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  • Debra Jeronimo v. City Of New York, Lutheran Medicalcenter, Nyu Langone Hospitals, Consolidated Edison, Inc.Torts - Other (Trip and Fall) document preview
  • Debra Jeronimo v. City Of New York, Lutheran Medicalcenter, Nyu Langone Hospitals, Consolidated Edison, Inc.Torts - Other (Trip and Fall) document preview
  • Debra Jeronimo v. City Of New York, Lutheran Medicalcenter, Nyu Langone Hospitals, Consolidated Edison, Inc.Torts - Other (Trip and Fall) document preview
  • Debra Jeronimo v. City Of New York, Lutheran Medicalcenter, Nyu Langone Hospitals, Consolidated Edison, Inc.Torts - Other (Trip and Fall) document preview
  • Debra Jeronimo v. City Of New York, Lutheran Medicalcenter, Nyu Langone Hospitals, Consolidated Edison, Inc.Torts - Other (Trip and Fall) document preview
  • Debra Jeronimo v. City Of New York, Lutheran Medicalcenter, Nyu Langone Hospitals, Consolidated Edison, Inc.Torts - Other (Trip and Fall) document preview
  • Debra Jeronimo v. City Of New York, Lutheran Medicalcenter, Nyu Langone Hospitals, Consolidated Edison, Inc.Torts - Other (Trip and Fall) document preview
  • Debra Jeronimo v. City Of New York, Lutheran Medicalcenter, Nyu Langone Hospitals, Consolidated Edison, Inc.Torts - Other (Trip and Fall) document preview
						
                                

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FILED: KINGS COUNTY CLERK 03/01/2023 02:32 PM INDEX NO. 525864/2020 NYSCEF DOC. NO. 28 RECEIVED NYSCEF: 03/01/2023 JPC:cg SUPREME COURT OF THE STATE OF NEW YORK 03/01/23 COUNTY OF KINGS DEBRA JERONIMO, INDEX NO. 525864/20 Plaintiff, - against - VERIFIED ANSWER TO AMENDED COMPLAINT CITY OF NEW YORK, LUTHERAN MEDICAL CENTER, and AND CROSS-COMPLAINT NYU LANGONE HOSPITALS, and CONSOLIDATED EDISON, INC., Defendants. The defendant, Consolidated Edison Company of New York, Inc. s/h/a Consolidated Edison, Inc. (hereinafter “Consolidated Edison Company of New York, Inc.”), by its attorney, Lauren A. Jones, answering the amended complaint, alleges: FIRST: Denies knowledge or information sufficient to form a belief as to the allegations contained in paragraphs “1”, “2”, “3”, “4”, “5”, “6”, “7”, “8”, “9”, “10”, “11”, “12”, “13”, “14”, “15”, “16”, “17”, “18”, “19”, “20”, “21”, “22”, “23”, “24”, “25”, “26”, “34”, “35”, “36”, “37”, “38”, “39”, “40”, “41”, “42”, “43”, “44”, “45”, “46”, “47”, “48”, “49”, “50”, “51”, “52”, “53”, “54”, “55”, “56”, “57”, “63”, “65”, and “66”. SECOND: Denies the allegations contained in paragraph “29”. THIRD: Denies knowledge or information sufficient to form a belief as to the allegations contained in paragraph “32“ and “33”, except admits defendant, Consolidated Edison Company of New York, Inc., was and still is a domestic corporation, duly organized and existing under the Transportation Corporations Law of the State of New York, was and still is engaged in the generation, distribution and sale of electric energy to its customers in New York City and Westchester County, and was and still is a gas and electric corporation subject to the Public Service Our File #: 2023-000832 FN2047630 1 of 42 FILED: KINGS COUNTY CLERK 03/01/2023 02:32 PM INDEX NO. 525864/2020 NYSCEF DOC. NO. 28 RECEIVED NYSCEF: 03/01/2023 Law of the State of New York and to the jurisdiction of the Public Service Commission of the State of New York. FOURTH: Denies upon information and belief each allegation in paragraphs “58”, “59”, “60”, “61”, “62”, and “64”. AS TO THE FIRST ALLEGED CAUSE OF ACTION: FIFTH: Repeats each denial made of the allegations contained in all prior paragraphs and repeated in paragraph “67”. SIXTH: Denies knowledge or information sufficient to form a belief as to the allegations contained in paragraphs “68”, “69”, “70”, “71”, “72”, “73”, “74”, “75”, “76”, “77”, “78”, and “80”. SEVENTH: Denies upon information and belief