Preview
FILED: SUFFOLK COUNTY CLERK 10/01/2021 02:56 PM INDEX NO. 616809/2021
NYSCEF DOC. NO. 7 RECEIVED NYSCEF: 10/01/2021
SUPREME COURT OF THE STATE OF NEW YORK
COUNTY OF SUFFOLK
Index No.: 616809/2021
MATHEW WELNER,
DEMAND FOR VERIFIED
Plaintiff, BILL OF PARTICULARS
-against-
S A RAIBANMARIN and MICHAEL ORTEGA,
Defendants.
C O U N S E L O R S:
PLEASE TAKE NOTICE, that pursuant to the provisions of the Rules of the Civil Practice
Laws and Rules, the undersigned hereby demands that you serve upon him, within thirty (30) days, a
Verified Bill of Particulars of the Plaintiff’s claims as alleged in the Complaint, setting forth specifically
and in detail the answers to the following items.
1. The date and approximate time of day of the occurrence alleged in the complaint (hereinafter
referred to as the “accident”).
2. The approximate place and location where the alleged accident occurred showing on what street
or road, with the name thereof; if it occurred at intersecting streets, the names thereof and the
particular part of the intersection; if it occurred between intersecting streets, the names thereof
and the distances from the intersection.
3. The general direction and on what street or road, with the name thereof, that it is claimed
Plaintiffs' motor vehicle was proceeding at the time of the accident.
4. The general direction and on what street or road, with the name thereof, that it is claimed
Defendants' motor vehicle was proceeding at the time of the accident.
5. A general statement of the acts and/or omissions constituting the negligence on the part of the
Defendants, of which Plaintiff complains.
6. State how it is claimed the accident occurred.
7. The particular provision of the rules, regulations, statutes and ordinances of the State of New
York, and any applicable municipal entity or subdivision thereof, with the title, article and
section number thereof which it is claimed the Defendants violated when the accident occurred.
8. Set forth with specificity the portions of the Defendants' vehicle which were not safe and/or were
defective. With regards to each portion of the vehicle, state whether the Defendants had actual or
constructive notice of the unsafe and defective condition. If actual notice is claimed, state when,
where and to whom such notice is claimed, set forth the period of time in units of time
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measurements that the unsafe and defective condition existed with regards to each unsafe and
defective portion of the Defendants' vehicle.
9. Set forth the nature, location, extent and duration of each and every injury claimed to have been
sustained by Plaintiff as a result of the accident. In addition, set forth:
i. Which of the above listed injuries Plaintiffs claims are "serious injuries" within
the scope, definition and meaning of Section 5102(d) of the New York State
Insurance Law, specifying the section or subdivision of that statute under which it
is claimed each such injury so qualifies and the manner in which each such injury
so qualifies;
ii. Which of the above listed injuries, including a description thereof, Plaintiff claims
are permanent;
iii. Whether Plaintiff claims any economic loss greater than basic economic loss as
defined in Insurance Law Section 5102(a); if so, state the amount(s) of each and
every item of economic loss so claimed.
10. State whether Plaintiff claims that the accident operated to aggravate, activate and/or exacerbate
any pre-existing condition, illness, disease and/or injury. If so, set forth with specificity the
following:
i. The name and nature of such pre-existing condition, illness, disease and/or injury;
ii. The length of time such pre-existing condition, illness, disease and/or injury
existed prior to the date of the accident; and
iii. The cause and/or origin of the pre-existing condition, illness, disease and/or
injury; and
iv. The names and addresses of all medical care providers who rendered treatment
and/or services to Plaintiff for such pre-existing condition, illness, disease and/or
injury, prior to the accident.
11. State the length of confinement of Plaintiff, following the accident, to:
i. Bed; and
ii. Home.
12. State the name of each and every hospital, clinic or institution where any treatment or
examination was rendered to Plaintiff, and the period of time, if any, of any confinement therein.
13. If it is claimed that Plaintiff was treated by a physician other than at the hospital/clinic, give the
name and address of each such physician(s). Accurately state the number of visits it is claimed
that Plaintiff made to each of the physicians so named.
