Court Opinion

ID: 9956492
Source: CourtListenerOpinion
Date Created: 2024-04-02 14:09:22.215556+00
Date Added: 2024-06-11T08:17:33.951638
License: Public Domain

NOT FOR PUBLICATION WITHOUT THE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-0759-22

FRANCESCO MONGELLI,

          Plaintiff-Appellant,

v.

ROCCO V. MAZZA,
ANTOINETTE MAZZA,
EMANUEL SOTO, SOLANGE
PENA, BELLA N. DOMINGUEZ,
CHARMAINE BURTON, and
YAHAIRA GUTIERREZ,1

     Defendants-Respondents.
_____________________________

                   Argued March 6, 2024 – Decided April 2, 2024

                   Before Judges Susswein and Vanek.

                   On appeal from the Superior Court of New Jersey, Law
                   Division, Middlesex County, Docket No. L-0146-18.

                   Michele Labrada argued the cause for appellant (Law
                   Offices of Karim Arzadi, attorneys; Michele Labrada,
                   on the briefs).

1
     Yahaira Gutierrez was improperly pled as Yahaira Guiterrez.
            Scott Barry Lipowitz argued the cause for respondent
            Yahaira Gutierrez (Goetz Schenker Blee &
            Wiederhorn, attorneys; Scott Barry Lipowitz, of
            counsel and on the brief).

            Mario C. Colitti argued the cause for respondents
            Rocco V. Mazza and Antoinette Mazza (Law Office of
            Frank A. Viscomi, attorneys; Nicole Lynn
            Hollingsworth, of counsel and on the brief).

            Stephen A. Rudolph argued the cause for respondents
            Solange Pena and Bella N. Dominguez (Rudolph Kayal
            & Almeida Counselors at Law, PA, attorneys; Stephen
            A. Rudolph, on the brief).

            Nathan C. Orr argued the cause for respondent
            Charmaine Burton (Dyer & Peterson, PC, attorneys;
            Nathan C. Orr, on the brief).

PER CURIAM

      This appeal follows a six-day civil trial after which the jury reached a

verdict finding defendants Rocco V. Mazza and Solange Pena liable for damages

and determining plaintiff Francesco Mongelli did not prove by a preponderance

of the evidence he sustained a permanent injury as a result of any of the three

automobile accidents that were litigated. Plaintiff appeals from the October 7,

2022 final judgment in favor of defendants Mazza, Antionette Mazza,2 Emanuel

2
  Because defendants Rocco V. Mazza and Antoinette Mazza, share a surname,
we refer to Antoinette Mazza by her first name for ease of reference. We intend
no disrespect in doing so.
                                                                         A-0759-22
                                      2
Soto, Pena, and Bella N. Dominguez, arguing the trial court erred in: requiring

plaintiff to establish causation; barring the testimony of Dr. Wael Elkholy and

Dr. Konstantine Fotiou on the issue of causation through apportionment of his

injuries to the three accidents at issue; barring evidence of plaintiff's medical

bills from being presented to the jury; and granting summary judgment in favor

of defendants Charmaine Burton and Yahaira Gutierrez. Because we discern no

abuse of discretion in the trial court's evidential rulings on causation proofs, we

affirm the October 7, 2022 final judgment based on the jury verdict. Our

affirmance of the final judgment moots plaintiff's appeal of the two February

14, 2020 orders granting summary judgment to defendants Burton and Gutierrez.

                                         I.

      Plaintiff was involved in three motor vehicle accidents that occurred as

follows: March 8, 2017 (the first accident), October 14, 2017 (the second

accident), and April 27, 2018 (the third accident). We derive the following

material facts relevant to disposition of this appeal from the trial record.

                    A. The First Accident – March 8, 2017

      At the time of the first accident, plaintiff, who was twenty-two years old,

was driving in a work-issued van to a warehouse during the course of his

employment. While plaintiff was driving in the right-most lane, his vehicle was

                                                                               A-0759-22
                                         3
struck by a car owned by Antionette and driven by Mazza. Plaintiff asserts the

collision occurred because Mazza was attempting to make a left turn but failed

to obey a stop sign and struck plaintiff's vehicle, which was continuing straight.

      After the impact, plaintiff immediately "felt lots of throbbing pain and

tingl[i]ness" radiating throughout his back, neck, shoulders, arms, fingers, legs,

ankles, and feet. Plaintiff called emergency services, the police arrived on the

scene, and an ambulance transported plaintiff to the hospital. In the emergency

room, doctors took several x-rays and told plaintiff he had a fractured rib.

Plaintiff was prescribed pain relief medication and released the same day.

      Plaintiff began a course of chiropractic treatment with Dr. Fotiou

beginning in September of 2017. Dr. Fotiou told plaintiff he was showing

"positive signs of severe spasm" following the first accident.

                 B. The Second Accident – October 14, 2017

      The second accident occurred when plaintiff's vehicle was stationary at a

stop sign. As plaintiff signaled to make a right turn, Soto began making a left

turn onto the street where plaintiff was stopped. Plaintiff asserts the collision

occurred because Soto was not in the lane designated for left-hand turns and

instead crossed into the lane in which his car was stopped. Police were called

                                                                             A-0759-22
                                        4
to the scene, but there was no ambulance summoned and plaintiff was not taken

to the hospital.

