KATHLEEN TRELA and CHRISTOPHER TRELA VS. DARREN ROSE (L-0324-16, MIDDLESEX COUNTY AND STATEWIDE) ( 2021 )


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  •                                 NOT FOR PUBLICATION WITHOUT THE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-4426-18
    KATHLEEN TRELA and
    CHRISTOPHER TRELA,
    Plaintiffs-Appellants,
    v.
    DARREN ROSE, MEINEKE
    CAR CARE CENTER,
    Defendants-Respondents,
    and
    THE ESTATE OF KRISTI
    SEEGER,
    Defendant.
    __________________________
    Argued September 23, 2020 – Decided August 13, 2021
    Before Judges Fuentes, Whipple and Rose.
    On appeal from the Superior Court of New Jersey, Law
    Division, Middlesex County, Docket No. L-0324-16.
    Michael Confusione argued the cause for appellant
    (Hegge & Confusione, LLC and The Maglione Firm
    PC, attorneys; Michael Confusione and Dean R.
    Maglione, on the brief).
    Richard J. Mirra argued the cause for respondents
    (Hoagland, Longo, Moran, Dunst & Doukas, LLP,
    attorneys; Richard J. Mirra, of counsel and on the
    brief).
    PER CURIAM
    On July 16, 2014, plaintiff Kathleen Trela was involved in a motor vehicle
    accident when defendant Darren Rose rear-ended her car as she turned left to
    enter her driveway. At the time of the accident, Rose was employed by Meineke
    Car Care Center (Meineke) and was test driving a 2006 Mazda 5 owned by Kristi
    Seeger. Plaintiff's automobile policy contained a "verbal threshold" provision
    under N.J.S.A. 39:6A-8(a), that limits her right to recover monetary damages
    only if she suffers permanent injuries.    Defendants conceded liability,1 but
    denied the accident was a proximate cause of plaintiff's alleged permanent
    injuries.
    On January 7, 2015, plaintiff filed a civil action against defendants Rose,
    Meineke, and Seeger alleging common law negligence, and negligent
    supervision by Meineke based on Rose's status as its employee.
    1
    Rose admitted he was speeding at the time of the accident and pled guilty in
    the Woodbridge Park Municipal Court to careless driving. N.J.S.A. 39:4-97.
    A-4426-18
    2
    Plaintiff amended her complaint thereafter multiple times. The third and
    final amended complaint, filed on November 29, 2016, added a per quod claim
    by plaintiff's husband Christopher Trela.2 Kristi Seeger died sometime after
    plaintiff filed her third amended complaint. On January 7, 2019, plaintiff
    executed a stipulation of dismissal with prejudice as to all claims against t he
    Estate of Seeger.
    After nearly three years of discovery, the case came to trial before a jury
    on May 14, 2019, limited to the issue of damages. Rose conceded he negligently
    drove the Mazda 5 that rear-ended plaintiff's car; Meineke conceded it was
    vicariously liable for Rose's negligence based on the doctrine of respondeat
    superior.3   The jury returned a verdict in favor of defendants in which it found:
    (1) plaintiff did not prove, by a preponderance of the objective credible medical
    evidence, that she sustained a permanent injury proximately caused by the July
    2
    Because Christopher Trela's per quod claim for damages is derived from his
    status as Kathleen Trela's spouse, we will refer to claims sought by both of them
    using "plaintiff" in the singular.
    3
    "For liability to attach to an employer under the doctrine of respondeat
    superior, the plaintiff must prove the existence of an employer-employee
    relationship and that the employee's tortious actions 'occurred within the scope
    of that employment.'" G.A.-H. v. K.G.G., 
    238 N.J. 401
    , 415 (2019) (quoting
    Carter v. Reynolds, 
    175 N.J. 402
    , 409 (2003)).
    A-4426-18
    3
    16, 2014, accident; and (2) plaintiff was not entitled to any monetary damages
    "for past and future lost wages and benefits."