each allegation in paragraph “79”. AS TO THE SECOND ALLEGED CAUSE OF ACTION: EIGHTH: Repeats each denial made of the allegations contained in all prior paragraphs and repeated in paragraph “81”. NINTH: Denies knowledge or information sufficient to form a belief as to the allegations contained in paragraphs “82”, “83”, “84”, “85”, “86”, “87”, “88”, “89”, “90”, “91”, “92”, and “94”. TENTH: Denies upon information and belief each allegation in paragraph “93”. AS TO THE THIRD ALLEGED CAUSE OF ACTION: ELEVENTH: Repeats each denial made of the allegations contained in all prior paragraphs and repeated in paragraph “95”. Our File #: 2023-000832 FN2047630 2 of 42 FILED: KINGS COUNTY CLERK 03/01/2023 02:32 PM INDEX NO. 525864/2020 NYSCEF DOC. NO. 28 RECEIVED NYSCEF: 03/01/2023 TWELFTH: Denies knowledge or information sufficient to form a belief as to the allegations contained in paragraphs “96”, “97”, “98”, “99”, “100”, “101”, “102”, “103”, “104”, “105”, “106”, and “108”. THIRTEENTH: Denies upon information and belief each allegation in paragraph “107”. AS TO THE FOURTH ALLEGED CAUSE OF ACTION: FOURTEENTH: Repeats each denial made of the allegations contained in all prior paragraphs and repeated in paragraph “109”. FIFTEENTH: Denies upon information and belief each allegation in paragraphs “110”, “111”, “112”, “113”, “114”, “115”, “116”, “117”, “118”, “119”, “120”, “121”, and “122”. AS TO THE ALLEGATIONS AS TO ALL DEFENDANTS: SIXTEENTH: Repeats each denial made of the allegations contained in all prior paragraphs and repeated in paragraph “123”. SEVENTEENTH: Denies knowledge or information sufficient to form a belief as to the allegations contained in paragraph “124” and refers all questions of law to the Court. EIGHTEENTH: Denies knowledge or information sufficient to form a belief as to the allegations contained in paragraph “125”. AS A FIRST AFFIRMATIVE DEFENSE: NINETEENTH: Any injuries or damages which the plaintiff sustained were caused in whole or in part by the plaintiff's negligence. Our File #: 2023-000832 FN2047630 3 of 42 FILED: KINGS COUNTY CLERK 03/01/2023 02:32 PM INDEX NO. 525864/2020 NYSCEF DOC. NO. 28 RECEIVED NYSCEF: 03/01/2023 AS A SECOND, SEPARATE, AND COMPLETE DEFENSE TO THE ALLEGED CAUSES OF ACTION, THE DEFENDANT, CONSOLIDATED EDISON COMPANY OF NEW YORK, INC., ALLEGES, UPON INFORMATION AND BELIEF: TWENTIETH: That the defendant, Consolidated Edison Company of New York, Inc., is a New York corporation engaged in the sale and distribution of electricity, gas and steam under franchises. All work performed or equipment installed at the times mentioned in the amended complaint was pursuant to the rights granted by law and the permission or license of the proper municipal authorities. AS AND FOR A THIRD AFFIRMATIVE DEFENSE TO THE ENTIRE AMENDED COMPLAINT, THIS ANSWERING DEFENDANT ALLEGES: TWENTY-FIRST: That if any liability is found as against this answering defendant, then said liability will constitute 50% or less of the total liability assigned to all persons liable and, as such, the liability of this answering defendant to plaintiff for non- economic loss shall be limited and shall not exceed this answering defendant’s equitable share, as provided in Article 16 of the CPLR. AS A FOURTH AFFIRMATIVE DEFENSE: TWENTY-SECOND: To the extent plaintiff releases or otherwise settles with any other person/entity relative to the alleged injuries/damages in this action, answering defendant will be entitled to have any claim for damages asserted against it reduced to the extent permitted by operation of New York General Obligations Law Section 15-108 or any other applicable law. Our File #: 2023-000832 FN2047630 4 of 42 FILED: KINGS COUNTY CLERK 03/01/2023 02:32 PM INDEX NO. 525864/2020 NYSCEF DOC. NO. 28 RECEIVED NYSCEF: 03/01/2023 IF JUDGMENT IS RENDERED AGAINST CONSOLIDATED EDISON COMPANY OF NEW YORK, INC., IT ALLEGES