Preview
FILED: NEW YORK COUNTY CLERK 05/17/2023 04:04 PM INDEX NO. 154505/2023
NYSCEF DOC. NO. 1 RECEIVED NYSCEF: 05/17/2023
SUPREME COURT OF THE STATE OF NEW YORK
COUNTY OF NEW YORK
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HEREFORD INSURANCE COMPANY, Index No.:
Plaintiff, SUMMONS
-against-
Plaintiff
DAECHAUN KARON FREEMAN-ALEXANDER designates
JARRETT CANTY New York
JORDAN LEE CANTY County as a
place of trial
The “Individual Defendants”
Basis of
-and- venue is
address of
Defendants
ANGELA ABRAMOV-PLISCHTEJEW NP-PSYCH/ MENTAL HEALTH
ASM DIAGNOSTIC, INC
ATLANTIC MEDICAL & DIAGNOSTIC, PC
BHNM TECH SERVICES INC
BRIGHT STAR REHAB PHYSICAL THERAPY, PC
BVH DIAGNOSTICS, INC
COMPREHENSIVE DIAGNOSTICS AND IMAGING, PC
EPISCOPAL HEALTH SERVICES, INC d/b/a ST. JOHN'S EPISCOPAL
HOSPITAL,
ETZEM DIAGNOSTICS INC
GLOBAL TECH DIAGNOSTIC INC
H. LEVITAN MEDICAL, PC
INTEGRATED MEDICAL REHABILITATION DIAGNOSTICS, PC
JOSEPH RAIA, MD, PC
LANG EQUIPMENT INC
LIJ MEDICAL CENTER a/k/a LONG ISLAND JEWISH MEDICAL
CENTER a/k/a NSLIJ LONG ISLAND JEWISH
MEDICAL MRI, PC
MEDLINE PLUS PHARMACY INC
MIDLAND PHARMACY YONKERS CORP
NIMBLE SOLUTION INC
NORTH SHORE-LIJ MEDICAL, PC
NORTH SHORE UNIVERSITY HOSPITAL
ORTHOCOR SUPPLY INC.
ORTHOMOTION REHAB DME, INC
ORTHO SPORTS SUPPLY, INC
PARK CHEMISTS 4 AV LLC
PHARMAKON PHARMACY INC d/b/a NOTTINGHAM PHARMACY
PITCH MEDICAL SERVICES PC
PMK ACUPUNCTURE PC
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PULSE MED SUPPLY CORP
QUEENS CITY REHAB PT PC
RASHBI DIAGNOSTIC IMAGING, INC
RED MEDICAL SUPPLY INC.
RIGHT CHOICE SUPPLY, INC
SHMUEL GOLFEYZ MD
TRI-BOROUGH NY MEDICAL PRACTICE P.C. d/b/a BRONX MEDICAL
The “Medical Provider Defendants”
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To the above-named Defendants:
YOU ARE HEREBY SUMMONED to answer the complaint in this action and to serve
a copy of your answer, or, if the complaint is not served with this summons, to serve a notice of
appearance, on the plaintiff’s attorney(s) within 20 days after the service of this summons,
exclusive of the day of service (or within 30 days after the service is complete if this summons is
not personally delivered to you within the State of New York); and in case of your failure to appear
or answer, judgment will be taken against you by default for the relief demanded in the complaint.
Dated: May 10, 2023
New York, New York
___________________________________
GOLDBERG, MILLER & RUBIN, P.C.