    In this appeal, plaintiff argues the trial judge erred when he denied her
    motion for a directed verdict pursuant to Rule 4:40-1. Alternatively, plaintiff
    argues the judge should have granted her request to permit the jury to consider
    her scars as evidence to satisfy the "permanent injury" requirement in N.J.S.A.
    39:6A-8(a). Finally, plaintiff claims she was denied a fair trial when the judge
    misapplied N.J.R.E. 703 to limit the testimony of her orthopedic surgeon.
    Defendants argue the trial judge managed the proceedings in accordance with
    the relevant statutory standard and urge us not to disturb the jury's verdict
    finding plaintiff is not entitled to any monetary damages.
    After reviewing the record developed at trial, we discern no legal basis to
    disturb the jury's verdict. We will summarize the evidence the parties presented
    to the jury before we address plaintiff's arguments.
    I.
    The accident occurred on July 16, 2014. Defendant Rose was driving a
    2006 Mazda 5 owned by the late Kristi Seeger in his capacity as an employee of
    Meineke. Rose was driving the Mazda behind plaintiff's car when she turned
    into her driveway. Rose was unable to stop and negligently rear-ended plaintiff's
    A-4426-18
    4
    car.    These facts are undisputed.      Woodbridge Park Police Officer Diorca
    Hernandez responded to the scene of the accident and wrote a police report to
    memorialize what occurred. In his trial testimony on May 14, 2019, Officer
    Hernandez relied on the police report to refresh his recollection 4 about what he
    observed nearly five years earlier.
    I observed vehicle one had damages to the left corner
    of the rear bumper. Driver two had damages to the right
    corner of the front bumper. The damages found in both
    vehicles are consistent with each other. As a result of
    this collision, driver one had complain[ed] of shoulder
    and arm pain.
    Officer Hernandez noted that plaintiff was driving a black Ford. Rose told
    Officer Hernandez "that he was speeding on Highland Road when suddenly
    [plaintiff's car] made a left into her driveway, subsequently resulting in the
    collision[.]"     Rose was not injured.       Following police protocol, Officer
    Hernandez summoned an ambulance to the scene. Plaintiff testified that the
    medical staff who responded to the scene of the accident checked her vital signs
    and blood pressure and told her she was fine. Her husband drove her to the JFK
    Medical Center later that day because her "whole left arm went numb and it was
    4
    See N.J.R.E. 612.
    A-4426-18
    5
    hanging." Plaintiff did not reveal what treatment, if any, she received at the JFK
    Medical Center.
    Plaintiff's first consultation with orthopedic surgeon Dr. Steven Nehmer
    occurred on July 23, 2014, one week after the accident. However, as the
    following exchange shows, plaintiff was unable to remember the date of her first
    consultation with Dr. Nehmer, or any other medically-related events that follow
    without referring to "a list of medical treatment schedules" she compiled in
    anticipation of her testimony at trial.
    Q. What date did you go to Dr. Nehmer's?
    A. I can't tell you the exact date.
    Q. Is there anything I could give you to refresh your
    recollection as to the date you first went and saw Dr.
    Nehmer?
    A. Yes.
    Q. What is it that I could give you to help you
    remember?
    A. The list of medical treatment schedules.
    Q. What is this list of medical treatment schedules that
    you're talking about?
    A. Something I went through with every medical record
    that I had -- that we had and accumulated from the
    treatment.
    A-4426-18
    6
    Q. Okay. And why did you make this list?
    A. It showed every course of action that I went through.
    Q. Okay. And why did you want the course of action on
    a list?
    A. So that I couldn't have any discrepancies.
    Q. Okay. Fair enough. And how long did it take you
    to make this list?
    A. Like two or three days.
    This prompted an immediate objection from defense counsel and a
    subsequent lengthy sidebar discussion about hearsay evidence and treatments
    provided by physicians for medical problems unrelated to this accident. Equally
    disconcerting from the perspective of this appellate court, there are significant
    inaudible gaps in the transcription of these discussions which make the sidebar
    colloquy between the attorneys and the trial judge difficult, if not impossible to
    follow:
    PLAINTIFF'S COUNSEL: All right. Are you
    suggesting that the list is incorrect? You want to sit a
    half hour and cross-reference it (inaudible) –
    DEFENSE COUNSEL: (Inaudible)
    PLAINTIFF'S COUNSEL: If there's any discrepancy,
    I'll be more than happy to amend them.