UPON INFORMATION AND BELIEF, AS A CROSS-COMPLAINT AGAINST THE DEFENDANTS, CITY OF NEW YORK, LUTHERAN MEDICAL CENTER, AND NYU LANGONE HOSPITALS: TWENTY-THIRD: That any liability to the plaintiff against the defendant, Consolidated Edison Company of New York, Inc., will have arisen in whole or in part out of the negligent acts of the defendants, CITY OF NEW YORK, LUTHERAN MEDICAL CENTER, and NYU LANGONE HOSPITALS, its/their respective agents, and/or employees, and that defendant, Consolidated Edison Company of New York, Inc., are entitled to be indemnified in whole or in part by CITY OF NEW YORK, LUTHERAN MEDICAL CENTER, and NYU LANGONE HOSPITALS, for the amount of any verdict or judgment which may be recovered against it. WHEREFORE, Consolidated Edison Company of New York, Inc., demand judgment dismissing the amended complaint with costs and disbursements, and further demand judgment against defendants, CITY OF NEW YORK, LUTHERAN MEDICAL CENTER, and NYU LANGONE HOSPITALS, for all or part of any judgment recovered against it. Dated: New York, New York March 1, 2023. LAUREN A. JONES By:______________________________ John P. Campana, Esq. Attorney for Defendant Consolidated Edison Company of New York, Inc. s/h/a Consolidated Edison, Inc. Address: 4 Irving Place, Room 1800 New York, NY 10003-3598 Our File #: 2023-000832 FN2047630 5 of 42 FILED: KINGS COUNTY CLERK 03/01/2023 02:32 PM INDEX NO. 525864/2020 NYSCEF DOC. NO. 28 RECEIVED NYSCEF: 03/01/2023 RIDER TO: LAW OFFICES OF MICHAEL S. LAMONSOFF, PLLC Attorneys for Plaintiff Financial Square at 32 Old Slip – 8th Floor New York, NY 10005 SYLVIA HINDS-RADIX, ESQ. Corporation Counsel Attorney for Defendant CITY OF NEW YORK 100 Church Street, 4th Floor New York, NY 10007 HEIDELL, PITTONI, MURPHY & BACH, LLP Attorneys for Defendants NYU LANGONE HOSPITAL and LUTHERAN MEDICAL CENTER 99 Park Avenue New York, NY 10005 Our File #: 2023-000832 FN2047630 6 of 42 FILED: KINGS COUNTY CLERK 03/01/2023 02:32 PM INDEX NO. 525864/2020 NYSCEF DOC. NO. 28 RECEIVED NYSCEF: 03/01/2023 VERIFICATION STATE OF NEW YORK ) ) SS.: COUNTY OF KINGS ) Scott A. Levinson, an attorney duly authorized to practice in the State of New York who is not a party to this action and an officer of Consolidated Edison Company of New York, Inc., affirms under penalty of perjury that that the foregoing is true to his knowledge except as to the matters therein stated to be alleged upon information and belief, and that as to those matters, he believes them to be true. The grounds for his belief as to all matters not stated upon personal knowledge are the books and records of the corporation. Scott A. Levinson, Esq. Vice President Consolidated Edison Company of New York, Inc. 7 of 42 FILED: KINGS COUNTY CLERK 03/01/2023 02:32 PM INDEX NO. 525864/2020 NYSCEF DOC. NO. 28 RECEIVED NYSCEF: 03/01/2023 LAUREN A. JONES Attorney For Consolidated Edison Company of New York, Inc. s/h/a Consolidated Edison, Inc. 4 Irving Place New York, NY 10003 Tel. No. (212) 460-3355 Counselors: Enclosed herein is Consolidated Edison Company of New York, Inc.’s: ◼ Demand for a Verified Bill of Particulars ◼ Demand for Medical and Employment Records and Authorizations ◼ Notice for Discovery and Inspection for Medicare or Medicaid Liens ❑ Notice for Discovery and Inspection ◼ Combined Demand ◼ Notice for Discovery and Inspection of Plaintiff ◼ Notice for Discovery and Inspection of The City of New York ❑ Third Party Notice for Discovery and Inspection ◼ Notice of Discovery and Inspection for Collateral Source Reimbursement ◼ Demand for Expert Witness Information ◼ Notice of Consent to Accept Service by Email on this Case ◼ Notice to Take Deposition Upon Oral Questions ❑ Notice for Discovery and Inspection for Reimbursement for Property Damage ❑ First Notice to Produce Documents ❑ Demand for Insurance and Claim File Information ❑ Demand Pursuant to