Preview
FILED: QUEENS COUNTY CLERK 03/24/2023 08:24 AM INDEX NO. 706270/2023
NYSCEF DOC. NO. 6 RECEIVED NYSCEF: 03/24/2023
101 GREENWICH STREET
22ND FLOOR
NEW YORK, NEW YORK10006
(212) 766-1888
FAX (212) 766-3252
WWW.MDAFNY .COM
March 23, 2023
jason.zemsky@gmail.com
ZEMSKY & SALOMON PC
33 Front Street suite 207
Hemsptead, New York 11550
Claim No.: 202477632
Insured: PROGRESSIVE INSURANCE COMPANY
Date of Loss: 08-07-2020
Our File No.: (PRG) 75396
SANCHEZ v. PROGRESSIVE
Dear Counsel:
We have been retained by Progressive Insurance Company with respect to the above
referenced matter.
In accordance with the terms of the policy issued by Progressive, please allow this to
serve as a formal demand for authorizations to obtain all of plaintiff’s medical records, hospital
records, MRIs/X-rays, employment records, and no-fault file.
Additionally, we request authorizations for plaintiff’s primary care physician and
Ob/GYN.
We also request an EUO and IME of your client. Kindly contact our office to schedule
same.
Thank you for your attention to this matter.
Very truly yours,
Gail S. Karan
GSK/sd GAIL S. KARAN
FILED: QUEENS COUNTY CLERK 03/24/2023 08:24 AM INDEX NO. 706270/2023
NYSCEF DOC. NO. 6 RECEIVED NYSCEF: 03/24/2023
SUPREME COURT OF THE STATE OF NEW YORK
COUNTY OF QUEENS
----------------------------------------------------------------x
In the Matter of the Application for an Order Index No.:
Staying Arbitration Between
PROGRESSIVE CASUALTY INSURANCE DEMAND FOR VERIFIED
COMPANY, PROOF OF LOSS
Petitioner,
-against-
MARISELA SANCHEZ
Respondent.
---------------------------------------------------------------x
PLEASE TAKE NOTICE that you are required to serve upon the undersigned a Verified
written Proof of Loss, as to each claimant, responsive to the following demands within thirty (30)
days of service of this notice.
1. Set forth the name, current address, date of birth, marital status, and Social Security
number of claimant.
2. Set forth the date, time, and location (as nearly as possible the exact place with
particular reference to stationary objects, including curb or pavement lines of the highway which
could be employed to locate the exact point) of the accident that allegedly caused the claimant’s
injuries.
3. Set forth all defects of the property and/or vehicles of all of the tortfeasors which
are claimed to have caused or contributed to the accident.
4. Set forth a statement of the acts or omissions constituting the negligence on the part
of all tortfeasors.
FILED: QUEENS COUNTY CLERK 03/24/2023 08:24 AM INDEX NO. 706270/2023
NYSCEF DOC. NO. 6 RECEIVED NYSCEF: 03/24/2023
5. Specify the statutes, ordinances, rules or regulations (federal or state), stating the
sections or paragraphs thereof, which it is claimed were violated by any tortfeasor and state the
manner in which each was violated.
6. Set forth in detail a full description of any injuries, conditions and syndromes
claimant claims were caused or aggravated by the occurrence, stating separately which were
caused by the occurrence and which were aggravated.
(a) Specify which of such injuries, conditions and syndromes are claimed to still exist;
(b) Specify of which such injuries, conditions and syndromes are claimed will be
permanent;
(c) Specify which of such injuries, conditions and syndromes were activated by the
occurrence.
7. Set forth the following:
(i) The name, address, dates of treatment, nature of the treatment and the total expense
incurred for each of the following:
(a) Hospitals;
(b) Physicians;
(c) Dentists;
(d) Mental health providers;
(e) Physical therapists;
(f) Nurses;
(g) Any other person or entity which provided services or treatment to the claimant
for the injuries, conditions and syndromes which claimant claims were caused
or aggravated by the occurrence.