14. State Plaintiffs:
i. Present residence address;
ii. Address at the time of the occurrence;
iii. Date and place of birth; and
iv. Social Security number.
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15. If Plaintiff was employed at the time of the accident, state:
i. The name and address of each of Plaintiff’s employer(s), and Plaintiff’s job title
with each such employer;
ii. The name of Plaintiff’s immediate supervisor(s);
iii. The length of time Plaintiff was incapacitated from employment following the
accident, and;
iv. If Plaintiff was self-employed, state the name and nature of Plaintiff’s self-
employment, the business address, Plaintiff’s job title, and the length of time
Plaintiff was incapacitated from such self-employment following the accident.
16. If Plaintiff was a student at the time of the accident, set forth:
i. The name and address of the school or institution that Plaintiff attended as of the
date of the accident; and
ii. Plaintiff’s grade and class; and
iii. The length of time that Plaintiff was absent following the accident, stating the
specific dates.
17. State the total amount claimed by Plaintiff as special damages for:
i. Hospital expenses;
ii. Physician services;
iii. Medical expenses;
iv. Nursing expenses;
v. MRI/X-ray expenses; and
vi. Out of pocket expenses.
18. State whether Plaintiff claims that he/she will incur future special damages due to the accident.
If so, state: (i),the nature of each such item of future special damages; (ii)the total amount of
future special damages claimed; (iii) the amount claimed for each item of future special
damages; (iv) the duration of time for which each item of future special damages will be
claimed; (v) the factual basis of such claim.
19. State whether Plaintiff claims lost earnings and/or income due to the accident. If so, state: (i) the
length of time over which such lost earnings/income occurred; (ii) the nature of such lost
earnings/income; (iii) a detailed statement as to how such lost earnings/income were computed;
(iv) whether any portion, in whole or in part, of Plaintiff’s lost earnings/income was paid or
reimbursed by insurance and/or other source, including, but not limited to, disability insurance,
Workers' Compensation, Social Security, Personal Injury Protection insurance (no-fault), lost
earnings/income insurance, or some other source; if so paid or reimbursed, specify such source
including name, address and claim/file number.
20. State whether Plaintiff claims that he/she will incur future lost earnings/income and/or a
diminution of earning capacity due to the accident. If so, state: (i) the total amount of such
claim; (ii) the annual amount of such claim; (iii) the duration of time for which such loss will be
claimed; (iv) the factual basis of such claim.
21. State whether Plaintiff claims property damage due to the accident. If so, itemize each and every
item of property alleged to have been damaged in the accident, and accurately state: (i) the
original cost of each such item of property; (ii) its value immediately before the accident; (iii) its
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value immediately following the accident; (iv) the cost to repair and/or replace each item of
property; and (v) the salvage value of each such item of property.
22. State whether Plaintiff claims loss of use of a vehicle due to the accident. If so, state: (i) the
length of time for which such loss of use occurred; (ii) whether a vehicle was hired to replace the
vehicle out of use; (iii) the reasonable rate per unit of time and total cost thereof resulting from
the loss of use.
23. If loss of services is claimed, itemize the services Plaintiff has been deprived of, and state for
what length of time Plaintiff has been deprived of those services.
24. Pursuant to 42 U.S.C. 1395y(b)(7), (8) (Mandatory Medicare Reporting Act), state whether the
Plaintiff has received, presently receives, or has applied to receive, Medicare benefits, including,
but not limited to, whether Plaintiff was, is, or will be, or has received any benefits, under
Medicare Part C.
25. Pursuant to 42 U.S.C. 1395y(b)(7), (8) (Mandatory Medicare Reporting Act), state whether
Plaintiff had, has, or has applied to receive a Medicare card and/or a health insurance claim
number.
26. Pursuant to 42 U.S.C. 1395y(b)(7), (8) (Mandatory Medicare Reporting Act), state whether
Plaintiff has received or is receiving Social Security Disability Insurance (SSDI) benefits for 24
months.