CPLR 2103(e) ◼ Insurance Disclosure Pursuant to 3101(f) ❑ _______________________________________________ The undersigned certifies that to the best of my knowledge, information and belief that, as presented, served and/or filed, they are not frivolous as defined in Section 130-1.1(a) and (c) of the Rules of the Chief Administrator of the Courts (22 N.Y.C.R.R.) Very truly yours, Lauren A. Jones By: ______________________________ 170290 John P. Campana, Esq. 8 of 42 FILED: KINGS COUNTY CLERK 03/01/2023 02:32 PM INDEX NO. 525864/2020 NYSCEF DOC. NO. 28 RECEIVED NYSCEF: 03/01/2023 JPC:cg 03/01/23 SUPREME COURT OF THE STATE OF NEW YORK COUNTY OF KINGS DEBRA JERONIMO, INDEX NO. 525864/20 Plaintiff, - against - DEMAND FOR A VERIFIED BILL CITY OF NEW YORK, LUTHERAN MEDICAL CENTER, OF PARTICULARS and NYU LANGONE HOSPITALS, and CONSOLIDATED EDISON, INC., Defendants. COUNSELORS: PLEASE TAKE NOTICE, that pursuant to CPLR §§3041, 3042, 3043, and 3044, you are required to serve the attorney for defendant, Consolidated Edison Company of New York, Inc. s/h/a Consolidated Edison, Inc., at 4 Irving Place, New York, NY 10003, within thirty (30) days after service of this demand, a Verified Bill of Particulars, setting forth the following: 1. Plaintiff's date of birth, Social Security Number, and residence. 2. Is the plaintiff Medicare eligible? 3. Has the plaintiff applied for or received any Medicare payments in connection with the injury alleged in this lawsuit? 4. The date and approximate time of the occurrence. 5. The approximate location of the occurrence. 6. A general description of the occurrence. 7. A statement of the acts or omissions constituting each defendant's negligence. 8. A detailed description of the defect that caused the occurrence. Our File #: 2023-000832 FN2047630 9 of 42 FILED: KINGS COUNTY CLERK 03/01/2023 02:32 PM INDEX NO. 525864/2020 NYSCEF DOC. NO. 28 RECEIVED NYSCEF: 03/01/2023 9. Whether actual or constructive notice is claimed. 10. The facts supporting any claim of actual notice of a defect, including: (a) The date or dates of each notice. (b) The names of the agents or employees of the defendant receiving notice. (c) The name of the individual giving notice. (d) The precise language of the notice. (e) The form of the notice (oral or written). 11. The facts supporting any claim of constructive notice, including the length of time the condition existed prior to the occurrence. 12. Any statute, ordinance, or regulation violated by the defendant. 13. The names and addresses of all witnesses. 14. The nature and duration of each injury. 15. The length of time plaintiff was confined to (a) hospital, (b) bed, and (c) home. 16. The cost of: (a) hospital, (b) medical, (c) X-rays, (d) nurses, (e) medicines, (f) medical supplies, and (g) any other medical expenses. 17. The dollar value of other damages, item by item. 18. Plaintiff's occupation, name and address of employer, dates absent from employment, and amount of lost earnings. If a student, name and address of school, grade and dates absent. a) the method of calculation used to derive any and all lost earnings claimed; and Our File #: 2023-000832 FN2047630 10 of 42 FILED: KINGS COUNTY CLERK 03/01/2023 02:32 PM INDEX NO. 525864/2020 NYSCEF DOC. NO. 28 RECEIVED NYSCEF: 03/01/2023 b) the name and address of any entity, carrier, or organization providing plaintiff with compensation for any lost earnings claimed, including, but not limited to No Fault compensation and Workers Compensation. 