      The day prior to the second accident, plaintiff saw Dr. Fotiou. However,

because of the timing of the second accident, plaintiff had to wait several days

until he received further treatment. By the time of his appointment, plaintiff

was having "shooting" pain in his arms, hands, fingers, legs, feet, and back. Dr.

Fotiou told plaintiff the range of motion in his cervical and lumbar areas was

significantly reduced following the second accident.

      Plaintiff underwent an MRI of the cervical and lumbar spine and

commenced electrical stimulation therapy. Dr. Fotiou told plaintiff his MRI

results were consistent with the pain he was experiencing.

      In March of 2018, plaintiff began treatment with Dr. Elkholy, who was

board-certified in pain management. Dr. Elkholy reviewed some of plaintiff's

previous MRI studies and medical reports before determining plaintiff had

herniations and bulging in several places throughout his lumbar and cervical

spine. Plaintiff underwent a discectomy in the lumbar spine.

                   C. The Third Accident – April 27, 2018

      Approximately three weeks after plaintiff's discectomy, plaintiff was a

passenger in a car owned by Dominguez and driven by Pena. When the vehicle

                                                                           A-0759-22
                                       5
was approximately halfway through an intersection, it was struck by two cars,

one driven by Burton, and the other by Gutierrez.

      Plaintiff testified the severity of the third accident was such that he

thought he was going to die. An ambulance arrived on the scene and transported

plaintiff to the hospital. At the hospital, plaintiff was "on [his] knees" in pain,

unable to lay down or turn over, and "crying with [his] father." Plaintiff was

discharged from the hospital the same day.

      Plaintiff felt his neck "snap" during the collision and he was not able to

turn his head for the next several weeks. Due to the extreme pain, he began

taking pain relief medication with greater frequency.         Plaintiff continued

receiving treatment from Dr. Fotiou until September 2018, when the doctor told

plaintiff he had received the maximum benefit chiropractic care could provide

and discharged him. Plaintiff continued to receive treatment from Dr. Elkholy.

                              D. Pre-Trial Motions

      On January 8, 2018, plaintiff filed a two-count complaint in the Law

Division seeking damages from the first two accidents. On June 6, 2018,

plaintiff amended his complaint to add a count seeking damages resulting from

the third accident.

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                                        6
      The discovery period concluded on January 29, 2020. On February 14,

2020, the trial court granted both Gutierrez and Burton's motion and cross-

motion for partial summary judgment on liability, and dismissed plaintiff's

claims against them with prejudice.

      On February 24, 2022, over two years after the close of discovery, plaintiff

served the remaining defendants with a January 2, 2018 Raritan Bay Medical

Imaging report as to a lumbar spine MRI. On March 16, 2022, plaintiff served

defendants with a February 10, 2020 report from the Precision Pain & Spine

Institute.

      Pena and Dominguez jointly filed a motion to bar plaintiff from using any

medical records served after the January 29, 2020 discovery end date at the trial.

Plaintiff opposed the motion and cross-moved to extend discovery.

      On April 21, 2022, the trial court denied plaintiff's motions for

reconsideration of the orders granting summary judgment to Burton and

Gutierrez and denied plaintiff's cross-motion seeking a discovery extension.

The trial court partially granted the motion to bar late discovery as to the

February 10, 2020 Precision Pain & Spine Institute report served on March 16,

2022, after the discovery end date.         Plaintiff's subsequent motion for

reconsideration was denied.

                                                                            A-0759-22
                                        7
                                      E. Trial

      The jury trial commenced on September 19, 2022.3 Defense counsel

moved in limine to exclude any medical bills that were not submitted for

payment to the worker's compensation carrier for plaintiff's employer, through

plaintiff's personal injury protection (PIP) coverage, or provided to defendants

during discovery. When neither plaintiff's counsel nor defense counsel could

identify what medical bills they had served or received, respectively, during the

discovery period, the trial court instructed counsel for defendants to "come up

with a draft order . . . as to what bills" they each received during discovery so

the trial court could address admissibility.

      Counsel for Mazza certified that plaintiff had not served any bills that

were not already paid by plaintiff's worker's compensation carrier; counsel for

Soto certified plaintiff served eight bills totaling $130,598.31; counsel for Pena

certified plaintiff served one bill but it had been paid by plaintiff's PIP carrier.

3
  The parties all stipulated to the dismissal of Dominguez from the matter.
Therefore, trial proceeded only as to plaintiff's claims against Soto, Pena and
both Mazza defendants.

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                                         8
      Plaintiff's counsel could not identify which bills were served on all

defense counsel during discovery. Among other dialogue between the trial court

and counsel, the court said to plaintiff's counsel:

            [I]f you have an objection [to the entry of orders
            submitted by defense counsel], I need to hear that on
            the record. Okay? So I don't believe that you're in a
            position now where you can provide an objection, so
            I'm going to grant those orders, subject to – I guess it
            would be an in limine motion to reconsider.

