Preview
FILED: NEW YORK COUNTY CLERK 01/16/2019 02:39 PM INDEX NO. 650302/2019
NYSCEF DOC. NO. 6 RECEIVED NYSCEF: 01/16/2019
"D"
EXHIBIT
FILED: NEW YORK COUNTY CLERK 01/16/2019 02:39 PM INDEX NO. 650302/2019
NYSCEF DOC. NO. 6 RECEIVED NYSCEF: 01/16/2019
P Bretshe Ciahns Rnamch
1 cagwas ar,as201
Bakunta , Nr117162665
January 29, 2016
fWsphone: (631) 320-2370
Facnhntle:
(691) 389-3128
Joseph Peretz
477 Fdr Dr Apt M106
New York, NY 10002
Policyholder: Peretz, Joseph L
Underwritten by: Progressive Casualty Insurance Company
Claim Number: 164401062
Date of Loss: January 07, 2016
Your Client: Joseph Pentz
We acknowledge your representation of the above named injured party, and receipt of your client'sNollee of
Intent to make an Uninsured or b¾pplementary Uninsursd/Underinsured Motorist Claim.
All future correspondence, including any Denmand for Arbitration, must be directed to the undersigned at
the address noted above.
We are the dan=da pursuant to the terms and provisions under which you are
making following policy seeking
Uninsumd or S:çp!ementary Uninsured/Underinsured Motorist Benefits:
1. You must forward duly and comapletely executed, appropriately directed, original authorizations for
the following: any and all medical/health care providers, including authorizations to obtain copies of any and
alldiagacstic tests,films etc.; and allhospital records; employment records; educational records;
wh+=1
any
sources (hcluding No-Fault) which shallinclude claim and policy numbers, and worker's compensation
carriers (including case file numbers) within thirty (30) days of receipt of thiswritten demand.
2. In the event you initiated a lawsuit as a resultof a prior and/or subsequent aneidenWury, you shall
furnish the authorizations requested herein above, also within thirty (30) days of receipt of thiswritten
deamand, in eddi+ian to an authorization(s) permitting us to obtain a copy of your legal files(s)in connection
with same.
3. In the event that the insured or said insured's legal repr-+•+ive has initiated a lawsuit against any person
or org-i-No legally responsible for the use of a motor vehicle involved in the accident/loss,then you, or
your legalrepresentative, shall immediately forward a copy of the &==:.-.: and Complaing as well as, any
and alllegal documents relating to said accident/loss.
4. Please provide a copy of the Tortfeasar's Declarations Page.
FILED: NEW YORK COUNTY CLERK 01/16/2019 02:39 PM INDEX NO. 650302/2019
NYSCEF DOC. NO. 6 RECEIVED NYSCEF: 01/16/2019
5. Please also provide a copy of the letterconfirming the Tortfeasor has tendered their liabilitylimits.
Please be further advised that pursuant to the policy terms under which you am seeking Uninsured or
Supplemenhary Uninsumd/Underinsured Motorist Benef ts, you areobligated to comply with the following
enditions precedent before proceeding to arbitration,and thatwe, Progressive Casualty hsurance Company,
retain our right to damand compli-.ne in the future with any and allof the following conditions:
specifically
1. Notif y Progressive Casualty hsurance Company of an accident/loss arising out of the ownership,
maintenanna or use of a vehicle for which coverage may be provided under thispolicy within 24 hours, or as
soon as ispracticable, by calling1-800-274.4499.
2. In the event that a hitand run vehicle isinvolved, you should have also notified the police within 24 hours,
or as soon as ispracticable, of the accident/loss.
3. Cooperate with Pmgressive Casualty Insurance Company in any matter concerning a claim or lawsuit.
4. The insured, or other person making a claim, shall pmvide Progressive Casualty Insurance Company with a
written proof of said claim, under oath, ifrequired, as soon as ispracticable after Progressive Casualty
hsurance Company's written request for same. Said written pmof shallinclude, but shallnot be limited to the
following: the detailsof how the •.middJloss occurred, the nature and extent of the alleged injuries,the nature
and extent of any/all treatment received and any and alldetails necessary to our determinadon of the amount of
Uninaund or S·.g: p!cmentary Uninsured/Underinsured Motorist Benef itsto be paid.
5. In the event that you initiatea lawsuit as a resultof a subsequent accident/injury, you shall furnish the
authorizations requested and described in damand #1 herein above immediately upon said lawsuit in
filing
addition to any and all legal documents relating to said lawsuit.
