On March 09, 2022 a
Exhibit,Appendix
was filed
involving a dispute between
Kalween Rodriguez,
and
Metropolitan Realty Management, Inc.,
Metropolitan Realty & Management Ny Inc,
Tov Management Corp.,
Tov Property Management Corp.,
for Torts - Other Negligence (Premises)
in the District Court of Kings County.
Preview
FILED: KINGS COUNTY CLERK 08/10/2022 03:11 PM INDEX NO. 506931/2022
NYSCEF DOC. NO. 19 RECEIVED NYSCEF: 08/10/2022
EXHIBIT J
FILED: KINGS COUNTY CLERK 08/10/2022 03:11 PM INDEX NO. 506931/2022
NYSCEF DOC. NO. 19 RECEIVED NYSCEF: 08/10/2022
26087467
STATE OF NEW YORK
WORKERS'
NEW COMPENSATION BOARD
e rg
YORK . PO BOX 5205
ATE CompeRSatIOR
BNGHAMTON, NY 13902-5205
wwnweb.ny.gov
(877)632-4996
State of New York - Workers' Compensation Board
In regard to Kalween Rodriguez, WCB Case #G310 1442
NOTICE OF DECISION
keepforyouracords
Workers'
At the Coinpensationhearing heldon 02/08/2022 involving the claim
of Kalween Rodriguez at the
Brooklyn hearinglócation,Judge Stephane Martinmade the following findings
decision, and directions:
DECISION: The claimant'saverageweekly wage forthe year workedbeforethiswork relatedinjuryor
occupationaldiseaseis $600.00withoutprejudice. Issues in controversy
have been raised
by the carrier/employer.
Medical treatmentand care, as necessary,
forestablishedsites of
injuryand/orconditions,is authorized.
Treatment
rendered to one of the body
partscovered by theMedical Treatment Guidelinesmust be consistent
with those
Guidelines.
Form(s) C-8.1 which raisedissues relating
to treatment
and/or disputedmedical bills
are resolvedinfavorof the
carrier
without prejudiceto resubmissionifadditionalsites are established.
Ifthe carrier/employer
wishes to producea consultant's
m edicalreport Workers'
(IME) in accordancewith
Compensation Law Section 137 and BoardRule 300.2 on the current
medical of
issue(s) on alladditional
sites for
which PFME has beenfound within60 days, it must
be produced beforeor at the next
hearing.Ifsuch reportis not
produced,a findingmay be made thatthe carrier
has waivedthe opportunityto submita consultant's
medical
report.
Proper employer is CountyAgency Inc.,locatedat 129 South8thStreet,
Brooklyn, NY 11211. Board tochange to
reflect
to properemployer.
PFME(prima facie
medical evidence)forthe followingsites:
head/face per the ERrecordsdated 9/20/19,
post-concussionsyridrome per Dr.Hylton 11/16/21,postconcussion syndrome with post-traumavisionsyndrome
and paresisof accommodation and oculom otordysfunctionper Dr.Reuter 12/1/21,anxietyand traumaticbrain
injuryper Dr.Sadana 11/24/21,neck and left
shoulder per Dr.McGee 8/24/21.
Claimant also raises
teethno PFME.
*** ***
Continued on next page
Claimant - Kalween Rodriguez Employer - Inc
County Agency
SocialSecurityNo. - Carrier- OriskaInsurance Co.
WCB Case No. - G310 1442 CarrierID No. - W166250
Date ofAccident - 09/20/2019 CarrierCase No. -
DistrictOffice- NYC Date of Filing Decision-
of this 02/11/2022
ATENCION:
Puede 11amara la oficina
de la Junta de Compensacion
Obrera, en su area correspondiente,
cuyo numero de telefono
aparece al
principio acerca de su reclamacion(caso).
de la pagina y pida informacion
EC-23 (4/98) Page 1 of2
FILE COPY
FILED: KINGS COUNTY CLERK 08/10/2022 03:11 PM INDEX NO. 506931/2022
NYSCEF DOC. NO. 19 RECEIVED NYSCEF: 08/10/2022
26007467
Carrierraisesall
issues ofcontroversyand requestscross examinationof the doctors.
The requestforcross
examination is held
in abeyancepending production of the ]ME.
. No furtheraction s plannedby the Boardat this
time.