    DEFENSE COUNSEL: I believe (inaudible)
    A-4426-18
    7
    (Inaudible discussion continues)
    THE COURT: We had a conversation in chambers
    about (inaudible). (Inaudible).
    PLAINTIFF'S COUNSEL: Judge, I guess the argument
    is (inaudible). She's going to say who she treated with,
    the time period she treated with them, and what they
    treated her for. That's very simple. (Inaudible
    discussion continues).
    DEFENSE COUNSEL: So the identification of these
    providers is not something that's (inaudible). But I just
    know what the record says.
    (Inaudible discussion continues)
    [(Emphasis added).]
    The irony in this statement is the only thing that is clear from the record.
    Based on this incomprehensible discussion, plaintiff's counsel provided his
    client with the following instructions:
    You are only permitted -- I'm not going to ask any
    questions, when you get to Dr. Ryan, what he treated
    you for. We're not going to talk about any treatment,
    what they did for you, anything like that. We're just
    going to give the jurors the dates, other than two
    doctors we're going to talk about. So will you just –
    A. And I can't say what kind of doctors they are?
    Q. No.
    A. Okay.
    A-4426-18
    8
    ....
    PLAINTIFF'S COUNSEL: That's my -- that's my
    understanding of the ruling, Judge. She will not even
    say what type of doctor they are? Or will she able to
    say it's an orthopedic doctor, it's a –
    THE COURT: The witness will be permitted to identify
    who she saw and the dates and that's it.
    PLAINTIFF'S COUNSEL: Not the type of doctor.
    THE COURT: Other than Dr. Nehmer and Dr. Hunt.
    PLAINTIFF'S COUNSEL: Okay. Perfect. Thank you,
    Judge. Thank you for the clarification.
    Dr. Nehmer testified that the first time he saw plaintiff was on July 23,
    2014. He described her as a forty-three-year-old woman who complained "of
    pains [in] her neck, left shoulder and low back . . . the neck pains traveled to her
    left arm with numbness and tingling." She claimed that she never experienced
    any problems with her neck, back or left arm before the automobile accident.
    Dr. Nehmer testified that his "impression was that she had multiple sprains" and
    was going to try "to get the x-rays reports from JFK Medical Center rather than
    repeating them." Until then, he advised her to begin physical therapy.
    Plaintiff had a second consultation with Dr. Nehmer a few weeks later
    complaining of pain in her shoulder. He told her to continue the physical therapy
    A-4426-18
    9
    and suggested that she have a magnetic resonance imaging (MRI) scan. Plaintiff
    returned on September 12, 2014, complaining of multiple areas of discomfort,
    but her main problem was still her left shoulder. Dr. Nehmer told her to consult
    a pain management physician if her pain continued.
    Dr. Nehmer testified that the first time he raised the option of a surgical
    approach with plaintiff was on February 5, 2015, because "[a]t that point, it was
    more than six months that she'd been having a problem." He told her that the
    therapy did not appear to be alleviating her pain and discussed a potential
    surgery on her left shoulder. On March 3, 2015, Dr. Nehmer "brought her to the
    operating room . . . at the Center for Ambulatory Surgery" and diagnosed
    plaintiff's left shoulder "with something called impingement syndrome."
    What that means is the shoulder -- the top of the arm
    bone, it's like a ball, and there's a bone above it called
    the end of your collarbone and your acromion. Now,
    when you lift your arm up, there has to be enough space
    for it to come up. In between those two bones is your
    rotator cuff tendon and also a bursa on top of it. And if
    those swell up, if they get injured, when you lift, there's
    not enough room. And that's what we call nowadays
    impingement syndrome.
    So that's what she had. And I did surgery for it. What
    I did was I removed the bursa that, you know, lead.
    That gives some space. The top bone, that acromion, I
    removed the front half of it in order to give more space
    for everything. The part of the end of her clavicle was
    removed as well.