      Plaintiff's counsel replied: "Sure." The trial court granted the motions in

limine on this issue and ruled only the medical bills that had been provided to

all defendants during discovery could be utilized at trial. However, the trial

court stated if plaintiff could show the outstanding bills had been timely served

on all defense counsel, it would reconsider the decision.

      The trial court held a hearing pursuant to N.J.R.E. 1044 to determine if Dr.

Elkholy's opinion as to the apportionment of plaintiff's damages to each of the

three accidents was admissible. Dr. Elkholy testified he was plaintiff's treating

pain management doctor since March 5, 2018, following the first and second

4
  A hearing pursuant to N.J.R.E. 104 (Rule 104 hearing) allows the court to
determine the admissibility of evidence. See Kemp v. State, 174 N.J. 412, 427
(2002).
                                                                            A-0759-22
                                         9
accidents. During the hearing, Dr. Elkholy testified he had "been practicing for

[twenty-seven] years" and explained:

            I always believe that the first accident, it is very, very
            important because I consider it as a first insult.

            Our body is a very complex system of computers.
            When you get injured in the beginning, subsequently,
            it's very easy to get injured after this. So I always – the
            first accident, it is very important to me to put it around
            50 [%], especially if the patient has no pain, no problem
            prior to this. . . .

            ....

            Now, the second accident came. All right. So I always
            believe the first accident – I always give it 50[%], or a
            little bit even more. But I understand if somebody
            argues with me it's not 50[%], it's 55, it's 60. It's okay,
            because it is very – it's like the pain scale, [zero to ten].
            I think it's the most ridiculous thing, but we have to
            work with it.

            ....

            He had surgery after the second accident, and he had
            70[%] pain relief. And he was going for recovery, and
            then got hit with the third accident. I cannot take from
            the first accident because the first accident is the . . .
            initial problem which happened and insult for his body.
            I have to take from the second accident. Yes, I can
            lower the first accident to 60, I can lower it a little bit
            to 50, but I cannot lower it below 50[%].

            ....

                                                                            A-0759-22
                                        10
            So the third accident, I think, I blame it for the stopped
            recover[y] and going beyond what he had, beyond
            including the pain he has.

            So I put 50[%] for the first because I think it is very,
            very important and it's the initial insult, and then the
            third accident caused a lot of problem, so I divided
            10[%] and 40[%]. I understand if somebody argues
            with me okay, the second accident, we can do [20% and
            30%], it is – I'm not going to disagree with it because
            again, that is the most difficult thing I always do when
            I have a patient who has multiple accidents. If it's one
            accident, it's easier, but he had three accidents. But I
            believe the first accident, 50[%] because it is initial
            insult and then after that, divided between second and
            third accident.

      Dr. Elkholy did not testify to any particularized training or experience

allocating causation to injuries sustained in multiple accidents involving a single

individual. He also testified there is no consensus in the medical community as

to this apportionment.

      At the conclusion of the Rule 104 hearing, the trial court ruled plaintiff

did not establish Dr. Elkholy had the expertise to opine as to apportionment and

did not establish the methodology relied upon "regarding the percentage

allocation related–or the–the percentage causal relationship to each accident and

the injuries suffered by [plaintiff]." The trial court also found that Dr. Elkholy's

testimony regarding causation as to damages from the first accident was barred

because he did not review any records regarding the injuries plaintiff sustained.

                                                                              A-0759-22
                                        11
        During the trial, the jury heard testimony from plaintiff, Dr. Elkholy and

Dr. Fotiou, as well as Mazza, Soto, and several other expert witnesses.5 Plaintiff

proffered Dr. Fotiou, plaintiff's treating chiropractor from September 2017 to

September 2018, as a fact witness. Plaintiff did not attempt to qualify Dr. Fotiou

as an expert, and told the trial court outside the presence of the jury that plaintiff

"would like to bring in Dr. Fotiou just to testify that he did treat [plaintiff] . . .

obviously, he has not rendered a report according to the case law, but he won't

testify as to causation or anything else, just that he did treat [plaintiff]."

        Dr. Fotiou testified that plaintiff "presented maybe with – with 30 to

40[%] reduced ranges of motions in the neck and back," which was "something

that you . . . wouldn't expect on a [twenty-two-year-old man]." He continued to

explain plaintiff "was positive on the right side [for] severe muscle spasms"

which was "consistent with tearing the muscles and ligaments" along plaintiff's

spine. Dr. Fotiou detailed the electrical stimulation therapy plaintiff received.

        Dr. Fotiou testified he had seen plaintiff the day before the second

accident. Plaintiff's counsel asked Dr. Fotiou if plaintiff had shown signs of

improvement prior to the second accident. Dr. Fotiou replied:

              Yes. So now if we do a comparison from his – his
              reexamination that occurred [after the second accident],

5
    The other expert witnesses's opinions are not relevant to the issues on appeal.
                                                                                 A-0759-22
                                         12
            his ranges of motion significantly reduced in the
            cervical and lumbar spine. . . . [S]o he still had the
            symptoms of neck and back from the first accident.
            And now it's exacerbated from the second one.

            So, the second accident, my differential diagnosis is an
            exacerbation where . . . aggravated an injury, plus the
            injury mostly got worse.