Attorneys for Plaintiff
1501 Broadway, Suite 715
New York, New York 10036
(646) 863-1531
File No.: HF-00656
TO:
DAECHAUN KARON FREEMAN-ALEXANDER
219-16 Alecia Avenue
Laurelton, New York 11413
JARRETT CANTY
140-14 Marissa Street
Laurelton, New York 11413
JORDAN LEE CANTY
140-14 Marissa Street
Laurelton, New York 11413
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ANGELA ABRAMOV-PLISCHTEJEW NP-PSYCH/ MENTAL HEALTH
586 Midland Avenue, Suite 2C
Staten Island, New York 10306
ASM DIAGNOSTIC, INC
80 Orville Drive
Bohemia, New York 11716
Via Secretary of State
ATLANTIC MEDICAL & DIAGNOSTIC, PC
C/O Harfenist Kraut & Perlstein, LLP
3000 Marcus Avenue, Suite 2E1
Lake Success, New York 11042
Via Secretary of State
BHNM TECH SERVICES INC
100 S Bedford Road
Mt. Kisco, New York 10549
Via Secretary of State
BRIGHT STAR REHAB PHYSICAL THERAPY, PC
401 Ditmas Avenue
Brooklyn, New York 11218
Via Secretary of State
BVH DIAGNOSTICS, INC
73 Market Street, 3rd Floor
Yonkers, New York 10710
Via Secretary of State
COMPREHENSIVE DIAGNOSTICS AND IMAGING, PC
200 East 36th Street, 11C
New York, New York 10016
Via Secretary of State
EPISCOPAL HEALTH SERVICES, INC., D/B/A ST. JOHN'S EPISCOPAL HOSPITAL,
377 Oak Street, Suite 300
Garden City, New York 11530
Via Secretary of State
ETZEM DIAGNOSTICS INC
73 Market Street, 3rd Fl
Yonkers, New York 10710
Via Secretary of State
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GLOBAL TECH DIAGNOSTIC INC
100 South Bedford Road
Mt. Kisco, New York 10549
Via Secretary of State
H. LEVITAN MEDICAL, PC
301 East 79th Street, 37P
New York, New York 10075
Via Secretary of State
INTEGRATED MEDICAL REHABILITATION DIAGNOSTICS, PC
18 Green Lawn Road
Huntington, New York 11743
Via Secretary of State
JOSEPH RAIA, MD, PC
9101 4th Ave,
Brooklyn, New York 11209
Via Secretary of State
LANG EQUIPMENT INC
189 Sunrise Highway, Suite 301
Rockville Centre, New York 11570
Via Secretary of State
LIJ MEDICAL CENTER a/k/a LONG ISLAND JEWISH MEDICAL CENTER a/k/a
NSLIJ LONG ISLAND JEWISH
Office Of Legal Affairs
270-05 76th Avenue
New Hyde Park, New York 11040
Via Secretary of State
MEDICAL MRI, PC
101-07 Jamaica Ave
Richmond Hill, New York 11418
Via Secretary of State
MEDLINE PLUS PHARMACY INC
166 Stewart St
Elmont, New York 11003
Via Secretary of State
MIDLAND PHARMACY YONKERS CORP
861 Midland Avenue
Yonkers, New York 10704
Via Secretary of State
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NIMBLE SOLUTION INC
209 Hillside Avenue
Williston Park, New York 11596
Via Secretary of State
NORTH SHORE-LIJ MEDICAL, PC
2000 Marcus Avenue
New Hyde Park, New York 11042
Via Secretary of State
NORTH SHORE UNIVERSITY HOSPITAL
Attn: Administration
300 Community Drive
Manhasset, New York 11030
Via Secretary of State
ORTHOCOR SUPPLY INC.
85-93 66th Avenue, Suite 2
Rego Park, New York 11374
Via Secretary of State
ORTHOMOTION REHAB DME, INC
5 Brewster Street, Suite 113
Glen Cove, New York 11542
Via Secretary of State
ORTHO SPORTS SUPPLY, INC
2774 Coney Island Ave, Room #2
Brooklyn, New York 11235
Via Secretary of State
PARK CHEMISTS 4 AV LLC
500 4th Ave
Brooklyn, New York 11215
Via Secretary of State
PHARMAKON PHARMACY INC d/b/a NOTTINGHAM PHARMACY
585 Stewart Ave. Suite 700
Garden City, New York 11530
Via Secretary of State
PITCH MEDICAL SERVICES PC
100 Park Avenue, Suite 1600
New York, New York 10017
Via Secretary of State
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PMK ACUPUNCTURE PC
47-49 194th Street, 2nd Floor
Flushing, New York 11358
Via Secretary of State
PULSE MED SUPPLY CORP
621 Brighton Beach Ave 2nd Fl
Brooklyn, New York 11235
Via Secretary of State
QUEENS CITY REHAB PT PC
64-20 Saunders Street, Apt F12
Rego Park, New York 11374
Via Secretary of State
RASHBI DIAGNOSTIC IMAGING, INC
25302 Rockaway Blvd
Rosedale, New York 11422
Via Secretary of State
RED MEDICAL SUPPLY INC.