6. Submit to Examination(s) Under Oath (hereinafter referred to as an "EUO") conducted by a
representative of Progressive Casualty Insurance Company, or an attorney on behalf of Progressive Casualty
hsurance Company, as as Progressive Casualty Insurance Company may require/damand- The
frequently
BUO will be conducted in the presence of a Court Reporter. The EUO shall consist of questions including but
not limited to the fallcwing: damagan, alleged injuries, the nature and extent of the traatmant received,
liability,
any prior and/or subsequent accidents/injuries involving the same portion(s) of your body thatyou are elaiming
to have sustained injuty to in connection with the accident/loss of (date).
h the event that the EUO(s) cannot be coarylc‡cd or must be owinnad for any reason, you are obligated to
appear and submit to a further EUO(s).
7. You shall submit to a physical examination(s) conducted by a doctor(s) of 's de=ing.
These physical examination(s) are in no way affiliated with any obligations you may have pursuant to the
No-Fault provisions of your policy which require you to submit to No-Fault Independent Medical
Eravninefinna.
8. Permit Progressive Casualty Insurance Company to inspect, appraise and pictcgraph the d==e.ge to a
covered vehicle or non-owned vehicle prior to itsrepair or disposal.
9. Attend Henrings and Trials as Progressive Casualty Insurance Company may reasonably require.
FILED: NEW YORK COUNTY CLERK 01/16/2019 02:39 PM INDEX NO. 650302/2019
NYSCEF DOC. NO. 6 RECEIVED NYSCEF: 01/16/2019
10. An insured shall not otherwise settlewith any negligent party,without our written consent, such that our
rights would be impaired.
All the oceditions and requi-a are not listedabove. Please refer to our insured's for
policy policy
additional conditions and requitamanfa
In order to comply with the Section 111 ofthe Medicare, Medicaid and SCHIP Extensica Act, we need to
determine ifyour clientis currently receiving, or eligible to receive,Medicare benefits. Your clientmay be
eligible ifhe/she has been receiving SSDI benefits for 24 months or ifhe/ahe has been diagnosed with
End-Stage Renal Failure or ALS.
Should you have any questions, please feel Bee to contact me at631 320 2415. Thank you in advance for your
anticipated cooperation.
Sincerely,
Nanci Schlee, 631-320-2415
Claims Representative
NJS/ns
Preview
FILED: NEW YORK COUNTY CLERK 01/16/2019 02:39 PM INDEX NO. 650302/2019 NYSCEF DOC. NO. 6 RECEIVED NYSCEF: 01/16/2019 "D" EXHIBIT FILED: NEW YORK COUNTY CLERK 01/16/2019 02:39 PM INDEX NO. 650302/2019 NYSCEF DOC. NO. 6 RECEIVED NYSCEF: 01/16/2019 P Bretshe Ciahns Rnamch 1 cagwas ar,as201 Bakunta , Nr117162665 January 29, 2016 fWsphone: (631) 320-2370 Facnhntle: (691) 389-3128 Joseph Peretz 477 Fdr Dr Apt M106 New York, NY 10002 Policyholder: Peretz, Joseph L Underwritten by: Progressive Casualty Insurance Company Claim Number: 164401062 Date of Loss: January 07, 2016 Your Client: Joseph Pentz We acknowledge your representation of the above named injured party, and receipt of your client'sNollee of Intent to make an Uninsured or b¾pplementary Uninsursd/Underinsured Motorist Claim. All future correspondence, including any Denmand for Arbitration, must be directed to the undersigned at the address noted above. We are the dan=da pursuant to the terms and provisions under which you are making following policy seeking Uninsumd or S:çp!ementary Uninsured/Underinsured Motorist Benefits: 1. You must forward duly and comapletely executed, appropriately directed, original authorizations for the following: any and all medical/health care providers, including authorizations to obtain copies of any and alldiagacstic tests,films etc.; and allhospital records; employment records; educational records; wh+=1 any sources (hcluding No-Fault) which shallinclude claim and policy numbers, and worker's compensation carriers (including case file numbers) within thirty (30) days of receipt of thiswritten demand. 2. In the event you initiated a lawsuit as a resultof a prior and/or subsequent aneidenWury, you shall furnish the authorizations requested herein above, also within thirty (30) days of receipt of thiswritten deamand, in eddi+ian to an authorization(s) permitting us to obtain a copy of your legal files(s)in connection with same. 3. In the event that the insured or said insured's legal repr-+•+ive has initiated a lawsuit against any person or org-i-No legally responsible for the use of a motor vehicle involved in the accident/loss,then you, or your legalrepresentative, shall immediately forward a copy of the &==:.