19. State whether or not plaintiff has been reimbursed for claims of economic loss from any collateral source and, if so, set forth: a) the amount of reimbursement received and the name and addresses of the person, firm or organization from whom such reimbursement was received; and, b) if such reimbursement was made by an insurance company, state the number of the policy under which it was paid. 20. State whether or not plaintiff has made a claim for reimbursement for economic loss to any collateral source and said claim has not as yet been paid and, if so, set forth: a) the name and address of the person, corporation or organization to whom such claim was presented, the date of presentation and the amount claimed; and b) if such reimbursement was presented to an insurance company, state the policy number under which it was made. Dated: New York, New York March 1, 2023. Yours, etc., LAUREN A. JONES Attorney for Defendant Consolidated Edison Company of New York, Inc. s/h/a Consolidated Edison, Inc. 4 Irving Place, Room 1800 New York, NY 10003-3598 Our File #: 2023-000832 FN2047630 11 of 42 FILED: KINGS COUNTY CLERK 03/01/2023 02:32 PM INDEX NO. 525864/2020 NYSCEF DOC. NO. 28 RECEIVED NYSCEF: 03/01/2023 TO: LAW OFFICES OF MICHAEL S. LAMONSOFF, PLLC Attorneys for Plaintiff Financial Square at 32 Old Slip – 8th Floor New York, NY 10005 Our File #: 2023-000832 FN2047630 12 of 42 FILED: KINGS COUNTY CLERK 03/01/2023 02:32 PM INDEX NO. 525864/2020 NYSCEF DOC. NO. 28 RECEIVED NYSCEF: 03/01/2023 JPC:cg 03/01/23 SUPREME COURT OF THE STATE OF NEW YORK COUNTY OF KINGS DEBRA JERONIMO, INDEX NO. 525864/20 Plaintiff, NOTICE FOR DISCOVERY - against - AND INSPECTION FOR MEDICARE OR CITY OF NEW YORK, LUTHERAN MEDICAL CENTER, MEDICAID LIENS and NYU LANGONE HOSPITALS, and CONSOLIDATED EDISON, INC., Defendants. PLEASE TAKE NOTICE, that pursuant to Article 31 of the CPLR, you are hereby required to produce at the offices of Lauren A. Jones, the attorney for the defendant, Consolidated Edison Company of New York, Inc. s/h/a Consolidated Edison, Inc., within thirty (30) days, the following documents, items and information for discovery, inspection and/or copying: 1. A statement as to whether the plaintiff has received benefits from Medicaid, Medicare or any Medicare insurance program at any time, for any reason, not limited to the injuries alleged in the instant action. Please state and/or provide: a. Plaintiff’s full name; b. Plaintiff’s gender; c. Plaintiff’s date of birth; d. Plaintiff’s Social Security number; e. Is plaintiff enrolled in Medicare Part D? f. Is plaintiff enrolled in Medicare Part B? Our File #: 2023-000832 FN2047630 13 of 42 FILED: KINGS COUNTY CLERK 03/01/2023 02:32 PM INDEX NO. 525864/2020 NYSCEF DOC. NO. 28 RECEIVED NYSCEF: 03/01/2023 g. Plaintiff’s residence telephone number; h. The Health Insurance Claim Number, Medicare/Medicaid file number, New York State Department of Social Services (“DSS”) file number, and/or Medicare Secondary Payor (“MSP”) file number, if applicable; i. A copy of the plaintiff’s health insurance (Medicare) card; j. The address of the office handling the plaintiff’s Medicare/Medicaid claims and/or benefits; k. A duly executed and notarized written authorization fully compliant with the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) and regulations applicable thereto and expiring no less than six (6) months after the date of signature, and bearing plaintiff’s date of birth and Social Security number permitting this firm and/or the representatives of defendant to obtain copies of plaintiff’s Medicaid records; l. A duly executed consent to release (see attached CMS form “Consent to Release” http://www.cms.gov/Medicare/Coordination-of-Benefits-And- Recovery-Overview/Non-Group-Health-Plan- Recovery/Downloads/Consent to Release.pdf), valid for at least three (3) years, which permits this firm to obtain plaintiff’s Medicare records and to communicate with Medicare and its contractors (MSPRC or COBC); m. Identify any ICD-9 codes reported to Medicare and/or its contractors as alleged to be related to injuries sustained in the incident which is the subject of this litigation. 