1041A Oyster Bay Rd
East Norwich, Ny 11732
Via Secretary of State
RIGHT CHOICE SUPPLY, INC
104-17 Jamaica Ave
Richmond Hill, New York 11418
Via Secretary of State
SHMUEL GOLFEYZ MD
1674 East 22nd Street, 2nd Floor
Brooklyn, New York 11229
TRI-BOROUGH NY MEDICAL PRACTICE P.C. d/b/a BRONX MEDICAL
790 Bloomfield Ave, Suite 1a
Clifton, New Jersey 07012
Via Secretary of State
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SUPREME COURT OF THE STATE OF NEW YORK
COUNTY OF NEW YORK
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HEREFORD INSURANCE COMPANY, Index No.:
Plaintiff COMPLAINT
-against-
DAECHAUN KARON FREEMAN-ALEXANDER
JARRETT CANTY
JORDAN LEE CANTY
The “Individual Defendants”
-and-
ANGELA ABRAMOV-PLISCHTEJEW NP-PSYCH/ MENTAL HEALTH
ASM DIAGNOSTIC, INC
ATLANTIC MEDICAL & DIAGNOSTIC, PC
BHNM TECH SERVICES INC
BRIGHT STAR REHAB PHYSICAL THERAPY, PC
BVH DIAGNOSTICS, INC
COMPREHENSIVE DIAGNOSTICS AND IMAGING, PC
EPISCOPAL HEALTH SERVICES, INC d/b/a ST. JOHN'S EPISCOPAL
HOSPITAL,
ETZEM DIAGNOSTICS INC
GLOBAL TECH DIAGNOSTIC INC
H. LEVITAN MEDICAL, PC
INTEGRATED MEDICAL REHABILITATION DIAGNOSTICS,
PC
JOSEPH RAIA, MD, PC
LANG EQUIPMENT INC
LIJ MEDICAL CENTER a/k/a LONG ISLAND JEWISH MEDICAL
CENTER a/k/a NSLIJ LONG ISLAND JEWISH
MEDICAL MRI, PC
MEDLINE PLUS PHARMACY INC
MIDLAND PHARMACY YONKERS CORP
NIMBLE SOLUTION INC
NORTH SHORE-LIJ MEDICAL, PC
NORTH SHORE UNIVERSITY HOSPITAL
ORTHOCOR SUPPLY INC.
ORTHOMOTION REHAB DME, INC
ORTHO SPORTS SUPPLY, INC
PARK CHEMISTS 4 AV LLC
PHARMAKON PHARMACY INC d/b/a NOTTINGHAM PHARMACY
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PITCH MEDICAL SERVICES PC
PMK ACUPUNCTURE PC
PULSE MED SUPPLY CORP
QUEENS CITY REHAB PT PC
RASHBI DIAGNOSTIC IMAGING, INC
RED MEDICAL SUPPLY INC.
RIGHT CHOICE SUPPLY, INC
SHMUEL GOLFEYZ MD
TRI-BOROUGH NY MEDICAL PRACTICE P.C. d/b/a BRONX
MEDICAL
The “Medical Provider Defendants”
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Plaintiffs, HEREFORD INSURANCE COMPANY, by its attorneys, Goldberg, Miller &
Rubin, P.C., allege, on information and belief, as follows:
I. THE PARTIES
A. PLAINTIFFS
1. That HEREFORD INSURANCE COMPANY (“HEREFORD”) has been and still
is a foreign insurance company organized and authorized by the State of New York to conduct the
business of insuring New York State vehicles.
B. DEFENDANTS
INDIVIDUAL DEFENDANTS
2. That Defendant, DAECHAUN KARON FREEMAN-ALEXANDER, has been and
still is a New York State resident.
3. That Defendant, JARRETT CANTY, has been and still is a New York State
resident.
4. That Defendant, JORDAN LEE CANTY, has been and still is a New York State
resident.
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MEDICAL PROVIDER DEFENDANTS
5. That Defendant, ANGELA ABRAMOV-PLISCHTEJEW NP-PSYCH/ MENTAL
HEALTH, has been and still is a New York State resident.