      The trial court sustained the objection to Dr. Fotiou's testimony on

exacerbation and aggravation relating to causation of the injuries and ruled:

            Counsel, this is specifically what he was not going to
            testify to because he’s not an expert. He–he's a fact
            witness. . . . You're going into actual testimony of
            causation. So I'm going to ask them to disregard his
            testimony.

When the sidebar ended, the court addressed the jury:

            Okay. I'm going to sustain the objection. Members of
            the jury, you may have heard this witness testify about
            an aggravation or an exacerbation . . . of an injury. This
            – you've heard from witnesses. There are two general
            categories of witnesses, fact witnesses and expert
            witnesses. You've heard from expert witnesses, you've
            heard from fact witnesses. The doctor is here today as
            a fact witness. . . . [H]e's not qualified as an expert and
            can testify as to facts, for instance, the treatment of the
            patient. . . . [T]he jury will disregard any testimony he
            may have given as to causation or as to exacerbation or
            aggravation of injuries. . . . [H]e's been proffered to
            provide testimony as to the . . . course of treatment that
            "he provided to . . . plaintiff. Okay."

            Is that satisfactory to . . . the parties?

                                                                           A-0759-22
                                         13
      In response to the trial court's question, plaintiff's counsel did not object

and continued questioning Dr. Fotiou as to plaintiff's treatment following the

second accident. Dr. Fotiou said plaintiff "presented in the office with severe

neck and back pain, pain radiating into both shoulders, both legs which are

similar to the findings from his first accident." Additionally, Dr. Fotiou said

plaintiff "presented worse than his examination that happened" before the

second accident.

      Reviewing his notes in response to a question about the third accident, Dr.

Fotiou testified that "also in his history, [plaintiff] had a discectomy in his lower

back from the prior accident."      Defense counsel objected.       The trial court

sustained the objection and instructed the jury as follows:

             Ladies and gentlemen of the jury, the witness has
             testified that there was surgery that was performed.
             The witness can certainly testify about the surgery, it
             occurred, but the jury will disregard any testimony as
             to why that surgery was performed which is sometimes
             called a causation. Okay.

             Counsel, is that satisfactory to all parties?

      Plaintiff's counsel again did not object and continued questioning Dr.

Fotiou as to plaintiff's treatment following the third accident.         Dr. Fotiou

testified plaintiff's "ranges of motion . . . decreased over 60[%] in the cervical

lumbar spine" after the third accident. He provided plaintiff with a neck brace.

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                                        14
      Prior to resting, plaintiff's counsel requested permission to recall Dr.

Elkholy solely to testify as to medical bills.       The trial court denied the

application since plaintiff's counsel still had not provided defendants and the

trial court with a proffer as to what bills had been served during the discovery

period.

      After plaintiff rested, counsel for Mazza moved for a directed verdict,

based in part on the lack of evidence of permanency and causation. Counsel's

argument proceeded as follows:

            THE COURT:          Okay. So let's address the other
            issues. . . .

            [MAZZA'S COUNSEL]: Causation and permanency.

            [PLAINTIFF'S COUNSEL]: Your Honor, we know
            that [Dr. Fotiou] that just got off the stand . . . because
            he didn't provide his report, he couldn't testify as to
            causation and permanency, we know that. . . . [Dr.]
            Elkholy, through his own mouth, testified that he didn't
            see the records for the first accident . . . . And we were
            prohibited from having him indicate there was
            causation and permanency.

            THE COURT: Well, [what I'd] like to hear, though, is
            not what you couldn't present or what you'd like to have
            presented, but what you did present. At this stage
            there's a motion and I'd like you to address the facts that
            were presented.

            [PLAINTIFF'S COUNSEL]: Dr. Elkholy did testify
            that he . . . was not involved at the time of the first

                                                                          A-0759-22
                                       15
             accident. . . . He took into consideration, not the records
             because he didn't see them, but . . . the patient and what
             he told him as to his prior treatment. And, honestly,
             [j]udge, that's all we were able to obtain . . . .

       The court considered counsels' arguments before denying the motion,

explaining it was required to view the facts in the light most favorable to

plaintiff.

             [T]here was an accident. I . . . don't know that there is
             enough on the record [to establish liability], but it's not
             for me to decide. I will take the evidence in the light
             most favorable to the plaintiff. And the plaintiff has
             testified that he was not at fault and that this other
             vehicle struck his vehicle. And given the standards that
             apply in this case, I think by the thinnest of margins,
             I'm going to deny that motion.

             As to the issue of causation and the issue of . . .
             permanency . . . the same standards would apply and
             the same principles would apply. I think this is a razor-
             thin margin by which there has been testimony
             provided by Dr. Elkholy and . . . Dr. Fotiou, indicating
             that there was an accident [and] that he treated [plaintiff
             when he] came in was following that first accident. I
             think that there's enough of an inference from that at
             this stage to permit this to go forward to the jury.

             Counsel, I'll be candid with you both as to causation
             and as to the permanency[,] I don't know that there's
             much beyond just the razor-thin inference at this stage
             [but] I'm going to deny the motion . . . .