Claimant - Kalween Rodriguez Employer - County Agency Inc
SocialSecurityNo. - Carrier- OriskaInsurance Co.
WCB Case No. - G310 1442 CarrierID No. - W166250
Date of Accident- 09/20/2019 CarrierCase No. -
DistrictOffice- NYC Date of Filing Decision-
of this 02/11/2022
ATENCION:
Puede 11amara la oficina
de la Junta de Compensacion
Obrera, en su area correspondiente,
cuyo numero de telefono
aparece al
de la pagina y pida informacion
principio acerca de su reclamacion(caso).
EC-23 (4/98) Page 2 of 2
FILE COPY
FILED: KINGS COUNTY CLERK 08/10/2022 03:11 PM INDEX NO. 506931/2022
NYSCEF DOC. NO. 19 RECEIVED NYSCEF: 08/10/2022
Copies To: Case #G310 1442
Claimant: Kalween Rodriguez
Carrier: OriskaInsurance Co.
Employer: County Agency Inc
Other: SchotterMillican,LLP
Law OfficeMelissa A Day PLLC
Kernan Professional
Group
Please see below tor Recipien ts.
PMGT Med & SurgicalAssoc
Brain InjuryMedicine Assoc.
Pasternack, Ziegler
Tilker,
Kalween Rodriguez County Agency Inc Oriska InsuranceCo.
233 Jamaica Avenue 129 South 8th Street 1310 UticaStreet
Apt IB Brooklyn,NY 11211 PO Box 855
Brooklyn, NY 11207 Oriskany,NY 13424
SchotterMillican,LLP Law OfficeMelissa A Day PLLC Kernan ProfessionalGroup
300 Cadman PlazaWest 636 North French Road, Ste 3 1310 Utica Street
12th Floor Amherst, NY 14228-1900 Oriskany,NY 13424
Brooklyn, NY 11201
NYC Medical Neurological PMGT Med & SurgicalAssoc Brain InjuryMedicine Assoc.
116 Sanford St 116 Sanford Street 116 Sanford Street
Brooklyn, NY 1 1205. Brooklyn,NY 11205 Brooklyn, NY 1 1205.
Pasternack, Ziegler
Tilker,
Walsh, Stanton& Romanoj LLP
180 Livingston St, 2nd Floor
Brooklyn, NY 11201
EC-23 (4/98) OVER
FILE COPY
Document Filed Date
August 10, 2022
Case Filing Date
March 09, 2022
Category
Torts - Other Negligence (Premises)
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Preview
FILED: KINGS COUNTY CLERK 08/10/2022 03:11 PM INDEX NO. 506931/2022 NYSCEF DOC. NO. 19 RECEIVED NYSCEF: 08/10/2022 EXHIBIT J FILED: KINGS COUNTY CLERK 08/10/2022 03:11 PM INDEX NO. 506931/2022 NYSCEF DOC. NO. 19 RECEIVED NYSCEF: 08/10/2022 26087467 STATE OF NEW YORK WORKERS' NEW COMPENSATION BOARD e rg YORK . PO BOX 5205 ATE CompeRSatIOR BNGHAMTON, NY 13902-5205 wwnweb.ny.gov (877)632-4996 State of New York - Workers' Compensation Board In regard to Kalween Rodriguez, WCB Case #G310 1442 NOTICE OF DECISION keepforyouracords Workers' At the Coinpensationhearing heldon 02/08/2022 involving the claim of Kalween Rodriguez at the Brooklyn hearinglócation,Judge Stephane Martinmade the following findings decision, and directions: DECISION: The claimant'saverageweekly wage forthe year workedbeforethiswork relatedinjuryor occupationaldiseaseis $600.00withoutprejudice. Issues in controversy have been raised by the carrier/employer. Medical treatmentand care, as necessary, forestablishedsites of injuryand/orconditions,is authorized. Treatment rendered to one of the body partscovered by theMedical Treatment Guidelinesmust be consistent with those Guidelines. Form(s) C-8.1 which raisedissues relating to treatment and/or disputedmedical bills are resolvedinfavorof the carrier without prejudiceto resubmissionifadditionalsites are established. Ifthe carrier/employer wishes to producea consultant's m edicalreport Workers' (IME) in accordancewith Compensation Law Section 137 and BoardRule 300.2 on the current