6. That Defendant, ASM DIAGNOSTICS INC., has been and still is a New York State
corporation.
7. That Defendant, ATLANTIC MEDICAL & DIAGNOSTIC PC, has been and still
is a New York State professional corporation.
8. That Defendant, BHNM TECH SERVICES INC, has been and still is a New York
State corporation.
9. That Defendant, BRIGHT STAR REHAB PHYSICAL THERAPY, PC, has been
and still is a New York State professional corporation.
10. That Defendant, BVH DIAGNOSTICS INC., has been and still is a New York State
corporation.
11. That Defendant, COMPREHENSIVE DIAGNOSTICS AND IMAGING, PC, has
been and still is a New York State professional corporation.
12. That Defendant, EPISCOPAL HEALTH SERVICES, INC., D/B/A ST. JOHN'S
EPISCOPAL HOSPITAL, has been and still is a New York State not-for-profit corporation.
13. That Defendant, ETZEM DIAGNOSTICS, INC, has been and still is a New York
State corporation.
14. That Defendant, GLOBAL TECH DIAGNOSTIC, INC has been and still is a New
York State corporation.
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15. That Defendant, H. LEVITAN MEDICAL, PC, has been and still is a New York
State professional corporation.
16. That Defendant INTEGRATED MEDICAL REHABILITATION
DIAGNOSTICS, PC, has been and still is a New York State professional corporation.
17. That Defendant, JOSEPH RAIA, MD, P.C., has been and still is a New York State
professional corporation.
18. That Defendant LANG EQUIPMENT, INC, has been and still is a New York State
corporation.
19. That Defendant, LIJ MEDICAL CENTER a/k/a LONG ISLAND JEWISH
MEDICAL CENTER a/k/a NSLIJ LONG ISLAND JEWISH, has been and still is a New York
State not-for-profit corporation.
20. That Defendant MEDICAL MRI, PC, has been and still is a New York State
professional corporation.
21. That Defendant MEDLINE PLUS PHARMACY, INC, has been and still is a New
York State corporation.
22. That Defendant MIDLAND PHARMACY YONKERS, CORP, has been and still
is a New York State corporation.
23. That Defendant, NIMBLE SOLUTION, INC, has been and still is a New York State
corporation.
24. That Defendant, NORTH SHORE-LIJ MEDICAL, has been and still is a New York
State professional corporation.
25. That Defendant, NORTH SHORE UNIVERSITY HOSPITAL, has been and still
is a New York State not-for-profit corporation.
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26. That Defendant, ORTHOCOR SUPPLY, INC., has been and still is a New York
State corporation.
27. That Defendant, ORTHOMOTION REHAB DME, INC., has been and still is a
New York State corporation.
28. That Defendant, ORTHO SPORTS SUPPLY, INC., has been and still is a New
York State corporation.
29. That Defendant, PARK CHEMISTS 4 AV, LLC, has been and still is a New York
State limited liability company.
30. That Defendant, PHARMAKON PHARMACY INC d/b/a NOTTINGHAM
PHARMACY, INC., has been and still is a New York State corporation.
31. That Defendant, PITCH MEDICAL SERVICES, PC, has been and still is a New
York State professional corporation.
32. That Defendant, PMK ACUPUNCTURE, PC, has been and still is a New York
State professional corporation.
33. That Defendant, PULSE MED SUPPLY CORP, has been and still is a New York
State corporation.
34. That Defendant, QUEENS CITY REHAB PT, PC, has been and still is a New York
State professional corporation.
35. That Defendant, RASHBI DIAGNOSTIC IMAGING, INC., has been and still is a
New York State corporation.
36. That Defendant, RED MEDICAL SUPPLY, INC., has been and still is a New York
State corporation.
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37. That Defendant, RIGHT CHOICE SUPPLY, INC., has been and still is a New York
State corporation.
38. That Defendant, SHMUEL GOLFEYZ MD, has been and still is a New York State
resident.
39. That Defendant, TRI-BOROUGH NY MEDICAL PRACTICE P.C. d/b/a BRONX
MEDICAL, PC, has been and still is a New York State professional corporation.
II. JURISDICTION AND VENUE
40. That this Court has jurisdiction over the Defendants because (i) they are persons
and/or entities that are citizen of New York and/or that conduct business within New York State(ii)
the insurance Policy was issued by HEREFORD in New York State, and (iii) the conduct which
forms the basis for this action occurred in New York State.