-.: and Complaing as well as, any and alllegal documents relating to said accident/loss. 4. Please provide a copy of the Tortfeasar's Declarations Page. FILED: NEW YORK COUNTY CLERK 01/16/2019 02:39 PM INDEX NO. 650302/2019 NYSCEF DOC. NO. 6 RECEIVED NYSCEF: 01/16/2019 5. Please also provide a copy of the letterconfirming the Tortfeasor has tendered their liabilitylimits. Please be further advised that pursuant to the policy terms under which you am seeking Uninsured or Supplemenhary Uninsumd/Underinsured Motorist Benef ts, you areobligated to comply with the following enditions precedent before proceeding to arbitration,and thatwe, Progressive Casualty hsurance Company, retain our right to damand compli-.ne in the future with any and allof the following conditions: specifically 1. Notif y Progressive Casualty hsurance Company of an accident/loss arising out of the ownership, maintenanna or use of a vehicle for which coverage may be provided under thispolicy within 24 hours, or as soon as ispracticable, by calling1-800-274.4499. 2. In the event that a hitand run vehicle isinvolved, you should have also notified the police within 24 hours, or as soon as ispracticable, of the accident/loss. 3. Cooperate with Pmgressive Casualty Insurance Company in any matter concerning a claim or lawsuit. 4. The insured, or other person making a claim, shall pmvide Progressive Casualty Insurance Company with a written proof of said claim, under oath, ifrequired, as soon as ispracticable after Progressive Casualty hsurance Company's written request for same. Said written pmof shallinclude, but shallnot be limited to the following: the detailsof how the •.middJloss occurred, the nature and extent of the alleged injuries,the nature and extent of any/all treatment received and any and alldetails necessary to our determinadon of the amount of Uninaund or S·.g: p!cmentary Uninsured/Underinsured Motorist Benef itsto be paid. 5. In the event that you initiatea lawsuit as a resultof a subsequent accident/injury, you shall furnish the authorizations requested and described in damand #1 herein above immediately upon said lawsuit in filing addition to any and all legal documents relating to said lawsuit. 6. Submit to Examination(s) Under Oath (hereinafter referred to as an "EUO") conducted by a representative of Progressive Casualty Insurance Company, or an attorney on behalf of Progressive Casualty hsurance Company, as as Progressive Casualty Insurance Company may require/damand- The frequently BUO will be conducted in the presence of a Court Reporter. The EUO shall consist of questions including but not limited to the fallcwing: damagan, alleged injuries, the nature and extent of the traatmant received, liability, any prior and/or subsequent accidents/injuries involving the same portion(s) of your body thatyou are elaiming to have sustained injuty to in connection with the accident/loss of (date). h the event that the EUO(s) cannot be coarylc‡cd or must be owinnad for any reason, you are obligated to appear and submit to a further EUO(s). 7. You shall submit to a physical examination(s) conducted by a doctor(s) of 's de=ing. These physical examination(s) are in no way affiliated with any obligations you may have pursuant to the No-Fault provisions of your policy which require you to submit to No-Fault Independent Medical Eravninefinna. 8. Permit Progressive Casualty Insurance Company to inspect, appraise and pictcgraph the d==e.ge to a covered vehicle or non-owned vehicle prior to itsrepair or disposal. 9. Attend Henrings and Trials as Progressive Casualty Insurance Company may reasonably require. FILED: NEW YORK COUNTY CLERK 01/16/2019 02:39 PM INDEX NO. 650302/2019 NYSCEF DOC. NO. 6 RECEIVED NYSCEF: 01/16/2019 10. An insured shall not otherwise settlewith any negligent party,without our written consent, such that our rights would be impaired. All the oceditions and requi-a are not listedabove. Please refer to our insured's for policy policy additional conditions and requitamanfa In order to comply with the Section 111 ofthe Medicare, Medicaid and SCHIP Extensica Act, we need to determine ifyour clientis currently receiving, or eligible to receive,Medicare benefits. Your clientmay be eligible ifhe/she has been receiving SSDI benefits for 24 months or ifhe/ahe has been diagnosed with End-Stage Renal Failure or ALS. Should you have any questions, please feel Bee to contact me at631 320 2415. Thank you in advance for your anticipated cooperation. Sincerely, Nanci Schlee, 631-320-2415 Claims Representative NJS/ns