2. State whether Medicare and/or Medicaid has a lien and the amount of any such lien. 3. Provide copies of all documents, records, memoranda, notes, etc., in plaintiff’s possession pertaining to plaintiff’s receipt of Medicare and/or Medicaid benefits, including copies of all documents provided to or received from the Medicare and/or Medicaid administrators and/or contractors, including but not limited to: Our File #: 2023-000832 FN2047630 14 of 42 FILED: KINGS COUNTY CLERK 03/01/2023 02:32 PM INDEX NO. 525864/2020 NYSCEF DOC. NO. 28 RECEIVED NYSCEF: 03/01/2023 a. Case reporting correspondence to Medicare COBC (Coordination of Benefits Contractor) b. Rights and responsibilities letter; c. Conditional payment letters; d. Payment summary forms e. Demand/Recovery letters f. Final demand letters 4. Provide a copy of any claims summaries from Medicaid, Medicare or any Medicare insurance program. 5. If plaintiff has not received Medicare and/or Medicaid benefits in the past or is not receiving Medicare and/or Medicaid benefits now, state whether plaintiff is eligible to receive Medicare and/or Medicaid benefits. 6. Has the plaintiff applied for Social Security Disability Benefits? a. If so, when? b. Was the application denied? c. Is plaintiff appealing or re-filing for Social Security Disability benefits? 7. Has plaintiff received dialysis treatment for kidney disease? 8. Has plaintiff received treatment for End-Stage Renal Disease? 9. If plaintiff has been receiving Medicare and/or Medicaid benefits and is now deceased, please provide the following: a. Relationship of the administrator of plaintiff’s estate to plaintiff’s decedent; b. Name and address of plaintiff’s administrator; Our File #: 2023-000832 FN2047630 15 of 42 FILED: KINGS COUNTY CLERK 03/01/2023 02:32 PM INDEX NO. 525864/2020 NYSCEF DOC. NO. 28 RECEIVED NYSCEF: 03/01/2023 c. Telephone number and/or e-mail address of plaintiff’s administrator; d. Social Security number of plaintiff’s administrator; e. An authorization to examine and copy deceased’s Medicare and/or Medicaid records. PLEASE TAKE FURTHER NOTICE, that pursuant to CPLR, this is a continuing demand and that you are required to serve the demanded information within thirty (30) days of the date of this demand. PLEASE TAKE FURTHER NOTICE, that failure to comply with this Demand for Medicare/Medicaid information may result in the necessity of a motion to compel discovery accompanied by a request for the appropriate costs. Dated: New York, New York March 1, 2023 Yours, etc., LAUREN A. JONES Attorney for Defendant Consolidated Edison Company of New York, Inc. s/h/a Consolidated Edison, Inc. 4 Irving Place, Room 1800 New York, NY 10003-3598 TO: LAW OFFICES OF MICHAEL S. LAMONSOFF, PLLC Attorneys for Plaintiff Financial Square at 32 Old Slip – 8th Floor New York, NY 10005 Our File #: 2023-000832 FN2047630 16 of 42 FILED: KINGS COUNTY CLERK 03/01/2023 02:32 PM INDEX NO. 525864/2020 NYSCEF DOC. NO. 28 RECEIVED NYSCEF: 03/01/2023 CONSENT TO RELEASE The language below should be used when you, a Medicare beneficiary, want to authorize someone other than your attorney or other representative to receive information, including identifiable health information, from the Centers for Medicare & Medicaid Services (CMS) related to your liability insurance (including self-insurance), no-fault insurance or workers' compensation claim. I, (print your name exactly as shown on your Medicare card) hereby authorize the CMS, its agents and/or contractors to release, upon request, information related to my injury/illness and/or settlement for the specified date of injury/illness to the individual and/or entity listed below: CHECK ONLY ONE OF THE FOLLOWING TO INDICATE WHO MAY RECEIVE INFORMATION AND THEN PRINT THE REQUESTED INFORMATION; (If you intend to have your information released to more than one individual or entity, you must complete a separate release for each one.) ( ) Insurance Company ( ) Workers' Compensation