       The parties do not dispute that Dr. Fotiou did not issue a narrative report

pursuant to Rules 4:17-4(a), (e) and 4:10-2(d)(1), his records do not contain any

                                                                            A-0759-22
                                        16
opinion on causation, exacerbation or aggravation of prior injuries or

permanency,6 and no testimony regarding apportionment of plaintiff's injuries

to the three accidents was proffered to the jury.

        On September 27, 2022, the jury reached a verdict finding Mazza was

liable for the first accident, Soto was not liable for the second accident, and Pena

was liable for the third accident. The jury found plaintiff had not proven by a

preponderance of the evidence that he sustained a permanent injury resulting

from any of the three accidents and, therefore, did not award plaintiff any non-

economic damages pursuant to the verbal threshold set forth at N.J.S.A.

39:6A-8(a). Plaintiff did not offer any evidence of economic damages at trial.

As a result, on October 7, 2022, the trial court entered final judgment in favor

of defendants based on the jury verdict.

        On October 17, 2022, plaintiff filed a motion for a new trial arguing there

was confusion among the parties as to the issue of the admissibility of medical

bills resulting in the jury's verdict being against the weight of the evidence.

6
    Dr. Fotiou's records are not contained in the appendices.
                                                                              A-0759-22
                                        17
Plaintiff withdrew the motion during oral argument on November 10, 2022. This

appeal follows.

                                             II.

      On appeal, plaintiff argues the trial court abused its discretion by

preventing evidence of outstanding medical bills from being presented to the

jury and by barring the testimony of Drs. Elkholy and Fotiou as to the issues of

causation including exacerbation, aggravation and apportionment of injuries to

each of the three accidents. Plaintiff also posits the trial court erred by granting

summary judgment to Gutierrez and Burton because there were outstanding

issues of material fact.

      Rulings as to the admissibility of evidence or testimony are governed by

an abuse of discretion standard. Rowe v. Bell & Gossett Co., 239 N.J. 531, 551

(2019). This standard also extends to "[t]he admission or exclusion of expert

testimony" which is entrusted to "the sound discretion of the trial court."

Townsend v. Pierre, 221 N.J. 36, 52 (2015); see In re Accutane Litig., 234 N.J.

340, 391 (2018) (noting we "must apply an abuse of discretion standard to a trial

court's determination, after a full Rule 104 hearing, to exclude expert testimony

on unreliability grounds"). Therefore, we "review a trial court's evidentiary

ruling only for a 'clear error in judgment.'" State v. Medina, 242 N.J. 397, 412

                                                                              A-0759-22
                                        18
(2020) (quoting State v. Scott, 229 N.J. 469, 479 (2017)). The de novo standard

of review only governs where the trial court applies the incorrect legal standard.

Hassan v. Williams, 467 N.J. Super. 190, 214 (App. Div. 2021). See Pomerantz

Paper Corp. v. New Cmty. Corp., 207 N.J. 344, 371 (2011).

                                              III.

      The remedy plaintiff seeks on appeal is to vacate the final judgment and

grant a new trial. Plaintiff requested the same relief from the trial court but

withdrew the request on the record at oral argument. We need not determine if

plaintiff's prior withdrawal of the request for the same relief is fatal to his appeal.

Instead, the issue is moot because we are unconvinced by plaintiff's substantive

arguments and affirm the October 7, 2022 final judgment.

      It is undisputed that for plaintiff to recover non-economic damages, such

as compensation for pain and suffering, he was required to establish he sustained

a permanent injury by a preponderance of the credible evidence pursuant to the

statutory verbal threshold set forth at N.J.S.A.39:6A-8(a), as interpreted in our

well-settled decisional law. The verbal threshold restricts an individual injured

in an automobile accident from recovering non-economic damages unless they

suffer bodily injury that results in death; dismemberment; significant

disfigurement or significant scarring; displaced fractures; loss of a fetus; or a

                                                                                A-0759-22
                                         19
permanent injury within a reasonable degree of medical probability, other than

scarring or disfigurement. N.J.S.A. 39:6A-8(a).

      Plaintiff asserts the jury verdict against Mazza and Pena on liability for

the first and third accidents, respectively, coupled with the jury finding the

injuries stemming from those accidents were not permanent shows that the jury

was confused as a direct result of the trial court's incorrect evidence rulings.

Plaintiff proffers two central arguments: the trial court improperly placed the

burden on him to establish apportionment of damages to each accident; and the

trial court improperly barred testimony that would have assisted the jury in

making its determination as to apportionment of damages to each accident.

      Plaintiff's argument that he improperly bore the burden of establishing

apportionment of damages was not raised before the trial court. We consider

issues raised for the first time on appeal only if plain error is established. R.

2:10-2.

      The plain error standard under Rule 2:10-2 requires the appellate court to

"determine whether any error . . . was 'of such a nature as to have been clearly

capable of producing an unjust result.'" Toto v. Ensuar, 196 N.J. 134, 144 (2008)

(quoting Mogull v. CB Com. Real Est. Grp., Inc., 162 N.J. 449, 464 (2000)); see

also T.L. v. Goldberg, 238 N.J. 218, 232 (2019) ("To warrant reversal and

                                                                           A-0759-22
                                      20
entitlement to a new trial, the plain error must have been clearly capable of

producing an unjust result.").    "If not, the error is deemed harmless and

disregarded." Toto, 196 N.J. at 144. "Relief under the plain error rule, R[ule]

2:10-2, at least in civil cases, is discretionary and 'should be sparingly

employed.'" Baker v. Nat'l State Bank, 161 N.J. 220, 226 (1999) (quoting Ford

v. Reichert, 23 N.J. 429, 435 (1957)).