(ii) The name, address, date of service or sale, description of the service or items
supplied and total expense for each of the following:
(a) Medical supplies;
(b) X-rays, CT scans, MRIs;
(c) Ambulance;
(d) Prescription medications;
FILED: QUEENS COUNTY CLERK 03/24/2023 08:24 AM INDEX NO. 706270/2023
NYSCEF DOC. NO. 6 RECEIVED NYSCEF: 03/24/2023
(e) Orthopedic appliances, braces, prosthetic devices;
(f) Dental appliances;
(g) Housekeeping services;
(h) Any other expenses incurred by the claimant as a result of the injuries, conditions,
and syndromes which claimant claims were caused or aggravated by the occurrence.
8. Set forth the following:
(i) The nature of the treatment needed and the total expense which claimant claims
will be incurred in the future for each of the following:
(a) Hospitals;
(b) Physicians;
(c) Dentists;
(d) Mental health providers;
(e) Physical therapists;
(f) Nurses;
(g) Any other person or entity which will provide services or treatment to the claimant
in the future for the injuries, conditions and syndromes which claimant claims were caused or
aggravated by the occurrence and state the nature of such service or treatment and the total claims.
(i) A description of the service or items to be supplied in the future and the total
expense for each of the following:
(a) Medical supplies;
(b) X-rays, CT scans, MRIs;
(c) Ambulance;
(d) Prescription medications;
(e) Orthopedic appliances, braces, prosthetic devices;
(f) Dental appliances;
(g) Housekeeping services;
(h) Any other expenses incurred by the claimant as a result of the injuries, conditions, and
syndromes which claimant claims were caused or aggravated by the occurrence.
9. Set forth the name and address of each and every medical provider the claimant
treated with prior to the subject accident, for injuries to similar areas of the body allegedly injured
in this accident.
10. Set forth the dates on which claimant was confined to:
(a) Bed;
FILED: QUEENS COUNTY CLERK 03/24/2023 08:24 AM INDEX NO. 706270/2023
NYSCEF DOC. NO. 6 RECEIVED NYSCEF: 03/24/2023
(b) Home.
as a result of the injuries, conditions, and syndromes claimant claims were caused or aggravated
by the occurrence.
11. Set forth the following:
(a) The name and address of claimant’s employer on the date of the occurrence;
(b) The claimant’s job title or position and a description of the claimant’s job duties at
the time of the occurrence;
(c) The claimant’s hourly, weekly, monthly or annual wage or salary at the time of the
occurrence;
(d) The dates of incapacity from working at said employment as a result of the injuries,
conditions and syndromes claimant claims were caused or aggravated by the occurrence;
(e) The total amount of lost earnings (including but not limited to bonuses,
commissions, and fringe benefits) which claimant claims has been lost to date as a result of the
injuries, conditions and syndromes which claimant claims were caused or aggravated by the
occurrence;
(f) The total amount of earnings (including but not limited to bonuses, commissions,
and fringe benefits) which claimant claims will be lost in the future as a result of the injuries,
conditions and syndromes which claimant claims were caused or aggravated by the occurrence.
12. Set forth the following:
(a) The name and address of the school claimant was attending at the time of the
occurrence;
(b) The grade attended at the time of the occurrence; and
FILED: QUEENS COUNTY CLERK 03/24/2023 08:24 AM INDEX NO. 706270/2023
NYSCEF DOC. NO. 6 RECEIVED NYSCEF: 03/24/2023
(c) The dates of incapacity from attending said school as a result of the injuries,
conditions and syndromes which claimant claims were caused or aggravated by the occurrence;
(d) Whether claimant was prevented from progressing with his/her graduation track.
13. Set forth a statement specifying the period to be claimed for loss of society,
companionship, affection or services and describe the services lost.
14. Set forth any other item of special damage claimed by the claimant as a result of
the occurrence and the amount claimed.
15. State the manner in which claimant complies with §5102 of the Insurance Law of
the State of New York.
16. Set forth the following:
(a) If it is claimed that claimant sustained a significant disfigurement under Insurance
Law §5102(d), identify the disfigurement and provide a detailed description of said disfigurement
including its location, size, shape and coloration;
(b) If it is claimed that claimant sustained a fracture, identify the body part fractured
and provide a description of said fracture;
(c) If it is claimed that claimant sustained a permanent loss of use of a body organ,
member, function or system pursuant to Insurance Law §5102(d), identify the specific body organ,
member, function or system and describe in detail the nature of the permanent loss of use;
(d) If it is claimed that claimant sustained a permanent consequential limitation of use
of a body organ or member pursuant to Insurance Law §5102(d), identify the body organ or
member and escribe in detail the permanent limitation;
FILED: QUEENS COUNTY CLERK 03/24/2023 08:24 AM INDEX NO. 706270/2023
NYSCEF DOC. NO. 6 RECEIVED NYSCEF: 03/24/2023
(e) If it is claimed that claimant sustained a significant limitation of use of a body
function or system pursuant to Insurance Law §5102(d), identify the body function or system and
describe in detail the significant limitation;
(f) If it is claimed that claimant sustained a medically determined injury or impairment
of a non-permanent nature which prevents claimant from performing substantially all of the
material acts which constitute such person’s usual and customary daily activities for not less than
ninety (90) days during the one hundred eighth (180) days immediately following the occurrence
of the injury or impairment pursuant to Insurance Law §5102(d), identify:
(1) the medically determined injury or impairment;
(2) the material acts which constitute claimant’s usual and customary activities;
(3) the usual and customary acts which claimant was prevented from engaging in due to
the impairment or injury; and
(4) the dates which claimant was prevented from engaging in substantially all the material
acts which constitute his/her usual and customary daily activities.
PLEASE TAKE FURTHER NOTICE, that your failure to serve a Verified written Proof
of Loss of the above will be used as a basis for denial of SUM/UM benefits.
Dated: New York, New York
March 23, 2023
Yours etc.,
MORRIS DUFFY ALONSO FALEY & PITCOFF
By: _________________________________________
GAIL S. KARAN
Attorneys for Petitioner
101 Greenwich Street, 22nd Floor
New York, New York 10006
(212) 766-1888; fax: (212) 766-3252
FILED: QUEENS COUNTY CLERK 03/24/2023 08:24 AM INDEX NO. 706270/2023
NYSCEF DOC. NO. 6 RECEIVED NYSCEF: 03/24/2023
Our File No.: (PRG) 75396
To:
ZEMSKY & SALOMON PC
Attorney for Respondent
33 Front Street suite 207
Hemsptead, New York 11550
(516) 485 3800
jason.zemsky@gmail.com
FILED: QUEENS COUNTY CLERK 03/24/2023 08:24 AM INDEX NO. 706270/2023
NYSCEF DOC. NO. 6 RECEIVED NYSCEF: 03/24/2023
AFFIDAVIT OF SERVICE BY EMAIL
STATE OF NEW YORK )
ss.:
COUNTY OF NEW YORK )
SANDI DEFAZIO being duly sworn, says: I am not a party to the action, am
over 18 years of age and reside in Peekskill, New York. That on the 23rd day of March, 2023, I
served the within DEMAND FOR PROOF OF LOSS upon:
ZEMSKY & SALOMON PC
Attorney for Respondent
33 Front Street suite 207
Hemsptead, New York 11550
jason.zemsky@gmail.com
SANDI DEFAZIO
Sworn to before me this
23rd day of March 2023
Notary Public
GAIL S. KARAN
Notary Public, State of New York
No. 01KA5049651
Commission Expires 9/18/2025
FILED: QUEENS COUNTY CLERK 03/24/2023 08:24 AM INDEX NO. 706270/2023
NYSCEF DOC. NO. 6 RECEIVED NYSCEF: 03/24/2023
Index No.:
SUPREME COURT OF THE STATE OF NEW YORK
COUNTY OF QUEENS
---------------------------------------------------------------------X
In the Matter of the Application for an Order
Staying Arbitration Between
PROGRESSIVE CASUALTY INSURANCE
COMPANY,
Petitioner,
-against-
MARISELA SANCHEZ
Respondent.
------------------------------------------------------------------X
DEMAND FOR PROOF OF LOSS
MORRIS DUFFY ALONSO FALEY & PITCOFF
Attorneys for Petitioner
101 Greenwich Street, 22nd Floor
New York, New York 10006
(212) 766-1888
Preview
FILED: QUEENS COUNTY CLERK 03/24/2023 08:24 AM INDEX NO. 706270/2023 NYSCEF DOC. NO. 6 RECEIVED NYSCEF: 03/24/2023 101 GREENWICH STREET 22ND FLOOR NEW YORK, NEW YORK10006 (212) 766-1888 FAX (212) 766-3252 WWW.MDAFNY .COM March 23, 2023 jason.zemsky@gmail.com ZEMSKY & SALOMON PC 33 Front Street suite 207 Hemsptead, New York 11550 Claim No.: 202477632 Insured: PROGRESSIVE INSURANCE COMPANY Date of Loss: 08-07-2020 Our File No.: (PRG) 75396 SANCHEZ v. PROGRESSIVE Dear Counsel: We have been retained by Progressive Insurance Company with respect to the above referenced matter. In accordance with the terms of the policy issued by Progressive, please allow this to serve as a formal demand for authorizations to obtain all of plaintiff’s medical records, hospital records, MRIs/X-rays, employment records, and no-fault file. Additionally, we request authorizations for plaintiff’s primary care physician and Ob/GYN. We also request an EUO and IME of your client. Kindly contact our office to schedule same. Thank you for your attention to this matter. Very truly yours, Gail S. Karan GSK/sd GAIL S. KARAN FILED: QUEENS COUNTY CLERK 03/24/2023 08:24 AM INDEX NO. 706270/2023 NYSCEF DOC. NO. 6 RECEIVED NYSCEF: 03/24/2023 SUPREME COURT OF THE STATE OF NEW YORK COUNTY OF QUEENS ----------------------------------------------------------------x In the Matter of the Application for an Order Index No.: Staying Arbitration Between PROGRESSIVE CASUALTY INSURANCE DEMAND FOR VERIFIED COMPANY, PROOF OF LOSS Petitioner, -against- MARISELA SANCHEZ Respondent. ---------------------------------------------------------------x PLEASE TAKE NOTICE that you are required to serve upon the undersigned a Verified written Proof of Loss, as to each claimant, responsive to the following demands within thirty (30) days of service of this notice. 1. Set forth the name, current address, date of birth, marital status, and Social Security number of claimant. 2. Set forth the date, time, and location (as nearly as possible the exact place with particular reference to stationary objects, including curb or pavement lines of the highway which could be employed to locate the exact point) of the accident that allegedly caused the claimant’s injuries. 3. Set forth all defects of the property and/or vehicles of all of the tortfeasors which are claimed to have caused or contributed to the accident. 4. Set forth a statement of the acts or omissions constituting the negligence on the part of all tortfeasors. FILED: QUEENS COUNTY CLERK 03/24/2023 08:24 AM INDEX NO. 706270/2023 NYSCEF DOC. NO. 6 RECEIVED NYSCEF: 03/24/2023 5. Specify the statutes, ordinances, rules or regulations (federal or state), stating the sections or paragraphs thereof, which it is claimed were violated by any tortfeasor and state the manner in which each was violated. 6. Set forth in detail a full description of any injuries, conditions and syndromes claimant claims were caused or aggravated by the occurrence, stating separately which were caused by the occurrence and which were aggravated. (a) Specify which of such injuries, conditions and syndromes are claimed to still exist; (b) Specify of which such injuries, conditions and syndromes are claimed will be permanent; (c) Specify which of such injuries, conditions and syndromes were activated by the occurrence. 7. Set forth the following: (i) The name, address, dates of treatment, nature of the treatment and the total expense incurred for each of the following: (a) Hospitals; (b) Physicians; (c) Dentists; (d) Mental health providers; (e) Physical therapists; (f) Nurses; (g) Any other person or entity which provided services or treatment to the claimant for the injuries, conditions and syndromes which claimant claims were caused or aggravated by the occurrence. (ii) The name, address, date of service or sale, description of the service or items supplied and total expense for each of the following: (a) Medical supplies; (b) X-rays, CT scans, MRIs; (c) Ambulance; (d) Prescription medications; FILED: QUEENS COUNTY CLERK 03/24/2023 08:24 AM INDEX NO. 706270/2023 NYSCEF DOC. NO. 6 RECEIVED NYSCEF: 03/24/2023 (e) Orthopedic appliances, braces, prosthetic devices; (f) Dental appliances; (g) Housekeeping services; (h) Any other expenses incurred by the claimant as a result of the injuries, conditions, and syndromes which claimant claims were caused or aggravated by the occurrence. 8. Set forth the following: (i) The nature of the treatment needed and the total expense which claimant claims will be incurred in the future for each of the following: (a) Hospitals; (b) Physicians; (c) Dentists; (d) Mental health providers; (e) Physical therapists; (f) Nurses; (g) Any other person or entity which will provide services or treatment to the claimant in the future for the injuries, conditions and syndromes which claimant claims were caused or aggravated by the occurrence and state the nature of such service or treatment and the total claims. (i) A description of the service or items to be supplied in the future and the total expense for each of the following: (a) Medical supplies; (b) X-rays, CT scans, MRIs; (c) Ambulance; (d) Prescription medications; (e) Orthopedic appliances, braces, prosthetic devices; (f) Dental appliances; (g) Housekeeping services; (h) Any other expenses incurred by the claimant as a result of the injuries, conditions, and syndromes which claimant claims were caused or aggravated by the occurrence. 9. Set forth the name and address of each and every medical provider the claimant treated with prior to the subject accident, for injuries to similar areas of the body allegedly injured in this accident. 10. Set forth the dates on which claimant was confined to: (a) Bed; FILED: QUEENS COUNTY CLERK 03/24/2023 08:24 AM INDEX NO. 706270/2023 NYSCEF DOC. NO. 6 RECEIVED NYSCEF: 03/24/2023 (b) Home. as a result of the injuries, conditions, and syndromes claimant claims were caused or aggravated by the occurrence. 11. Set forth the following: (a) The name and address of claimant’s employer on the date of the occurrence; (b) The claimant’s job title or position and a description of the claimant’s job duties at the time of the occurrence; (c) The claimant’s hourly, weekly, monthly or annual wage or salary at the time of the occurrence; (d) The dates of incapacity from working at said employment as a result of the injuries, conditions and syndromes claimant claims were caused or aggravated by the occurrence; (e) The total amount of lost earnings (including but not limited to bonuses, commissions, and fringe benefits) which claimant claims has been lost to date as a result of the injuries, conditions and syndromes which claimant claims were caused or aggravated by the occurrence; (f) The total amount of earnings (including but not limited to bonuses, commissions, and fringe benefits) which claimant claims will be lost in the future as a result of the injuries, conditions and syndromes which claimant claims were caused or aggravated by the occurrence. 12. Set forth the following: (a) The name and address of the school claimant was attending at the time of the occurrence; (b) The grade attended at the time of the occurrence; and FILED: QUEENS COUNTY CLERK 03/24/2023 08:24 AM INDEX NO. 706270/2023 NYSCEF DOC. NO. 6 RECEIVED NYSCEF: 03/24/2023 (c) The dates of incapacity from attending said school as a result of the injuries, conditions and syndromes which claimant claims were caused or aggravated by the occurrence; (d) Whether claimant was prevented from progressing with his/her graduation track. 13. Set forth a statement specifying the period to be claimed for loss of society, companionship, affection or services and describe the services lost. 14. Set forth any other item of special damage claimed by the claimant as a result of the occurrence and the amount claimed. 