medical of issue(s) on alladditional sites for which PFME has beenfound within60 days, it must be produced beforeor at the next hearing.Ifsuch reportis not produced,a findingmay be made thatthe carrier has waivedthe opportunityto submita consultant's medical report. Proper employer is CountyAgency Inc.,locatedat 129 South8thStreet, Brooklyn, NY 11211. Board tochange to reflect to properemployer. PFME(prima facie medical evidence)forthe followingsites: head/face per the ERrecordsdated 9/20/19, post-concussionsyridrome per Dr.Hylton 11/16/21,postconcussion syndrome with post-traumavisionsyndrome and paresisof accommodation and oculom otordysfunctionper Dr.Reuter 12/1/21,anxietyand traumaticbrain injuryper Dr.Sadana 11/24/21,neck and left shoulder per Dr.McGee 8/24/21. Claimant also raises teethno PFME. *** *** Continued on next page Claimant - Kalween Rodriguez Employer - Inc County Agency SocialSecurityNo. - Carrier- OriskaInsurance Co. WCB Case No. - G310 1442 CarrierID No. - W166250 Date ofAccident - 09/20/2019 CarrierCase No. - DistrictOffice- NYC Date of Filing Decision- of this 02/11/2022 ATENCION: Puede 11amara la oficina de la Junta de Compensacion Obrera, en su area correspondiente, cuyo numero de telefono aparece al principio acerca de su reclamacion(caso). de la pagina y pida informacion EC-23 (4/98) Page 1 of2 FILE COPY FILED: KINGS COUNTY CLERK 08/10/2022 03:11 PM INDEX NO. 506931/2022 NYSCEF DOC. NO. 19 RECEIVED NYSCEF: 08/10/2022 26007467 Carrierraisesall issues ofcontroversyand requestscross examinationof the doctors. The requestforcross examination is held in abeyancepending production of the ]ME. . No furtheraction s plannedby the Boardat this time. Claimant - Kalween Rodriguez Employer - County Agency Inc SocialSecurityNo. - Carrier- OriskaInsurance Co. WCB Case No. - G310 1442 CarrierID No. - W166250 Date of Accident- 09/20/2019 CarrierCase No. - DistrictOffice- NYC Date of Filing Decision- of this 02/11/2022 ATENCION: Puede 11amara la oficina de la Junta de Compensacion Obrera, en su area correspondiente, cuyo numero de telefono aparece al de la pagina y pida informacion principio acerca de su reclamacion(caso). EC-23 (4/98) Page 2 of 2 FILE COPY FILED: KINGS COUNTY CLERK 08/10/2022 03:11 PM INDEX NO. 506931/2022 NYSCEF DOC. NO. 19 RECEIVED NYSCEF: 08/10/2022 Copies To: Case #G310 1442 Claimant: Kalween Rodriguez Carrier: OriskaInsurance Co. Employer: County Agency Inc Other: SchotterMillican,LLP Law OfficeMelissa A Day PLLC Kernan Professional Group Please see below tor Recipien ts. PMGT Med & SurgicalAssoc Brain InjuryMedicine Assoc. Pasternack, Ziegler Tilker, Kalween Rodriguez County Agency Inc Oriska InsuranceCo. 233 Jamaica Avenue 129 South 8th Street 1310 UticaStreet Apt IB Brooklyn,NY 11211 PO Box 855 Brooklyn, NY 11207 Oriskany,NY 13424 SchotterMillican,LLP Law OfficeMelissa A Day PLLC Kernan ProfessionalGroup 300 Cadman PlazaWest 636 North French Road, Ste 3 1310 Utica Street 12th Floor Amherst, NY 14228-1900 Oriskany,NY 13424 Brooklyn, NY 11201 NYC Medical Neurological PMGT Med & SurgicalAssoc Brain InjuryMedicine Assoc. 116 Sanford St 116 Sanford Street 116 Sanford Street Brooklyn, NY 1 1205. Brooklyn,NY 11205 Brooklyn, NY 1 1205. Pasternack, Ziegler Tilker, Walsh, Stanton& Romanoj LLP 180 Livingston St, 2nd Floor Brooklyn, NY 11201 EC-23 (4/98) OVER FILE COPY