      The trial court did not err in requiring plaintiff to establish causation

through apportionment of injuries to each of the three accidents based upon our

well-settled decisional law. "It is generally plaintiff's burden to prove not only

that defendant was negligent, but also that defendant's negligence was a

proximate cause of the injuries and damages suffered."         O'Brien (Newark)

Cogeneration, Inc. v. Automatic Sprinkler Corp. of Am., 361 N.J. Super. 264,

274 (App. Div. 2003) (citing Paxton v. Misiuk, 34 N.J. 453, 463 (1961)). As a

corollary, plaintiff must establish apportionment of damages proximately caused

by defendant's wrongful acts as follows:

            Thus, plaintiff, generally, must apportion or relate
            damages to defendant's wrongful acts. If proofs
            establish that plaintiff's injuries, for example, pre-
            existed and were unconnected with defendant's
            negligence, then defendant is not responsible for the
            pre-existing injuries.       A defendant should be
            responsible only for the value of the interest he [or she]
            destroyed.

                                                                            A-0759-22
                                         21
            . . . [T]he party in the best position to present evidence
            of non-aggravation or exacerbation is plaintiff.
            Plaintiffs should understand and appreciate whether
            and how a defendant's tort may have affected their prior
            or post injuries or conditions. The effect on plaintiff of
            defendant's tort is uniquely within plaintiff's
            knowledge.        Thus, in a routine personal injury
            aggravation claim, we do not shift the burden to
            defendants and to prevail, plaintiffs must separate
            those damages caused by a particular defendant's
            negligence from any prior or post injuries or
            conditions. . . .

            It is important to realize that when the burden is on
            plaintiff to apportion damages between particular
            defendants and prior or subsequent injuries or
            conditions, the result of failure to carry the burden may
            be dismissal of plaintiff's case.

            [Id. at 274-75 (first alteration in original) (citations and
            quotations omitted).]

      It is undisputed that in this case plaintiff claims aggravation and

exacerbation of injuries sustained in each of the accidents. Under New Jersey

law, "[n]ormally, the burden of proof for apportionment is on the plaintiff

because, '[i]n the normal prior or post-personal injury aggravation claim, the

party in the best position to present evidence of non-aggravation or exacerbation

is plaintiff.'" Boryszewski v. Burke, 380 N.J. Super. 361, 376 (App. Div. 2005)

(alteration in original) (quoting Reichert v. Vegholm, 366 N.J. Super. 209, 214

(App. Div. 2004)).

                                                                           A-0759-22
                                        22
      Although plaintiff argues generally he should not bear the burden of

establishing the apportionment of injuries to each accident in this case, he

presents no decisional law to support this argument. Plaintiff's reliance on

Campione v. Soden, 150 N.J. 163, 184 (1997), is misplaced. In Campione, the

Court set forth that "where there are collisions in rapid succession and no proofs

permitting allocation of damages among the tortfeasors, both tortfeasors are to

be held jointly and severally liable." Ibid. The plaintiff in Campione was first

struck by another vehicle while driving and then was crushed between two

vehicles immediately after exiting his car to inspect the damage. Id. at 168.

Although plaintiff here was in multiple accidents, the accidents took place

several months apart and he had the opportunity to be seen by medical

professionals to document his injuries between each accident, since he sought

differing medical treatment for the accidents. Accordingly, we find the Court's

ruling in Campione inapplicable to this appeal.

      Plaintiff does not dispute the trial court applied language closely tracking

the Model Jury Charge to instruct the jury as to plaintiff's burden of establishing

causation. "It is difficult to find that a charge that follows the Model Charge so

closely constitutes plain error." Mogull, 162 N.J. at 466. We find no plain error

                                                                             A-0759-22
                                       23
in the trial court's decision to require plaintiff bear the burden of establishing

causation through apportionment of damages.

      Next, we consider plaintiff's argument the trial court improperly barred

expert testimony that would have assisted the jury in apportioning damages to

each accident. Following a Rule 104 hearing, the trial court found Dr. Elkholy's

testimony on injury apportionment to each accident was "essentially, a net

opinion." We agree.

      When determining the apportionment of injuries, qualified "expert

testimony is needed [because] the factfinder would not be expected to have

sufficient knowledge or experience and would have to speculate without the aid

of expert testimony." 160 W. Broadway Assocs., LP v. 1 Mem'l Drive, LLC,

466 N.J. Super. 600, 615 (App. Div. 2021) (quoting Torres v. Schripps, Inc., 342

N.J. Super. 419, 430 (App. Div. 2001)).          Not only must the expert be

appropriately qualified to render the opinion but the prohibition on net opinions

"forbids the admission into evidence of an expert's conclusions that are not

supported by factual evidence or other data." Townsend, 221 N.J. at 53-54

(2015) (internal citations omitted). This principle requires "experts . . . be able

to identify the factual bases for their conclusions, explain their methodology,

                                                                             A-0759-22
                                       24
and demonstrate that both the factual bases and the methodology are

scientifically reliable." Landrigan v. Celotex Corp., 127 N.J. 404, 417 (1992).