    A-4426-18
    10
    The next day, I removed her bandages, and a couple
    weeks later, her stitches that she had from the surgery.
    And I recommended that she have physical therapy.
    On April 1, 2015, nearly a year after the accident, but less than a month
    after the shoulder surgery, plaintiff returned to Dr. Nehmer complaining of pain
    in her left elbow. He diagnosed plaintiff as suffering from lateral epicondylitis,
    also known as "tennis elbow." This is associated with a process that occurs over
    time due to repeated movement or overuse. Dr. Nehmer again opted for a
    surgical approach. He performed surgery on plaintiff's left elbow on February
    2, 2016.
    According Dr. Nehmer, two months of physical therapy is consistent with
    the type of surgery performed. Plaintiff had physical therapy from February 18,
    2016 through April 2016, and was discharged from Dr. Nehmer's care that same
    month. Plaintiff continued to have physical therapy for the left elbow at Edison
    Metuchen Orthopedics from May 2, 2016, to September 2, 2016. Dr. Nehmer
    testified that continued treatment for the elbow after September 2016 was not
    indicated.
    The elbow surgery performed by Dr. Nehmer required stitches to close the
    surgical incision. Plaintiff's friend Maria Tejas identified two photographs of
    plaintiff's elbow taken shortly after the surgery was performed on February 2,
    A-4426-18
    11
    2016, which depict the surgical stitches. The photographs were admitted into
    evidence without objection. On cross-examination, Tejas testified that the scars
    depicted in the photographs are still there, but "[t]hey're not as noticeable. You
    can't see the stitches."
    On June 1, 2017, Dr. Nehmer issued an expert report with the following
    "final diagnoses": (1) cervical strain with a bulging C5-C6 disc; (2) left shoulder
    posttraumatic impingement syndrome; (3) left cubital tunnel syndrome; (4) left
    elbow lateral epicondylitis (tennis elbow); (5) left hand carpal tunnel syndrome;
    (6) lumbar strain; (7) right hip derangement; (8) right sacroiliitis; (9) right
    piriformis syndrome. He confirmed these diagnoses on cross-examination by
    defense counsel. In an addendum filed on June 7, 2017, Dr. Nehmer noted that
    plaintiff received a cortisone injection to remediate her right hip trochanteri c
    bursitis.   The diagnoses in Dr. Nehmer's June 1, 2017, report remained
    unchanged.
    In a September 27, 2018, report Dr. Nehmer noted that plaintiff
    complained of pain and numbness in her hand. He recommended surgery to
    plaintiff's left wrist for carpal tunnel syndrome. On cross-examination, he
    conceded that carpal tunnel is a degenerative injury that can develop over the
    A-4426-18
    12
    course of time. Plaintiff declined Dr. Nehmer's recommendation to alleviate the
    symptoms of carpal tunnel through surgery.
    Dr. Stephen Hunt is also an orthopedic surgeon and testified as an expert
    witness for plaintiff in the field of orthopedic injuries. 5 He first saw plaintiff on
    November 3, 2017, nearly three and a half years after the accident. Dr. Hunt
    administered a hip injection in December 2017 and performed arthroscopic
    surgery on to plaintiff's right hip on September 6, 2018. Dr. Hunt opined the
    hip surgery was "causally related to the crash." When asked to state his opinion
    on plaintiff's prognosis regarding her hip, within reasonable degree of medical
    certainty, he responded:
    So currently she's still doing very well but she is still
    early in her recovery phase. We see people plateau
    about a year out from this surgical procedure. The
    general outcome study suggests that, you know, most
    people maintain a pretty high quality of lifestyle for a
    period of time; meaning around seven to ten years, but
    there is risk of deterioration in the form of arthritis or
    pain generation, stiffness, and things like that that can
    percept in some patient modulations.
    5
    Dr. Hunt's testimony was presented to the jury in a de bene esse deposition
    which was taken by the parties for potential use at trial. This form of testimony
    is not part of the trial itself until it is used. Mellwig v. Kebalo, 
    264 N.J. Super. 168
    , 171 (App. Div. 1993); see also R. 4:14-9.
    A-4426-18
    13
    Dr. Hunt last saw plaintiff in March of 2019.        He testified that she
    "expressed satisfaction with the procedure and that she seemed to have
    significant improvement from it." She "no longer had that significant pain and
    . . . was building up strength." Dr. Hunt acknowledged that there was a risk of
    deterioration in the form of arthritis and stiffness which increased the risk of
    future surgical intervention.     However, Dr. Hunt made clear on cross
    examination that, in his opinion, plaintiff made a full recovery from the hip
    condition.
    Counsel asked Dr. Hunt whether plaintiff had "sacroiliitis," which he
    defined as "an inflammation of the sacroiliac joint[,] which is where the lower
    spine meets the posterior pelvis joints." Dr. Hunt opined that it was possible
    she had "some degree of sacroiliitis . . . but . . . it may be secondary to these
    issues or it may be independent." However, although plaintiff had not recently
    complained of symptoms relating to sacroiliitis, he could not rule it out. Based
    on his notes, "it did appear that she was having major symptoms of that nature."
    In his September 25, 2018, report, Dr. Hunt only expressed his opinions
    related to the condition of plaintiff's hip, and not her shoulder, elbow, or any
    other body part. On April 10, 2019, Dr. Hunt opined that plaintiff would "be
    able to resume an active lifestyle and pain-free daily life." This prognosis
    A-4426-18
    14
    pertained only to plaintiff's hip condition. It did not include any prediction of
    her ability to function with her shoulder and elbow injuries.
    Against the backdrop of this medical testimony, plaintiff's attorney asked
    plaintiff "what parts of your body are different now than it was before that
    crash?" She explained that since the accident, she has reduced strength and
    mobility in her right leg and shoulder. She estimated that she has seventy
    percent mobility in her left shoulder and no sensation in her left forearm. She
    is still recovering from her hip surgery; this affected her entire right leg. She
    testified that her current physical condition causes her to struggle with everyday
    tasks, such as carrying a laundry basket in her home.
    Plaintiff testified she is unable to perform her normal routines and hobbies
    due to the injuries she suffered since the accident. She is unable to walk her
    dogs early in the morning nor cook breakfast for her children before they go to
    school. Her social life has been significantly diminished and she no longer hosts
    parties. Plaintiff's daughter testified that before the accident
    my mom every day before I would wake up for school
    . . . would make me breakfast with potatoes, eggs,
    waffles, bacon, basically anything I wanted every day
    and I would smell it. I would wake up to it and she
    would always just do that for me every day.
    Q. What time would your mother have this breakfast
    prepared for you?
    A-4426-18
    15
    A. Like 7:00 in the morning.
    Q. All right. Since the crash?
    A. Now I don't get breakfast. I have to wake her up. I
    have to use my alarm clock to get both of us up for
    school[.]
    A friend of the family testified that before the accident plaintiff had an
    active social life in her home. "We've become like family, including with my
    children and my wife. We were there often, parties, pool parties, Super Bowls."
    Since the accident, "we're really not there anymore. I don't recall the last time
    my family's been there. It's been years."
    Plaintiff also presented the testimony psychiatrist Dr. Grigory S. Rasin,
    whom she first met three years after her motor vehicle accident. According to
    Dr. Rasin, plaintiff developed an anxiety disorder and depression related to the
    injuries she suffered in the motor vehicle accident. Her depression "affected her
    daily life [and] . . . her relationship with her husband. . . ." In response to defense
    counsel's questions, Dr. Rasin confirmed that plaintiff's counsel referred
    plaintiff to him for evaluation and that he placed her on a course of treatment
    that involved "psychotherapy and medication management." Dr. Rasin also
    acknowledged that part of his practice as a psychiatrist involves forensic work
    referred to him by personal injury attorneys. Dr. Rasin did not review plaintiff's
    A-4426-18
    16
    medical records; he based his assessment of plaintiff's psychiatric issues only
    on what she told him about the accident.
    At this point, defense counsel read before the jury the first page of Dr.