41. That venue is appropriate in New York County pursuant to Section 503(a) of the
New York Civil Practice Law and Rules inasmuch as Defendants reside in New York County and
Plaintiff conducts business in New York County.
III. MOTOR VEHICLE INCIDENT AND INSURANCE POLICY INFORMATION
42. That HEREFORD claim number 99708 involves an alleged automobile incident,
which reportedly occurred on September 3, 2022, at approximately 345am (the “alleged loss”).
43. That according to the Police Report (the “Report”) for the alleged loss, at the time
of the loss, non-party Ahmed S. Youssef (“Youssef”) was driving a 2020 livery vehicle (the
“insured vehicle”), which contained passengers JORDAN LEE CANTY (“JORDAN”),
JARRETT CANTY (“JARRETT”) and DAECHAUN FREEMAN-ALEXANDER
(“DAECHAUN”) (and all referred to collectively as the “Claimants”) when the insured vehicle
was rear-ended by an adverse vehicle, while parked, on 228th Street in Queens, New York.
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44. That according to the Report, the adverse vehicle fled the scene without
exchanging information.
45. That the Claimants all claimed to be injured and were taken to the hospital from
the scene, but Youssef did not sustain any injuries.
46. That thereafter, the Claimants later reported to have sustained significant bodily
injuries in the collision, and HEREFORD assigned claim number 99708 to all No-Fault claims
relating to the September 3, 2022, collision.
47. That prior to September 3, 2022, HEREFORD issued a “New York For Hire”
automobile insurance policy no. CA286705 (the “Policy”) to Youssef for the insured vehicle,
covering any occupants of the insured vehicle for any medical necessary and causally related
medical expenses suffered arising out of the use or operation of the insured vehicle as a result of
an accidental collision or any other person who sustains personal injury arising out of the use or
operation of the insured vehicle in New York State.
48. That the Policy provides for different types of coverage, including but not limited
to Mandatory Personal Injury Protection (No-Fault), Additional Personal Injury Protection, Bodily
Injury and Property Damage Liability, Uninsured/Underinsured Motorist Coverage, and
Supplemental Uninsured/Underinsured Motorist Coverage.
49. That the Policy provides that this coverage does not apply to personal injury
sustained by any person who intentionally causes his or her own personal injury.
50. Additionally, the Policy provides that this coverage does not apply to the insured,
or any person insured under the policy that has made false statements with the intent to conceal or
misrepresent any material fact or circumstance in connection with any claims under the policy.
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51. That after the alleged loss, Youssef provided a sworn statement to HEREFORD,
attesting that at the time of the alleged loss, he was working for Uber when he picked up the
Claimants, drove them to their destination, and at the destination, he legally parked and waited for
them to exit the vehicle. He further stated that the Claimants were taking a while to exit the vehicle,
and during that time, a white U-Haul van, which had been following the insured vehicle throughout
the ride, rear ended the insured vehicle and fled the scene. Youssef further stated that he did not
notice any visible injuries on the Claimants.
52. That after the alleged loss, Youssef also provided photographs of the (only)
superficial damage sustained by the insured vehicle as a result of the alleged loss.
53. That the Claimants are people who allegedly sustained personal injuries arising out
of the use or operation of the insured motor vehicle and began receiving No-Fault treatment from
the Medical Provider Defendants.
54. That to date, the Medical Provider Defendants have submitted thousands of dollars
in No-Fault claims as the Claimant’s alleged assignees, exclusive of interest and attorneys’ fees.
IV. APPLICABLE NO-FAULT REGULATION AND POLICY PROVISIONS
55. That under 11 N.Y.C.R.R. § 65-1.1, which governs the No-Fault claims for the
Claimant, the “Mandatory Personal Injury Protection Endorsement” of the regulation requires that
insurers such as HEREFORD provide No-Fault benefits to persons injured in the use or operation
of vehicles in New York State, subject to certain conditions and terms.
56. That an “eligible injured person” is defined as:
(a) the named insured and any relative who sustains personal injury arising
out of the use or operation of any motor vehicle;
***
(c) any other person who sustains personal injury arising out of the use or
operation of the insured motor vehicle in the State of New York while not
occupying another motor vehicle[.]
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57. That the “Conditions” provision of the Mandatory Personal Injury Protection
Endorsement states: No action shall lie against the Company unless, as a condition precedent
thereto, there shall have been full compliance with the terms of this coverage.
* * *
Upon request by the Company, the eligible injured person or that person’s assignee
or representative shall:
* * *
(b) as may reasonably be required submit to examinations under oath by any
person named by the Company and subscribe the same.
* * *
(d) provide any other pertinent information that may assist the Company in
determining the amount due and payable.
The eligible injured person shall submit to medical examination by physicians
selected by, or acceptable to, the self-insurer, when, and as often as, the self-insurer
may reasonably [require].
58. That under 11 N.Y.C.R.R. § 65-3.5(c), “The insurer is entitled to receive all items
necessary to verify the claim directly from the parties from whom such verification was requested.
APPLICABLE UNINSURED, SUPPLEMENTARY
UNINSURED/UNDERINSURED MOTORIST COVERAGE PROVISIONS
59. That the Uninsured Motorists Endorsement provides:
INSURING AGREEMENTS
1.Damages for Bodily Injury Caused by Uninsured Motor Vehicles.
We will pay all sums which the insured, as defined herein, or the insured’s
legal representative, shall be legally entitled to recover as damages from the
owner or operator of an uninsured motor vehicle because of bodily injury
sustained by the insured, and caused by accident arising out of such
uninsured motor vehicle’s ownership, maintenance or use, subject to the
Exclusions, Conditions, Limits and other provisions of this UM
endorsement. . .
CONDITIONS
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1. Policy Provisions
None of the Insuring Agreements, Exclusions or Conditions of the
policy shall apply to this UM coverage except “Duties After an
Accident or Loss”; “Fraud”; and “Termination” if applicable.
60. That the Supplementary Uninsured/Underinsured Motorists Endorsement
provides:
2. Damages for Bodily Injury Caused by Uninsured Motor Vehicles.
We will pay all sums that the insured or the insured's legal
representative shall be legally entitled to recover as damages from
the owner or operator of an uninsured motor vehicle because of
bodily injury sustained by the insured, caused by an accident arising
out of such uninsured motor vehicle's ownership, maintenance or
use, subject to the Exclusions, Conditions, Limits and other
provisions of this SUM endorsement.
CONDITIONS
1. Policy Provisions
None of the Insuring Agreements, Exclusions or Conditions of the
policy shall apply to this SUM coverage except: “Duties After an
Accident or Loss”; “Fraud”; and “Termination” if applicable.
61. That the Policy, Section “K. New York Changes - Fraud (IL 01 83 08 08)” states:
We do not provide coverage for any insured (“insured”) who has made
fraudulent statements or engaged in fraudulent conduct in connection with
any loss (“loss”) or damage for which coverage is sought under this policy.
APPLICABLE LIABILITY COVERAGE PROVISIONS
62. That the Policy, Section "C. New York For Hire Automobile Policy (HICCAL 0/09)"
provides:
63. INSURING AGREEMENTS
A. The company agrees to pay any sums which the “Insured” may become
obligated to pay by reason of the liability imposed by law upon the
“Insured” for damages for and incident to death or injuries to persons for
damages for and incident to injury or destruction of property resulting from
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the ownership, operation, maintenance, use or defective construction of the
motor vehicles described in the Declarations, or any of them, if suffered or
alleged to have been suffered within the United States of America of the
Dominion of Canada, during the policy period by any person other persons,
except as hereinafter provided.
B. The Company, subject to the policy terms, agrees to
1. Investigate all reported “accidents” covered hereby;
2. To defend in the name and on behalf of the “Insured” any suits,
even if groundless, brought against the “Insured” to recover
damages covered by this Policy, with the right to make such
investigation, negotiation and settlement as it deems expedient.