      We discern no abuse of discretion in the trial court's ruling that Dr.

Elkholy was not qualified by training or experience to testify as to the

apportionment of damages to each accident. There was no testimony at the Rule

104 hearing establishing any specific basis for a conclusion the doctor was

qualified to render an apportionment opinion.

      The trial court properly barred Dr. Elkholy's testimony on apportionment

of plaintiff's injuries to each accident since it was not grounded in the facts of

this case and was admittedly not supported by any methodology. At the Rule

104 hearing, Dr. Elkholy testified he allocates 50% of the overall damage he

sees in patients with successive injuries to the first incident because " it is very

important to [him]" and he "always believe[s] that the first accident, it is very,

very important because [he] considers it as a first insult." The record supports

the trial court's ruling that Dr. Elkholy could not testify to an apportionment of

injuries to the first accident based on his own admission he reviewed no medical

documents regarding plaintiff's injuries or medical condition prior to the second

accident.

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                                        25
      Dr. Elkholy's testimony as to the apportionment of damages to each

accident was also equivocal and, therefore, speculative. "Damage awards may

not be based on mere speculation." Kelly v. Berlin, 300 N.J. Super. 256, 268

(App. Div. 1997). Dr. Elkholy's testimony was speculative and non-definitive,

first apportioning 60% to the first accident, then 50%, and ranging between a

10% - 40% split for the latter two accidents, a 20% - 30% split and then later

suggesting a general division between the second two accidents.

      We give deference to decisions made by the trial court as to the

admissibility of expert testimony after a Rule 104 hearing. In re Accutane Litig.,

234 N.J. at 392. After reviewing the transcript of the Rule 104 hearing and the

subsequent evidential rulings, we conclude the trial court's decision to bar Dr.

Elkholy's testimony as to apportionment of damages was not an abuse of

discretion.

      Not only did Dr. Elkholy's testimony fail to establish apportionment of

damages to each accident but the scope of Dr. Elkholy's proffered testimony also

fails to establish the comparative analysis required in cases where, as here,

exacerbation or aggravation based upon prior or subsequent injuries is alleged.

When a claim is predicated on aggravation of pre-existing injuries, "a plaintiff

will have to produce comparative-analysis evidence to establish a prima facie

                                                                            A-0759-22
                                       26
[case]." Davidson v. Slater, 189 N.J. 166, 186 (2007). "Such evidence provides

essential support for the pled theory of a plaintiff's cause of action and a

plaintiff's failure to produce such evidence can result in a directed verdict for

defendant." Ibid.

      We concluded that the required comparative analysis must be proffered

by plaintiff through expert testimony in Polk v. Daconceicao, 268 N.J. Super.

568, 575 (App. Div. 1993). In Polk, we determined that a physician must base

their testimony as to a "diagnosis of aggravation of a pre-existing injury or

condition . . . upon a comparative analysis of the plaintiff's residuals prior to the

accident with the injuries suffered in the automobile accident at issue." Ibid.

We determined the foundation for such a diagnosis "must encompass an

evaluation of the medical records of the patient prior to the trauma with the

objective medical evidence existent post trauma." Ibid.

      In Davidson, 189 N.J. at 185-86, the Court subsequently confirmed that a

comparative analysis is required in cases where the plaintiff pleads aggravation

and exacerbation of injuries in multiple accidents, setting forth as follows:

             When aggravation of a pre-existing injury is pled by a
             plaintiff, comparative medical evidence is necessary as
             part of a plaintiff's prima facie and concomitant verbal
             threshold demonstration in order to isolate the
             physician's diagnosis of the injury or injuries that are
             allegedly "permanent" as a result of the subject

                                                                               A-0759-22
                                        27
             accident. Causation is germane to the plaintiff's theory
             of aggravation of a pre-existing injury or new
             independent injury to an already injured body part. In
             such matters, a plaintiff generally bears the burden of
             production in respect of demonstrating that the accident
             was the proximate cause of the injury aggravation or
             new permanent injury to the previously injured body
             part. . . . Such evidence provides essential support for
             the pled theory of a plaintiff's cause of action and a
             plaintiff's failure to produce such evidence can result in
             a directed verdict for defendant.

             [Ibid. (internal citations omitted).]

      Plaintiff has proffered no evidence Dr. Elkholy based his opinion as to the

aggravation of plaintiff's injuries on a review of plaintiff's medical records either

before or after the first accident.       Without the proper foundation for a

comparative analysis, any expert testimony as to "the conclusion that

[plaintiff's] condition has been aggravated must be deemed insufficient to

overcome the [verbal] threshold" consistent with Polk, 268 N.J. Super. at 575.

      Plaintiff also argues Dr. Fotiou's testimony as to the causation,

aggravation and exacerbation of plaintiff's injuries should not have been barred.