27. Pursuant to 42 U.S.C. 1395y(b)(7), (8) (Mandatory Medicare Reporting Act), state whether
Plaintiff has been diagnosed with and/or is suffering from end stage renal failure or ALS disease
(Amyotrophic Lateral Sclerosis).
28. State whether Plaintiff received any APIP (Additional Personal Injury Protection) benefits. If so,
set forth: (i) the name, address and claim/file number of the insurer providing such benefits; and
(ii) the amount of APIP benefits received.
29. State whether plaintiff received any medical or health care benefits from any source which has
made claim for repayment or reimbursement and/or asserted any lien or subrogation right, under
ERISA. If so, state: (i) the name, address and claim/file number of such benefit provider; (ii) the
amount of benefits received by Plaintiff; and (iii) the amount of repayment or reimbursement
sought by such benefit provider.
PLEASE TAKE FURTHER NOTICE, that in case of your failure to serve said Bill of
Particulars as demanded, we will move for an Order precluding the Plaintiff(s) from giving any evidence
at the trial of this action concerning the matter contained in said terms.
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FILED: SUFFOLK COUNTY CLERK 10/01/2021 02:56 PM INDEX NO. 616809/2021
NYSCEF DOC. NO. 7 RECEIVED NYSCEF: 10/01/2021
DATED: Yonkers, NY
October 1, 2021
Respectfully submitted,
Robert Meyers, Esq.
LAW OFFICES OF JENNIFER S. ADAMS
Attorney for Defendant
Michael A. Ortega and Sarvelia Raiban
One Executive Boulevard, Suite 280
Yonkers, NY 10701
(516) 502-1340
Our File No.: 216589528-001
TO:
Andreia Bento, Esq.
Robert K. Young & Associates, P.C.
Attorney for Plaintiff
Mathew Welner
2284 Babylon Turnpike
Merrick, NY 11566
(516) 826-8938
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Preview
FILED: SUFFOLK COUNTY CLERK 10/01/2021 02:56 PM INDEX NO. 616809/2021 NYSCEF DOC. NO. 7 RECEIVED NYSCEF: 10/01/2021 SUPREME COURT OF THE STATE OF NEW YORK COUNTY OF SUFFOLK Index No.: 616809/2021 MATHEW WELNER, DEMAND FOR VERIFIED Plaintiff, BILL OF PARTICULARS -against- S A RAIBANMARIN and MICHAEL ORTEGA, Defendants. C O U N S E L O R S: PLEASE TAKE NOTICE, that pursuant to the provisions of the Rules of the Civil Practice Laws and Rules, the undersigned hereby demands that you serve upon him, within thirty (30) days, a Verified Bill of Particulars of the Plaintiff’s claims as alleged in the Complaint, setting forth specifically and in detail the answers to the following items. 1. The date and approximate time of day of the occurrence alleged in the complaint (hereinafter referred to as the “accident”). 2. The approximate place and location where the alleged accident occurred showing on what street or road, with the name thereof; if it occurred at intersecting streets, the names thereof and the particular part of the intersection; if it occurred between intersecting streets, the names thereof and the distances from the intersection. 3. The general direction and on what street or road, with the name thereof, that it is claimed Plaintiffs' motor vehicle was proceeding at the time of the accident. 4. The general direction and on what street or road, with the name thereof, that it is claimed Defendants' motor vehicle was proceeding at the time of the accident. 5. A general statement of the acts and/or omissions constituting the negligence on the part of the Defendants, of which Plaintiff complains. 6. State how it is claimed the accident occurred. 7. The particular provision of the rules, regulations, statutes and ordinances of the State of New York, and any applicable municipal entity or subdivision thereof, with the title, article and section number thereof which it is claimed the Defendants violated when the accident occurred. 8. Set forth with specificity the portions of the Defendants' vehicle which were not safe and/or were defective. With regards to each portion of the vehicle, state whether the Defendants had actual or constructive notice of the unsafe and defective condition. If actual notice is claimed, state when, where and to whom such notice is claimed, set forth the period of time in units of time 1 of 5 FILED: SUFFOLK COUNTY CLERK 10/01/2021 02:56 PM INDEX NO. 616809/2021 NYSCEF DOC. NO. 7 RECEIVED NYSCEF: 10/01/2021 measurements that the unsafe and defective condition existed with regards to each unsafe and defective portion of the Defendants' vehicle. 