Carrier ( ) Other (Explain) Name of entity: Contact for above entity: Address: Telephone: CHECK ONE OF THE FOLLOWING TO INDICATE HOW LONG CMS MAY RELEASE YOUR INFORMATION (The period you check will run from when you sign and date below.): ( ) One Year ( ) Two Years ( ) Other (Provide a specific period of time) I understand that I may revoke this "consent to release information" at any time, in writing. MEDICARE BENEFICIARY INFORMATION AND SIGNATURE: Beneficiary Signature: ______Date signed: ______________________ Note: If the beneficiary is incapacitated, the submitter of this document will need to include documentation establishing the authority of the individual signing on the beneficiary's behalf. Please visit http://go.cms.gov/cobro for further instructions. Medicare Health Insurance claim Number (The number on your Medicare card.): _________________ Date of Injury/Illness: _________________ 17 of 42 FILED: KINGS COUNTY CLERK 03/01/2023 02:32 PM INDEX NO. 525864/2020 NYSCEF DOC. NO. 28 RECEIVED NYSCEF: 03/01/2023 JPC:cg 03/01/23 SUPREME COURT OF THE STATE OF NEW YORK COUNTY OF KINGS DEBRA JERONIMO, INDEX NO. 525864/20 Plaintiff, DEMAND FOR - against - MEDICAL AND EMPLOYMENT CITY OF NEW YORK, LUTHERAN MEDICAL CENTER, RECORDS AND and NYU LANGONE HOSPITALS, and AUTHORIZATIONS CONSOLIDATED EDISON, INC., Defendants. COUNSELORS: PLEASE TAKE NOTICE, that pursuant to CPLR Rule 3120, the undersigned defendant herewith demands that you produce the authorizations specified and for the discovery and inspection of the records demanded, with leave to photocopy, at the office of the undersigned within twenty (20) days from the date hereof the following: a. Names and addresses and copies of any and all reports of those physicians and health care providers who have treated and/or examined plaintiff, DEBRA JERONIMO, and the names of all prescriptions by those physicians and health care providers issued to the examined plaintiff and the names and addresses of pharmacies at which said prescriptions issued by the aforementioned physicians and health care providers were filled, as a result of any injury (including prior injury) to the part or parts of the body allegedly injured as a result of the occurrence giving rise to this litigation, including any and all diagnostic reports, and ambulance call reports, and; b. Duly executed and acknowledged written authorizations, fully compliant with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the regulations applicable thereto and expiring no less than six (6) months after the date of signature, Our File #: 2023-000832 FN2047630 18 of 42 FILED: KINGS COUNTY CLERK 03/01/2023 02:32 PM INDEX NO. 525864/2020 NYSCEF DOC. NO. 28 RECEIVED NYSCEF: 03/01/2023 permitting the undersigned or their representative to inspect and obtain photostatic copies of the records, office charts, nurses' notes, diagnostic studies, x-rays and any other records maintained by plaintiff(s) insurer(s) and by those physicians and health care facilities referred to in paragraph "a" above, and permitting the undersigned or their representative to inspect and obtain photostatic copies of all records of filled pharmacy prescriptions identified and referred to in paragraph “a” above. c. Duly executed and notarized written authorizations, fully compliant with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the regulations applicable thereto and expiring no less than six (6) months after the date of signature, permitting the undersigned or their representative to inspect and obtain photostatic copies of the records of any and all hospitals wherein Plaintiff(s) was/were treated and/or confined, including all x-ray reports. d. Names and addresses of all insurance carriers, including disability, no-fault, or workers compensation carriers who have received claims and/or provided benefits to the plaintiff as a result of any injury