IV. CONDITIONS
G. Notice, Claims and Suits
1. The “Insured” or their representative shall give to the Company or its
authorized agent, as soon as possible, written notice of any accident-causing
loss covered hereby and shall also give like notice of claims for damages on
account of such accidents. If any suit is brought against the “Insured” to
recover such damages, the “Insured” shall as soon as possible, forward to the
Company every summons or other process served upon him. The Company
shall have the exclusive right to contest or settle any said suits or claims. The
“Insured” shall not interfere in any way respecting any negotiations for the
settlement of any claim or suit, nor in the conduct of any legal proceedings,
but shall, at all times, at the request of the company, render to it all possible
cooperation and assistance. The “Insured” shall not voluntarily admit any
liability for the accident. Notice given by or on behalf of the “Insured” or any
other claimant to any authorized agent of the company with particulars
sufficient to identify the “Insured” shall be deemed notice to the Company.
64. That the Policy, Section “K. New York Changes - Fraud (IL 01 83 08 08)”
Endorsement provides:
FRAUD
We do not provide coverage for any insured (“insured”) who has made fraudulent statements or
engaged in fraudulent conduct in connection with any loss (“loss”) or damage for which coverage
is sought under this policy.
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V. DEFENDANTS’ BREACH OF THE NO- FAULT REGULATION AND THE POLICY
65. That HEREFORD questioned the claim’s legitimacy for the following reasons:
i. The alleged loss occurred at 3am and involved a phantom vehicle, which
allegedly fled the scene;
ii. Youssef provided a statement to HEREFORD that he did not see any visible
injuries on the Claimants, and that the adverse vehicle had been following
them;
iii. Youssef did not allege injuries as a result of the alleged loss, only the
Claimants did;
iv. That there was minimal to no damage to the insured vehicle as a result of
the loss, yet the Claimants were receiving excessive and boiler-plate No-
Fault treatment;
v. That the Claimants began treating at a medical facility that HEREFORD
is/was investigation for concerns regarding billing practices and ownership
and control of said entity; and
vi. That the Claimants all retained the same attorney.
66. That based on the factors set forth above, as well as the excess level of treatment
allegedly being rendered to the Claimants, HEREFORD sought to verify the facts and
circumstances surrounding the alleged loss.
67. That, accordingly, pursuant to its rights under the No-Fault Regulation,
HEREFORD duly and properly requested the Claimants to submit to Examinations Under Oath
(“EUOs”) to confirm the legitimacy of the alleged collision and any subsequent treatment.
68. That the Claimants each appeared for their EUOs, however, their testimonies were
questionable and suggested that the loss was not a legitimate covered event. For example:
a. JARRETT testified that he was not sure the exact date the alleged loss occurred,
was not sure where exactly the alleged loss occurred, and did not know who ordered
the Uber that night;
b. None of the Claimants could testify as to where or whose party they were going to
at the time of the loss;
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c. The Claimants had different accounts of where everyone was seated in the insured
vehicle. JORDAN testified that DAECHAUN was in the front seat, next to the
driver, while JARRETT and DAECHAUN testified that he was seated in the third
row;
d. The Claimants had different accounts of how the loss occurred. JORDAN alleged
that they were parked in the middle of the street, not in a parking lane, for just a
few seconds when the impact occurred, DAECHAUN testified that they were
parked for around two minutes when the adverse vehicle rearended the insured
vehicle, and JARRETT testified that the insured vehicle was not stopped when the
impact occurred, it was still moving, but it was about to come to a stop;
e. JORDAN testified that DAECHAUN arranged for several attorneys and clinics for
the Claimants; all three claimants testified that they switched attorneys and clinics
and that DAECHAUN handled the attorneys;
f. The Claimants each testified that when they switched attorneys, they switched
clinics;
g. DAECHAUN testified that a friend, Karen, picked him up from the hospital after
the loss, but he does not know her last name or where she lives;
h. JARRETT testified that his attorneys orchestrate when and where to go for
treatment and that when he switched attorneys he switched clinics; and
i. The Claimants all testified to various treatments that they did not receive, that
HEREFORD was nevertheless billed for.
69. That after the EUOs, HEREFORD duly forwarded copies of the EUO transcripts to
the Claimants for execution, but that the Claimants each failed to execute and return their
transcripts, breaching a condition of coverage.
70. That based upon the facts and circumstances outlined above and HEREFORD’s
investigation of the claim, HEREFORD maintains a founded belief that the alleged September 3,
2022, loss was not the product of a covered event, as it was the product of a staged and/or
intentional event, which was perpetrated by the Claimants, with the intent to obtain insurance
benefits that the Defendants would not otherwise be entitled to receive.
