Preview
FILED: NEW YORK COUNTY CLERK 05/18/2023 05:07 PM INDEX NO. 154505/2023
NYSCEF DOC. NO. 3 RECEIVED NYSCEF: 05/18/2023
SUPREME COURT OF THE STATE OF NEW YORK
COUNTY OF NEW YORK
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HEREFORD INSURANCE COMPANY, Index No.:
154505/2023
Plaintiff
AMENDED
-against- COMPLAINT
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
PITCH MEDICAL PC
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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.
MEDICAL PROVIDER DEFENDANTS
5. That Defendant, ANGELA ABRAMOV-PLISCHTEJEW NP-PSYCH/ MENTAL
HEALTH, has been and still is a New York State resident.
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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.
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.
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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.
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.
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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, 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.
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.
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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.
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.
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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.
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
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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[.]
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:
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* * *
(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
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:
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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
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;
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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.
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;
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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;
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;
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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.
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.
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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.
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)
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(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.
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.
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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 Coverage,
to any of the Defendants with respect to the September 3, 2022, collision,
HEREFORD claim number 99708, referenced in the complaint, as the
alleged automobile incident of September 3, 2022, HEREFORD claim
number 99708, was not the product of a covered event as defined by the
applicable policy of insurance issued by HEREFORD since the incident of
September 3, 2022, HEREFORD claim number 99708, was the product of
staged and/or intentional events.
b. On the Second Cause of Action against all Defendants, declaring that
HEREFORD has no duty to provide No-Fault reimbursements for any
claim or bill that may be submitted by or on behalf of the Claimants arising
out of the alleged incident of September 3, 2022, HEREFORD claim
number 99708, referenced in the complaint, as the Claimants each
breached a condition precedent to coverage established by the No-Fault
Regulation and the subject policy of insurance by failing to subscribe and
return their EUO transcripts.
c. A declaratory judgment that the alleged automobile incident of September
3, 2022, HEREFORD claim number 99708, was not the product of a
covered event as defined by the applicable policy of insurance issued by
HEREFORD since the incident of September 3, 2022, HEREFORD claim
number 99708, was the product of staged and/or intentional events;
d. A declaratory judgment that any personal injuries allegedly sustained by
the Claimants were intentionally caused by said individuals;
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FILED: NEW YORK COUNTY CLERK 05/18/2023 05:07 PM INDEX NO. 154505/2023
NYSCEF DOC. NO. 3 RECEIVED NYSCEF: 05/18/2023
e. For costs and disbursements of this action; and
f. For any other and further relief as the Court deems just and proper.
Dated: New York, New York
May 18, 2023
Yours, etc.
___________________________
By: Lindsay Padover, Esq.
GOLDBERG, MILLER & RUBIN, P.C.
Attorneys for Plaintiff
1501 Broadway Suite 715
New York, New York 10036
File No.: HF-00656