resulting from the occurrence giving rise to this litigation. e. Duly executed and acknowledged written authorizations, fully compliant with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the regulations applicable thereto and expiring no less than six (6) months after the date of signature, permitting the undersigned or their representative to inspect and obtain photostatic copies of all insurance records and files maintained by those carriers referred to in paragraph "d" above. f. Duly executed and acknowledged written authorizations, fully compliant with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the regulations applicable thereto and expiring no less than six (6) months after the date of signature, permitting the undersigned or their representative to inspect and obtain photostatic copies of all workers compensation records and files maintained either by those workers compensation carriers referred to in paragraph "d" above or maintained by The Workers Compensation Board. g. Duly executed and acknowledged written authorizations, fully compliant with the Health Insurance Portability and Accountability Our File #: 2023-000832 FN2047630 19 of 42 FILED: KINGS COUNTY CLERK 03/01/2023 02:32 PM INDEX NO. 525864/2020 NYSCEF DOC. NO. 28 RECEIVED NYSCEF: 03/01/2023 Act of 1996 (HIPAA) and the regulations applicable thereto and expiring no less than six (6) months after the date of signature, permitting the undersigned or his representative to inspect and obtain photostatic copies of all employment records and files maintained by plaintiff’s employer. If plaintiff is self-employed, then written authorizations, fully compliant with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the regulations applicable thereto and expiring no less than six (6) months after the date of signature, permitting the undersigned or their representative to inspect and obtain photostatic copies of plaintiff’s IRS tax returns for the year of accident and two years prior to the date of accident, including two forms of identification customarily required by the IRS to obtain such records. In lieu of appearing at the stated time and place, you may send by the time required copies of the documents and a statement that you are furnishing them pursuant to this notice. PLEASE TAKE FURTHER NOTICE, that this demand shall be deemed to continue during the pendency of this action, including the trial thereof. In the event of refusal to comply with this demand, the defendant shall seek to preclude the testimony of any parties in relation to the information and documentation sought herein. Dated: New York, New York March 1, 2023. Yours, etc., LAUREN A. JONES Attorney for Defendant Consolidated Edison Company of New York, Inc. s/h/a Consolidated Edison, Inc. 4 Irving Place, Room 1800 New York, NY 10003-3598 Our File #: 2023-000832 FN2047630 20 of 42 FILED: KINGS COUNTY CLERK 03/01/2023 02:32 PM INDEX NO. 525864/2020 NYSCEF DOC. NO. 28 RECEIVED NYSCEF: 03/01/2023 TO: LAW OFFICES OF MICHAEL S. LAMONSOFF, PLLC Attorneys for Plaintiff Financial Square at 32 Old Slip – 8th Floor New York, NY 10005 Our File #: 2023-000832 FN2047630 21 of 42 FILED: KINGS COUNTY CLERK 03/01/2023 02:32 PM INDEX NO. 525864/2020 NYSCEF DOC. NO. 28 RECEIVED NYSCEF: 03/01/2023 JPC:cg 03/01/23 SUPREME COURT OF THE STATE OF NEW YORK COUNTY OF KINGS DEBRA JERONIMO, INDEX NO. 525864/20 Plaintiff, - against - COMBINED DEMAND CITY OF NEW YORK, LUTHERAN MEDICAL CENTER, and NYU LANGONE HOSPITALS, and CONSOLIDATED EDISON, INC., Defendants. COUNSELORS: PLEASE TAKE NOTICE, that pursuant to CPLR Rule 3120, the undersigned defendant herewith demands that all parties produce within twenty (20) days at the Law Offices of Lauren A. Jones, located at 4 Irving Place, New York, NY 10003, the following information: 1. Set forth in writing the name and address of each witness to the following: