Exhibit,Appendix: Westmed Medical Group, P.C. v. Imperium Insurance Company

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                                FILED:         NASSAU        COUNTY         CLERK        02/20/2019             02:58       PM                      INDEX    NO.   600075/2019
   NYSCEF     DOC.   NO.   11                                                                                 RECEIVED      NYSCEF:     02/20/2019




                                                                                             "B"
                                                   EXHIBIT
   FILED:         NASSAU        COUNTY         CLERK        02/20/2019             02:58       PM                      INDEX    NO.   600075/2019
   NYSCEF     DOC.   NO.   11                                                                                 RECEIVED      NYSCEF:     02/20/2019




                                     Re:                        WestMed     Medical   Group,   PC  a/a/o  Natalie  Ruiz  v.
                                                                Imperium    Insurance   Company
                                     AAA     Case  No.:         41-17-1067-6574
                                     Dates   of Service:        1/18/11  -  9/3/15
                                     Amount     in Dispute:     $12,976.09
                                     Claim   No.:               1001304
                                     MK    File No.:            3723-0615P




                                                                     AFFIDAVIT


                    STATE     OF  NEW     YORK

                    COUNTY       OF  NEW     YORK

                             I, ROBERT      McCORMICK,         being  duly  sworn,   deposes   and  says  the  following   under  the


                    penalties  of perjury:


                             1.      I am  a  litigation paralegal   with  the law   firm  of McGivney,     Kluger   &  Cook,   P.C.,


                    attorneys  for  Respondents    in the  above-refereñced    arbitration.  I am  not  a party to this arbitration.


                             2.      I  understand     Applicant    WestMed      Medical     Group,    P.C.  has   commenced       an


                    arbitration  wherein   it seeks  to recover   $12,976.09    in no-fault  benefits  for  services  itprovided   to


                    Natalie  Ruiz   from   January   2011   to September     2015.  This   Affidavit   is submitted   in support   of


                    Respondent's     defense  in that arbitration.


                             3.      In  August    and   September     2016,   this office   settled  WestMed     Medical    Group,


                    P.C.'s  claims   for all outstanding   bills for  services  provided   to  Natalie  Ruiz   from  2011   to 2015.


                    As   a litigation  paralegal,   I  was  involved    in  those  settlement    discussions   and   have   personal


                    knowledge    regarding    same.


                             4.      In  August   2016,  my  office  learned  Applicant    was  seeking  to recover   $13,242.54




                    {N0643850-1}
   FILED:         NASSAU        COUNTY         CLERK        02/20/2019             02:58       PM                      INDEX    NO.   600075/2019
   NYSCEF     DOC.   NO.   11                                                                                 RECEIVED      NYSCEF:     02/20/2019




                    for twenty-two     (22) claims   for services   it allegedly  provided   to Natalie  Ruiz   from  January   2011


                    to September     2015.  A  copy   of the  correspondence     that Applicant    mailed  to  Respondent    seeking


                    payment    for these  claims  is attached   to Respondent's     Defense   Submissions     as Exhibit  B.  In that



                    correspondence,     dated  July  28,  2016,  Applicant    admitted   it initiallymailed   the bill to the  wrong


                    provider   and  was  then, years  later, resubmitting    a corrected  bill for consideration.


                             5.       Because    the   bills were    submitted    to  Respondent      late,  our  office   contacted


                    Applicant   regarding   possible   resolution  of this matter  for nuisance    value.


                             6.       On   an   unrecalled    date   in  August    2016,    I spoke    to  a  representative    from


                    Applicant's    billing  department    by  phone.   I can  no  longer  recall  his  or her  name.   Together   we


                    agreed   to settle alloutstanding    billsfrom   2011  through   2015   for $772.35.   In order  for payment   to


                    be  completed,    I requested    Applicant    provide   my   office  with   a  W-9   form   as  is our  standard


                    practice.


                             7.       During   August   2016,   I received  from   Applicant   the W-9   form.   A  copy  of same   is


                    attached   to Respondent's     Defense   Submissions     as Exhibit  C.    The   W-9   form  lists "Westchester


                                       PC"
                    Medical    Group,        as the  name   Applicant   uses  on  itsincome   tax returns.


                             8.       On   September     16,  2016,   I mailed   to  Applicant    correspondence      regarding   the


                    settlement   of all outstanding   no-fault  claims   for services  allegedly   provided   to Natalie  Ruiz  from


                    2011   to 2015.   A  copy  of  that correspondence     is attached   to Respondent's     Defense   Submissions


                    as Exhibit   D.  The   correspondence     states the  enclosed  check   for $772.35    is "for no-fault  benefits


                                                                                2011-2015."
                    of claimant   Natalie  Ruiz   for outstanding   bills from


                             9.       I enclosed    with  that  correspondence      a  check  in  the  amount    of  $772.35   made


                    payable   to  Westchester    Medical    Group,   P.C.  (the name   on  Applicant's    W-9)   and  dated  August



                    31,  2016.   A  copy  of that check   is attached  to Respondent's    Defense    Submissions    as Exhibit  E.




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   FILED:         NASSAU        COUNTY         CLERK        02/20/2019             02:58       PM                      INDEX    NO.   600075/2019
   NYSCEF     DOC.   NO.   11                                                                                 RECEIVED      NYSCEF:     02/20/2019




                             10.      This  office  settled  all Applicant's    claims   for  services  provided    to Natalie   Ruiz


                    from   2011    to 2015   and   Applicant    should   not  be  allowed    to  recover   for  same   again  in  this


                    arbitration.




                                                                                          RO        T  McCORMICK



                    Subscribed    and  Swornto    Before   me
                    This     /T   day  of August,   2017.




                               Notary   Public




                               DENISE FARNUM
                        Nokry        State of New York
                               Public,
                               No. 01FA4699589
                            QuahfiedIn Kings County
                      Commission ExpiresFeb.28, 20Â




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