9. Set forth the nature, location, extent and duration of each and every injury claimed to have been sustained by Plaintiff as a result of the accident. In addition, set forth: i. Which of the above listed injuries Plaintiffs claims are "serious injuries" within the scope, definition and meaning of Section 5102(d) of the New York State Insurance Law, specifying the section or subdivision of that statute under which it is claimed each such injury so qualifies and the manner in which each such injury so qualifies; ii. Which of the above listed injuries, including a description thereof, Plaintiff claims are permanent; iii. Whether Plaintiff claims any economic loss greater than basic economic loss as defined in Insurance Law Section 5102(a); if so, state the amount(s) of each and every item of economic loss so claimed. 10. State whether Plaintiff claims that the accident operated to aggravate, activate and/or exacerbate any pre-existing condition, illness, disease and/or injury. If so, set forth with specificity the following: i. The name and nature of such pre-existing condition, illness, disease and/or injury; ii. The length of time such pre-existing condition, illness, disease and/or injury existed prior to the date of the accident; and iii. The cause and/or origin of the pre-existing condition, illness, disease and/or injury; and iv. The names and addresses of all medical care providers who rendered treatment and/or services to Plaintiff for such pre-existing condition, illness, disease and/or injury, prior to the accident. 11. State the length of confinement of Plaintiff, following the accident, to: i. Bed; and ii. Home. 12. State the name of each and every hospital, clinic or institution where any treatment or examination was rendered to Plaintiff, and the period of time, if any, of any confinement therein. 13. If it is claimed that Plaintiff was treated by a physician other than at the hospital/clinic, give the name and address of each such physician(s). Accurately state the number of visits it is claimed that Plaintiff made to each of the physicians so named. 14. State Plaintiffs: i. Present residence address; ii. Address at the time of the occurrence; iii. Date and place of birth; and iv. Social Security number. 2 of 5 FILED: SUFFOLK COUNTY CLERK 10/01/2021 02:56 PM INDEX NO. 616809/2021 NYSCEF DOC. NO. 7 RECEIVED NYSCEF: 10/01/2021 15. If Plaintiff was employed at the time of the accident, state: i. The name and address of each of Plaintiff’s employer(s), and Plaintiff’s job title with each such employer; ii. The name of Plaintiff’s immediate supervisor(s); iii. The length of time Plaintiff was incapacitated from employment following the accident, and; iv. If Plaintiff was self-employed, state the name and nature of Plaintiff’s self- employment, the business address, Plaintiff’s job title, and the length of time Plaintiff was incapacitated from such self-employment following the accident. 16. If Plaintiff was a student at the time of the accident, set forth: i. The name and address of the school or institution that Plaintiff attended as of the date of the accident; and ii. Plaintiff’s grade and class; and iii. The length of time that Plaintiff was absent following the accident, stating the specific dates. 17. State the total amount claimed by Plaintiff as special damages for: i. Hospital expenses; ii. Physician services; iii. Medical expenses; iv. Nursing expenses; v. MRI/X-ray expenses; and vi. Out of pocket expenses. 18. State whether Plaintiff claims that he/she will incur future special damages due to the accident. If so, state: (i),the nature of each such item of future special damages; (ii)the total amount of future special damages claimed; (iii) the amount claimed for each item of future special damages; (iv) the duration of time for which each item of future special damages will be claimed; (v) the factual basis of such claim. 