However, plaintiff offered his treating chiropractor as a fact witness rather than

an expert and his counsel specified on the record that Dr. Fotiou would not opine

as to causation. Dr. Fotiou was permitted to testify about the symptoms plaintiff

had and the treatment he received, without objection. When Dr. Fotiou began

                                                                              A-0759-22
                                        28
to opine on the aggravation of plaintiff's injuries, opposing counsel objected.

After sustaining the objection, the trial court gave the jury a curative instruction

to "disregard any testimony [Dr. Fotiou] may have given as to causation or as to

exacerbation or aggravation of injuries" because as a fact witness Dr. Fotiou's

testimony was "as to facts" including "the course of treatment . . . he provided

to . . . plaintiff."

       The trial court then asked if that jury instruction was "satisfactory to . . .

the parties?" Plaintiff's counsel did not object or otherwise ask to expand the

scope of Dr. Fotiou's testimony. Since there was no objection to the trial court,

the instruction is reviewed under the plain error standard. R. 2:10-2.

       As to causation, plaintiff must be able to overcome the "important

limitation," Delvecchio v. Twp. of Bridgewater, 224 N.J. 559, 579 (2016), that

circumscribes the testimony of a treating physician, not qualified as an expert,

only to "the determination of the cause of" plaintiff's injuries as "an essential

part of diagnosis and treatment," as set forth under Stigliano by Stigliano v.

Connaught Laboratories, Inc., 140 N.J. 305, 314 (1995). The parties do not

dispute that Dr. Fotiou's notes did not include any causation opinion, including

an opinion on exacerbation or aggravation of injuries in the prior accidents. Nor

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                                        29
did Dr. Fotiou issue a report pursuant to Rules 4:17-4(a), (e) and 4:10-2(d)(1).7

Accordingly, plaintiff did not "disclose the substance of [Dr. Fotiou's]

anticipated testimony, and the basis for that testimony" in treating notes

produced during discovery, as required. Delvecchio, 224 N.J. at 579. Therefore,

the trial court properly determined that Dr. Fotiou could not testify as to

causation, exacerbation and aggravation "extending beyond the plaintiff's own

diagnosis and treatment." Ibid.

      Moreover, plaintiff's counsel represented on the record that Dr. Fotiou

would not testify as to causation before the witness testimony proceeded. Based

on our review of the trial transcript and prevailing law, we conclude plaintiff

has not demonstrated the trial court's decision to bar treating physician Dr.

Fotiou from testifying as to causation, including apportionment of injuries to

each of the three accidents, was plain error.

      Finally, we briefly address plaintiff's suggestion that the trial court made

incongruous rulings in placing the burden on plaintiff to prove apportionment

of damages while barring Dr. Elkholy and Dr. Fotiou from testifying on

7
   "A treating physician's report serves an important function; it provides the
adversary with notice of the facts and opinions to which the physician will
testify, and permits that party to assess the need for additional discovery and for
medical testimony at trial." Delvecchio, 224 N.J. at 582-83.
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                                       30
causation. Although the complaint could have been dismissed on defendants'

motion for involuntary dismissal at the conclusion of plaintiff's case based upon

the lack of required expert proofs on causation, we see no inconsistency between

the trial court's evidential decisions and the jury verdict. Plaintiff simply did

not proffer a qualified expert witness to opine as to causation through the

apportionment of injuries to each accident. Thus, the jury considered the issue

without that evidence.

      We also see no inconsistency in the jury determination of liability as to

Mazza and Pena followed by the finding that plaintiff did not sustain a

permanent injury causally related to the accidents involving those defendants.

The jury found liability but, as to damages, found no permanent injury

proximately caused by the first and third accidents.

                                        IV.

      "An issue is 'moot when our decision sought in a matter, when rendered,

can have no practical effect on the existing controversy.'" Redd v. Bowman,

223 N.J. 87, 104 (2015) (quoting Deutsche Bank Nat'l Tr. Co. v. Mitchell, 422

N.J. Super. 214, 221-22 (App. Div. 2011)). Based on our determination that

plaintiff failed to establish causation through apportionment of damages,

plaintiff's appeal of the trial court's ruling barring plaintiff from introducing the

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                                        31
unpaid medical bills as economic damages is moot. Plaintiff cannot recover any

damages,   whether    economic    or   non-economic,   if   causation   through

apportionment was not established. Davidson, 189 N.J. at 185.

      Plaintiff's appeal of the two February 14, 2020 summary judgment orders

dismissing the entirety of plaintiff's claims against Gutierrez and Burton with

prejudice is also moot based on our affirmance of the October 7, 2022 final

judgment. Plaintiff only alleges Gutierrez and Burton are liable for payment of

damages as to the third accident. The jury found plaintiff failed to show a

permanent injury resulting from the third accident as required to recover non-

economic damages under the verbal threshold. Plaintiff did not offer any expert

proofs of apportionment of damages. Therefore, plaintiff could not recover a

judgment against Gutierrez and Burton based upon the trial proofs, even if they

had not been dismissed from the case prior to trial on summary judgment.

      To the extent we have not addressed any of defendant's remaining

arguments, we conclude they lack sufficient merit to warrant discussion in a

written opinion. R. 2:11-3(e)(1)(E).

      Affirmed.

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