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71. That in addition, HEREFORD alleges that as a result of the intentional acts, the
Claimants have made material misrepresentations of fact and false and/or fraudulent statements in
the presentation of their claims and have violated the fraud provisions of the applicable policy of
insurance.
72. That as such, HEREFORD maintains a founded belief that the alleged injuries of
the Claimants and any subsequent No-Fault treatment submitted by the Medical Provider
Defendants were not causally related to the collision and/or did not arise from an insured event.
73. That as such, the Defendants are not entitled to Mandatory Personal Injury
Protection (No-Fault), Additional Personal Injury Protection, Bodily Injury and Property Damage
Liability Coverage, Uninsured/Underinsured Motorist Coverage, and Supplemental
Uninsured/Underinsured Motorist Coverage Policy underlying the caused, staged and/or
intentional claim because:
i. The injuries at issue, if any at all, were not caused by an accident;
ii. The injuries at issue, if any at all, were intentionally caused by the
Claimants; and
iii. The Claimants have made material misrepresentations of fact and
false and/or fraudulent statements and engaged in fraudulent conduct
in connection with the presentation of the “accident” claims to
HEREFORD.
74. That HEREFORD has duly denied all claims on these bases.
75. That the Defendants have commenced or will commence legal action or file for
arbitration against HEREFORD seeking money damages for the No-Fault claims that HEREFORD
properly denied as detailed above.
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76. That HEREFORD requires and requests a declaration of the rights and other legal
relations of the respective parties in accordance with the applicable laws relating to declaratory
judgment.
77. That HEREFORD has no adequate remedy at law.
78. That HEREFORD has not previously sought the relief requested herein in this or
any other court.
VI. CLAIMS FOR RELIEF
AS AND FOR PLAINTIFF’S FIRST CAUSE OF ACTION
(Declaratory Judgment)
(Founded belief that the September 3, 2022,
loss is not the product of a covered event)
79. HEREFORD repeats and realleges the allegations contained in paragraphs 1
through 78 of the complaint as if fully set forth herein.
80. That based on its investigation, HEREFORD maintains a founded belief that the
collision was not an insured incident and that the alleged injuries of the Claimants and any
subsequent treatment submitted by the Medical Provider Defendants did not arise from an insured
event and/or was not causally related to the alleged September 3, 2022, collision under
HEREFORD claim number 99708.
81. That HEREFORD is therefore entitled to a judgment declaring it owes no duty to
pay the claims of the defendants, including any and all No-Fault claims, any and all uninsured,
underinsured, or supplementary uninsured or underinsured motorist benefits claims, any and all
medical payment claims, and any and all bodily injury liability benefits under the Policy arising
from the alleged September 3, 2022, collision under HEREFORD claim number 99708.
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AS AND FOR PLAINTIFF’S SECOND CAUSE OF ACTION
Failure to Subscribe- No No-Fault Coverage, Breach of a
condition precedent to coverage as to the Claimants)
82. That HEREFORD repeats and realleges the allegations contained in paragraphs 1
through 81 of the complaint as if fully set forth herein.
83. That the Claimants each breached a condition precedent to coverage as established
by the No-Fault Regulation and the subject policy of insurance by failing to subscribe and return
the transcripts from their EUOs.
84. That this breach of the No-Fault Regulation relieves HEREFORD of any obligation
to pay the No-Fault claims of the Claimants, with respect to the September 3, 2022, collision under
HEREFORD claim number 99708.
85. That by reason of the foregoing, HEREFORD is entitled to a judgment declaring
that it owes no duty to pay any No-Fault claims submitted by the Medical Provider Defendants for
treatment allegedly provided to the Claimants with respect to the September 3, 2022, collision
under HEREFORD claim number 99708.
WHEREFORE, plaintiffs, HEREFORD, demands judgment as follows:
a. On the First Cause of Action against all Defendants, declaring that
HEREFORD has no duty to pay any sums, monies, damages, awards
and/or benefits including but not limited to Mandatory Personal Injury
Protection (No-Fault), Additional Personal Injury Protection, Bodily
Injury and Property Damage Liability, Uninsured/Underinsured Motorist
Coverage, and Supplemental Uninsured/Underinsured Motorist Cover