    Rasin's June 15, 2017, report:
    On July 16, 2014, Ms. Trela was a restrained driver of
    a car which struck in the rear when she was driving at
    speed of between four and five miles per hour. As a
    result of an impact, Ms. Trela struck her left shoulder
    against steering wheel. She had a bruise across her
    chest. She also injured her hip. Ms. Trela said, quote,
    "My arm became paralyzed. The ambulance arrived
    and they thought that I had a stroke."
    She was brought to JFK University Hospital by her
    husband within an hour of her accident.
    ....
    Q. And that's the history of what she told you when you
    first met with her?
    A. That's correct, sir.
    Q. Okay.       Now, the jury has heard from the
    investigating police officer who responded to the scene.
    Did she tell you that she refused medical attention at
    the scene of the accident?
    A. She didn't -- I cannot recall what she told me at that
    time. But it's obvious that her husband took her to a
    hospital within an hour.
    Q. Okay. I appreciate that response. But my question
    was, when you took this history from her, did she tell
    A-4426-18
    17
    you that she refused medical attention at the scene of
    the accident?
    A. I don't remember. No.
    Q. Do you have that noted in this initial report?
    A. No. It's not in my report. No.
    Q. Okay. And, in fact, she told you that my -- quote,
    "My arm became paralyzed at the scene of the
    accident"? That's what she told you?
    A. Yes. That's correct.
    Q. And she told you that she thought she had a stroke?
    That's what she told you?
    A. No. That the people from EMS felt . . . that she
    might have a stroke.
    Q. Okay. So the ambulance squad thought she had a
    stroke, but she refused medical attention?
    A. That's correct.
    [(Emphasis added).]
    II.
    Against these facts, plaintiff argues the trial judge erred in denying her
    motion for a directed verdict and submitting to the jury the question of whether
    she suffered a permanent injury within the meaning of N.J.S.A. 39:6A-8(a). We
    disagree. The standard for determining whether to grant a directed verdict at the
    A-4426-18
    18
    conclusion of the parties' presentation is codified in Rule 4:40-1, which
    provides:
    A motion for judgment, stating specifically the grounds
    therefor, may be made by a party either at the close of
    all the evidence or at the close of the evidence offered
    by an opponent. If the motion is made prior to the close
    of all the evidence and is denied, the moving party may
    then offer evidence without having reserved the right to
    do so. A motion for judgment which is denied is not a
    waiver of trial by jury even if all parties to the action
    have so moved.
    We review a motion for a directed verdict by applying the same standard
    that governs the trial courts. Smith v. Millville Rescue Squad, 
    225 N.J. 373
    ,
    397 (2016). A motion for a directed verdict shall be granted "only if, accepting
    as true all evidence supporting the party opposing the motion and according that
    party the benefit of all favorable inferences, reasonable minds could not differ."
    Edwards v. Walsh, 
    397 N.J. Super. 567
    , 571 (App. Div. 2007) (citing Dolson v.
    Anastasia, 
    55 N.J. 2
    , 5 (1969)). Conversely, a motion for a directed verdict
    "shall be denied if the evidence, together with the legitimate inferences
    therefrom, could sustain a judgment in the non-movant's favor." Sackman v.
    New Jersey Mfrs. Ins. Co., 
    445 N.J. Super. 278
    , 291 (App. Div. 2016) (quoting
    Edwards, 
    397 N.J. Super. at 571
    ).
    A-4426-18
    19
    Applying this standard of review to the trial record we have described here
    at great length, we are satisfied there was no factual or legal basis to grant
    plaintiff a directed verdict as a matter of law. Furthermore, the record shows
    plaintiff's counsel did not move for a directed verdict at the end of the case. The
    record only shows that on the final day of trial, plaintiff's counsel requested the
    jury be charged on category three of the verbal threshold, which refers to
    "scarring or disfigurement." N.J.S.A. 39:6A-8(a). This prompted an immediate
    objection from defense counsel, who noted that "the jury was never shown her
    scars, never."
