improvement at a follow-up visit in February and, thus, was referred to an orthopedic spine surgeon for an evaluation.

In February 2020, NSSS submitted a precertification request to CURE for Robinson to have an office visit with Dr. Cifelli, to which CURE responded its "[p]recertification decision [wa]s pending the result of an Independent Medical Exam" (IME) evaluating whether Robinson's treatment was a medical necessity. Dr. Michael J. Giordano subsequently conducted the IME; he reviewed, among other records, the three MRI reports of Robinson's cervical spine and performed a physical examination. He diagnosed Robinson with "[a]ctive cervical strain/sprain," "[r]esolved disc herniation," "[a]ctive cervical radiculopathy," and "[c]ervical spine pain secondary to radiculopathy." Dr. Giordano noted there was "no nerve root compression by any cervical disc" and attributed Robinson's radiculopathy symptoms to "a traction injury." He further found a "causal relationship between [Robinson's] injuries and the motor vehicle accident" from August 2016 but opined she had reached "maximum medical

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improvement" (MMI) and asserted no pre-existing medical conditions affected her recovery.

Based on Dr. Giordano's IME, CURE denied NSSS's precertification request for Robinson's appointment with Dr. Cifelli. NSSS appealed the denial through CURE's internal appeals process to no avail. CURE also denied NSSS's precertification request for Dr. Cifelli to perform cervical surgery on Robinson based on the IME findings.

Despite CURE's denials, Dr. Cifelli performed cervical spine surgery on Robinson in June 2020. Postoperatively, Robinson reported her symptoms had either improved or resolved. NSSS billed CURE approximately $296,258.50 for the surgery, but CURE denied payment based on the IME report's determination surgery was not a medical necessity; NSSS appealed. CURE also denied NSSS's precertification request for a second follow-up examination of Robinson in November 2020.

Having exhausted CURE's internal appeals process, NSSS filed a demand for personal injury protection (PIP) arbitration pursuant to N.J.S.A. 39:6A-5.1, seeking reimbursement of $297,928.30 for Robinson's surgery and follow-up appointments. In January 2021, CURE requested a medical review organization (MRO) perform an independent review of Robinson's medical records to assess

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the issues of medical necessity and causation. In March 2021, the MRO issued a report by Dr. Abbott J. Krieger, who, after reviewing Robinson's records, MRIs, and the IME, concluded "the procedure performed by Dr. Cifelli was not medical[ly] necessary or causally related to" the 2016 motor vehicle accident, noting there had been "multiple gaps in treatment" between the accident and when Dr. Cifelli recommended surgery nearly four years later. Dr. Krieger agreed with the IME's conclusion there were multiple disc bulges "but no appreciable neural element compromise," and that Robinson had reached neurosurgical MMI, which he wrote was supported by her 2019 MRI.

In September 2021, the parties appeared before a dispute resolution professional (DRP) for a Forthright 1 arbitration hearing. The DRP heard testimony from Dr. Cifelli, and reviewed Robinson's prior MRI reports, Dr. Krieger's MRO report, Dr. Giordano's IME, and a rebuttal report by Dr. Cifelli dated May 30, 2021. In November 2021, the DRP provided his findings of facts and conclusions of law in a comprehensive, thirteen-page arbitration award,

1 The Commissioner of Banking and Insurance has been authorized by the Legislature to designate an organization to serve as an arbitration forum for PIP disputes. N.J.S.A. 39:6A-5.1(b). Forthright currently serves in that capacity. Allstate N.J. Ins. Co. v. Carteret Comprehensive Med. Care, P.C., 480 N.J. Super. 566, 580 (App. Div. 2025); Kimba Med. Supply v. Allstate Ins. Co. of N.J., 431 N.J. Super. 463, 468 (2013).

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