19. State whether Plaintiff claims lost earnings and/or income due to the accident. If so, state: (i) the length of time over which such lost earnings/income occurred; (ii) the nature of such lost earnings/income; (iii) a detailed statement as to how such lost earnings/income were computed; (iv) whether any portion, in whole or in part, of Plaintiff’s lost earnings/income was paid or reimbursed by insurance and/or other source, including, but not limited to, disability insurance, Workers' Compensation, Social Security, Personal Injury Protection insurance (no-fault), lost earnings/income insurance, or some other source; if so paid or reimbursed, specify such source including name, address and claim/file number. 20. State whether Plaintiff claims that he/she will incur future lost earnings/income and/or a diminution of earning capacity due to the accident. If so, state: (i) the total amount of such claim; (ii) the annual amount of such claim; (iii) the duration of time for which such loss will be claimed; (iv) the factual basis of such claim. 21. State whether Plaintiff claims property damage due to the accident. If so, itemize each and every item of property alleged to have been damaged in the accident, and accurately state: (i) the original cost of each such item of property; (ii) its value immediately before the accident; (iii) its 3 of 5 FILED: SUFFOLK COUNTY CLERK 10/01/2021 02:56 PM INDEX NO. 616809/2021 NYSCEF DOC. NO. 7 RECEIVED NYSCEF: 10/01/2021 value immediately following the accident; (iv) the cost to repair and/or replace each item of property; and (v) the salvage value of each such item of property. 22. State whether Plaintiff claims loss of use of a vehicle due to the accident. If so, state: (i) the length of time for which such loss of use occurred; (ii) whether a vehicle was hired to replace the vehicle out of use; (iii) the reasonable rate per unit of time and total cost thereof resulting from the loss of use. 23. If loss of services is claimed, itemize the services Plaintiff has been deprived of, and state for what length of time Plaintiff has been deprived of those services. 24. Pursuant to 42 U.S.C. 1395y(b)(7), (8) (Mandatory Medicare Reporting Act), state whether the Plaintiff has received, presently receives, or has applied to receive, Medicare benefits, including, but not limited to, whether Plaintiff was, is, or will be, or has received any benefits, under Medicare Part C. 25. Pursuant to 42 U.S.C. 1395y(b)(7), (8) (Mandatory Medicare Reporting Act), state whether Plaintiff had, has, or has applied to receive a Medicare card and/or a health insurance claim number. 26. Pursuant to 42 U.S.C. 1395y(b)(7), (8) (Mandatory Medicare Reporting Act), state whether Plaintiff has received or is receiving Social Security Disability Insurance (SSDI) benefits for 24 months. 27. Pursuant to 42 U.S.C. 1395y(b)(7), (8) (Mandatory Medicare Reporting Act), state whether Plaintiff has been diagnosed with and/or is suffering from end stage renal failure or ALS disease (Amyotrophic Lateral Sclerosis). 28. State whether Plaintiff received any APIP (Additional Personal Injury Protection) benefits. If so, set forth: (i) the name, address and claim/file number of the insurer providing such benefits; and (ii) the amount of APIP benefits received. 29. State whether plaintiff received any medical or health care benefits from any source which has made claim for repayment or reimbursement and/or asserted any lien or subrogation right, under ERISA. If so, state: (i) the name, address and claim/file number of such benefit provider; (ii) the amount of benefits received by Plaintiff; and (iii) the amount of repayment or reimbursement sought by such benefit provider. PLEASE TAKE FURTHER NOTICE, that in case of your failure to serve said Bill of Particulars as demanded, we will move for an Order precluding the Plaintiff(s) from giving any evidence at the trial of this action concerning the matter contained in said terms. 4 of 5 FILED: SUFFOLK COUNTY CLERK 10/01/2021 02:56 PM INDEX NO. 616809/2021 NYSCEF DOC. NO. 7 RECEIVED NYSCEF: 10/01/2021 DATED: Yonkers, NY October 1, 2021 Respectfully submitted, Robert Meyers, Esq. LAW OFFICES OF JENNIFER S. ADAMS Attorney for Defendant Michael A. Ortega and Sarvelia Raiban One Executive Boulevard, Suite 280 Yonkers, NY 10701 (516) 502-1340 Our File No.: 216589528-001 TO: Andreia Bento, Esq. Robert K. Young & Associates, P.C. Attorney for Plaintiff Mathew Welner 2284 Babylon Turnpike Merrick, NY 11566 (516) 826-8938 5 of 5