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FILED: NEW YORK COUNTY CLERK 05/18/2023 05:07 PM INDEX NO. 154505/2023 NYSCEF DOC. NO. 3 RECEIVED NYSCEF: 05/18/2023 SUPREME COURT OF THE STATE OF NEW YORK COUNTY OF NEW YORK --------------------------------------------------------------------X HEREFORD INSURANCE COMPANY, Index No.: 154505/2023 Plaintiff AMENDED -against- COMPLAINT 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 PITCH MEDICAL PC 1 of 17 FILED: NEW YORK COUNTY CLERK 05/18/2023 05:07 PM INDEX NO. 154505/2023 NYSCEF DOC. NO. 3 RECEIVED NYSCEF: 05/18/2023 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” ------------------------------------------------------------------------X 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. MEDICAL PROVIDER DEFENDANTS 5. That Defendant, ANGELA ABRAMOV-PLISCHTEJEW NP-PSYCH/ MENTAL HEALTH, has been and still is a New York State resident. 2 of 17 FILED: NEW YORK COUNTY CLERK 05/18/2023 05:07 PM INDEX NO. 154505/2023 NYSCEF DOC. NO. 3 RECEIVED NYSCEF: 05/18/2023 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. 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. 3 of 17 FILED: NEW YORK COUNTY CLERK 05/18/2023 05:07 PM INDEX NO. 154505/2023 NYSCEF DOC. NO. 3 RECEIVED NYSCEF: 05/18/2023 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. 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. 4 of 17 FILED: NEW YORK COUNTY CLERK 05/18/2023 05:07 PM INDEX NO. 154505/2023 NYSCEF DOC. NO. 3 RECEIVED NYSCEF: 05/18/2023 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, 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. 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. 5 of 17 FILED: NEW YORK COUNTY CLERK 05/18/2023 05:07 PM INDEX NO. 154505/2023 NYSCEF DOC. NO. 3 RECEIVED NYSCEF: 05/18/2023 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. 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. 6 of 17 FILED: NEW YORK COUNTY CLERK 05/18/2023 05:07 PM INDEX NO. 154505/2023 NYSCEF DOC. NO. 3 RECEIVED NYSCEF: 05/18/2023 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. 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 7 of 17 FILED: NEW YORK COUNTY CLERK 05/18/2023 05:07 PM INDEX NO. 154505/2023 NYSCEF DOC. NO. 3 RECEIVED NYSCEF: 05/18/2023 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[.] 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: 8 of 17 FILED: NEW YORK COUNTY CLERK 05/18/2023 05:07 PM INDEX NO. 154505/2023 NYSCEF DOC. NO. 3 RECEIVED NYSCEF: 05/18/2023 * * * (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 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: 9 of 17 FILED: NEW YORK COUNTY CLERK 05/18/2023 05:07 PM INDEX NO. 154505/2023 NYSCEF DOC. NO. 3 RECEIVED NYSCEF: 05/18/2023 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 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; 10 of 17 FILED: NEW YORK COUNTY CLERK 05/18/2023 05:07 PM INDEX NO. 154505/2023 NYSCEF DOC. NO. 3 RECEIVED NYSCEF: 05/18/2023 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. 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; 11 of 17 FILED: NEW YORK COUNTY CLERK 05/18/2023 05:07 PM INDEX NO. 154505/2023 NYSCEF DOC. NO. 3 RECEIVED NYSCEF: 05/18/2023 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; 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; 12 of 17 FILED: NEW YORK COUNTY CLERK 05/18/2023 05:07 PM INDEX NO. 154505/2023 NYSCEF DOC. NO. 3 RECEIVED NYSCEF: 05/18/2023 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. 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. 13 of 17 FILED: NEW YORK COUNTY CLERK 05/18/2023 05:07 PM INDEX NO. 154505/2023 NYSCEF DOC. NO. 3 RECEIVED NYSCEF: 05/18/2023 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. 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) 14 of 17 FILED: NEW YORK COUNTY CLERK 05/18/2023 05:07 PM INDEX NO. 154505/2023 NYSCEF DOC. NO. 3 RECEIVED NYSCEF: 05/18/2023 (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. 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. 15 of 17 FILED: NEW YORK COUNTY CLERK 05/18/2023 05:07 PM INDEX NO. 154505/2023 NYSCEF DOC. NO. 3 RECEIVED NYSCEF: 05/18/2023 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 Coverage, to any of the Defendants with respect to the September 3, 2022, collision, HEREFORD claim number 99708, referenced in the complaint, as the alleged automobile incident of September 3, 2022, HEREFORD claim number 99708, was not the product of a covered event as defined by the applicable policy of insurance issued by HEREFORD since the incident of September 3, 2022, HEREFORD claim number 99708, was the product of staged and/or intentional events. b. On the Second Cause of Action against all Defendants, declaring that HEREFORD has no duty to provide No-Fault reimbursements for any claim or bill that may be submitted by or on behalf of the Claimants arising out of the alleged incident of September 3, 2022, HEREFORD claim number 99708, referenced in the complaint, as the Claimants each breached a condition precedent to coverage established by the No-Fault Regulation and the subject policy of insurance by failing to subscribe and return their EUO transcripts. c. A declaratory judgment that the alleged automobile incident of September 3, 2022, HEREFORD claim number 99708, was not the product of a covered event as defined by the applicable policy of insurance issued by HEREFORD since the incident of September 3, 2022, HEREFORD claim number 99708, was the product of staged and/or intentional events; d. A declaratory judgment that any personal injuries allegedly sustained by the Claimants were intentionally caused by said individuals; 16 of 17 FILED: NEW YORK COUNTY CLERK 05/18/2023 05:07 PM INDEX NO. 154505/2023 NYSCEF DOC. NO. 3 RECEIVED NYSCEF: 05/18/2023 e. For costs and disbursements of this action; and f. For any other and further relief as the Court deems just and proper. Dated: New York, New York May 18, 2023 Yours, etc. ___________________________ By: Lindsay Padover, Esq. GOLDBERG, MILLER & RUBIN, P.C. Attorneys for Plaintiff 1501 Broadway Suite 715 New York, New York 10036 File No.: HF-00656 17 of 17