15. State the manner in which claimant complies with §5102 of the Insurance Law of the State of New York. 16. Set forth the following: (a) If it is claimed that claimant sustained a significant disfigurement under Insurance Law §5102(d), identify the disfigurement and provide a detailed description of said disfigurement including its location, size, shape and coloration; (b) If it is claimed that claimant sustained a fracture, identify the body part fractured and provide a description of said fracture; (c) If it is claimed that claimant sustained a permanent loss of use of a body organ, member, function or system pursuant to Insurance Law §5102(d), identify the specific body organ, member, function or system and describe in detail the nature of the permanent loss of use; (d) If it is claimed that claimant sustained a permanent consequential limitation of use of a body organ or member pursuant to Insurance Law §5102(d), identify the body organ or member and escribe in detail the permanent limitation; FILED: QUEENS COUNTY CLERK 03/24/2023 08:24 AM INDEX NO. 706270/2023 NYSCEF DOC. NO. 6 RECEIVED NYSCEF: 03/24/2023 (e) If it is claimed that claimant sustained a significant limitation of use of a body function or system pursuant to Insurance Law §5102(d), identify the body function or system and describe in detail the significant limitation; (f) If it is claimed that claimant sustained a medically determined injury or impairment of a non-permanent nature which prevents claimant from performing substantially all of the material acts which constitute such person’s usual and customary daily activities for not less than ninety (90) days during the one hundred eighth (180) days immediately following the occurrence of the injury or impairment pursuant to Insurance Law §5102(d), identify: (1) the medically determined injury or impairment; (2) the material acts which constitute claimant’s usual and customary activities; (3) the usual and customary acts which claimant was prevented from engaging in due to the impairment or injury; and (4) the dates which claimant was prevented from engaging in substantially all the material acts which constitute his/her usual and customary daily activities. PLEASE TAKE FURTHER NOTICE, that your failure to serve a Verified written Proof of Loss of the above will be used as a basis for denial of SUM/UM benefits. Dated: New York, New York March 23, 2023 Yours etc., MORRIS DUFFY ALONSO FALEY & PITCOFF By: _________________________________________ GAIL S. KARAN Attorneys for Petitioner 101 Greenwich Street, 22nd Floor New York, New York 10006 (212) 766-1888; fax: (212) 766-3252 FILED: QUEENS COUNTY CLERK 03/24/2023 08:24 AM INDEX NO. 706270/2023 NYSCEF DOC. NO. 6 RECEIVED NYSCEF: 03/24/2023 Our File No.: (PRG) 75396 To: ZEMSKY & SALOMON PC Attorney for Respondent 33 Front Street suite 207 Hemsptead, New York 11550 (516) 485 3800 jason.zemsky@gmail.com FILED: QUEENS COUNTY CLERK 03/24/2023 08:24 AM INDEX NO. 706270/2023 NYSCEF DOC. NO. 6 RECEIVED NYSCEF: 03/24/2023 AFFIDAVIT OF SERVICE BY EMAIL STATE OF NEW YORK ) ss.: COUNTY OF NEW YORK ) SANDI DEFAZIO being duly sworn, says: I am not a party to the action, am over 18 years of age and reside in Peekskill, New York. That on the 23rd day of March, 2023, I served the within DEMAND FOR PROOF OF LOSS upon: ZEMSKY & SALOMON PC Attorney for Respondent 33 Front Street suite 207 Hemsptead, New York 11550 jason.zemsky@gmail.com SANDI DEFAZIO Sworn to before me this 23rd day of March 2023 Notary Public GAIL S. KARAN Notary Public, State of New York No. 01KA5049651 Commission Expires 9/18/2025 FILED: QUEENS COUNTY CLERK 03/24/2023 08:24 AM INDEX NO. 706270/2023 NYSCEF DOC. NO. 6 RECEIVED NYSCEF: 03/24/2023 Index No.: SUPREME COURT OF THE STATE OF NEW YORK COUNTY OF QUEENS ---------------------------------------------------------------------X In the Matter of the Application for an Order Staying Arbitration Between PROGRESSIVE CASUALTY INSURANCE COMPANY, Petitioner, -against- MARISELA SANCHEZ Respondent. ------------------------------------------------------------------X DEMAND FOR PROOF OF LOSS MORRIS DUFFY ALONSO FALEY & PITCOFF Attorneys for Petitioner 101 Greenwich Street, 22nd Floor New York, New York 10006 (212) 766-1888