    Citing Soto v. Scaringelli, 
    189 N.J. 558
     (2007), defense counsel argued
    that this instruction to the jury was inappropriate and unsupported by the
    evidence. The trial judge accepted defense counsel's argument and rejected
    defense counsel's application to instruct the jury on this aspect of the verbal
    threshold statute. We agree.
    The Supreme Court explained in DiProspero v. Penn the public policy
    underpinning the verbal threshold restrictions:
    The 1998 Automobile Insurance Cost Reduction Act
    (AICRA), N.J.S.A. 39:6A-1.1 to -35, provides
    automobile insurance policyholders with a choice:
    lower premium payments in exchange for limiting their
    right (and the right of those covered by the policy) to
    sue for noneconomic damages if injured in an accident.
    A-4426-18
    20
    That option, known as the "limitation on lawsuit"
    threshold, restricts an accident victim covered by the
    policy from suing a defendant for noneconomic
    damages unless she suffers "a bodily injury which
    results in death; dismemberment; significant
    disfigurement or significant scarring; displaced
    fractures; loss of a fetus; or a permanent injury within
    a reasonable degree of medical probability, other than
    scarring or disfigurement." N.J.S.A. 39:6A-8(a).
    [
    183 N.J. 477
    , 480-81 (2005).]
    In Soto v. Scaringelli, the Supreme Court specifically addressed the issue
    of scarring or disfigurement as a basis to overcome the verbal threshold
    restrictions in N.J.S.A. 39:6A-8(a):
    In respect of the "significant disfigurement or
    significant scarring" statutory threshold applicable to a
    plaintiff's appearance, we hold that the threshold is
    satisfied only if an objectively reasonable person would
    regard the scar or disfigurement as substantially
    detracting from the automobile accident victim's
    appearance, or so impairing or injuring the beauty,
    symmetry, or appearance of a person as to render him
    or her unsightly, misshapen, or imperfect. Applying
    that standard, we also hold that the trial court properly
    concluded that injuries claimed did not satisfy the
    "significant disfigurement or significant scarring"
    statutory threshold. Finally, we hold that, in the future
    and as a condition precedent to meaningful appellate
    review, a plaintiff who seeks to resist a defense based
    on that threshold bears the burden of establishing a
    proper record. That record must include the trial court's
    direct observations and description of the disfigurement
    or scarring alleged to be significant, together with an
    accurate photographic record thereof.
    A-4426-18
    21
    [
    189 N.J. at 564
     (emphasis added).]
    Here, the only evidence plaintiff presented at trial to overcome this aspect
    of the verbal threshold limitations was the testimony of her friend Maria Tejas,
    who briefly commented on plaintiff's elbow surgery. Tejas also identified two
    photographs of plaintiff's elbow taken shortly after the surgery on February 2,
    2016. These photographs depict the surgical stitches as they appear days after
    the surgery. However, when Tejas testified on May 14, 2019, she made clear
    that the stitches were then hardly noticeable. Under these circumstances, the
    photographs are not competent evidence under the standard established by the
    Court in Soto. In fact, the photographs are misleading and should have been
    excluded under N.J.R.E. 403 because their prejudicial effect far outweighed
    their probative value, if any.
    Forty-four years ago, Chief Justice Hughes articulated the high level of
    respect a court must show when reviewing a jury's verdict:
    The judgment of the initial factfinder then, whether it
    be a jury, as here, or a judge as in a non-jury case is
    entitled to very considerable respect. It should not be
    overthrown except upon the basis of a carefully
    reasoned and factually supported (and articulated)
    determination, after canvassing the record and
    weighing the evidence, that the continued viability of
    the judgment would constitute a manifest denial of
    justice.
    A-4426-18
    22
    [Baxter v. Fairmont Food Co., 
    74 N.J. 588
    , 597-98
    (1977) (internal citations omitted).]
    Mindful of these guiding principles, we discern no factual or legal basis
    to disturb the jury's verdict. Plaintiff's remaining arguments lack sufficient merit
    to warrant discussion in a written opinion. R. 2:11-3(e)(1)(E).
    Affirmed.
    A-4426-18
    23