Preview
(FILED: KINGS COUNTY CLERK 1272272016 05:17 PM INDEX NO. 521396/2016 |
NYSCEF DOC. NO. 2 RECEIVED NYSCEF: 12/22/2016
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AFFIDAVIT OF SERVICE BY MAIL
STATE OF NY )
) ss:
COUNTY OF KINGS )
Sheron L. Robinson, being duly sworn, deposes and says, that he/she is not a party to the action
herein, and that he/she is an administrative assistant for the Law Offices of Karen L. Lawrence,
the attorney for the within named Defendant(s), IRVING SPITZER. That on the December,
2016, he/she served the within ANSWER, COMBINED DEMAND, DEMAND FOR |
VERIFIED BILL OF PARTICULARS, MEDICAL REPORTS, NOTICE OF . |
EXAMINATION BEFORE TRIAL, DEMAND PURSUANT TO C.P.L.R. 306(a), NOTICE —
DECLINING SERVICE BY FAX, CERTIFICATION, DEMAND FOR MEDICARE |
REIMBURSEMENT INFORMATION, MEDICARE AUTHORIZATION, AND MEDICARE |
AUTHORIZATION TO DISCLOSE PERSONAL HEALTH INFORMATION FORM. by |
depositing a true copy of the same securely enclosed in a post-paid wrapper in a Post Office Box
regularly maintained by the United States Government at 4 Metrotech Center, Suite 2000,
Brooklyn, in the County of KINGS, State of NY, directed to:
MARK. E. WEINBERGER, P.C.
Attorneys for the Plaintiff
50 Merrick Rd
Rockville Centre NY 11570
516-829-7270
that being the address(es) within the state designated by him/her for that purpose upon the
preceding papers in this action, or the place where he/she then kept an office, between which
places there then was and now is a regular communication by mail.
a |
Deponent is over the age of eighteen (18) years. i
L—
> 1
“7
Sheron L. Robinson
Subscribed and sworn to before me this
AA day ot 2 , 2016.
_
a
DOLSKA
Fotery Putt aaa rete ot jew York
Notary Public No.02R06313338
/ Qualified In Richmond County
My ommiséi on Expires: My Commlesion Explras: October 20, 2018
Morales vs. Spitzer
Index No. 521396/16
Our File No. 0413966292. 1-
1 of 31SUPREME COURT OF THE STATE OF NEW YORK
COUNTY OF KINGS
x
GILBERTO MORALES,
ANSWER
Dot etce
Plaintirt,
-against- Index No. 521396/16
IRVING SPITZER,
Defendant.
x
The Defendant(s) IRVING SPITZER by Law Offices of Karen L. Lawrence, as
and for his/her/their Answer to the Complaint herein, allege(s) as follows:
FIRST: Denies/deny any knowledge or information sufficient to form a belief as
to the allegation(s) contained in paragraph(s) designated as “1, 3,.4, 5, 6, 7, 8, 9, 10 and 19” of
the Complaint herein.
SECOND: Upon information and belief, denies/deny each and every allegation
contained in paragraphs designated as “11, 12, 13, 14, 15, 16, 17, 18 and 20” of the Complaint
herein.
AS AND FOR A FIRST AFFIRMATIVE DEFENSE
THIS (THESE) ANSWERING DEFENDANT(S) ALLEGE(S):
Any damages sustained by the Plaintiff(s) were caused by the culpable conduct of
the Plaintiff(s), including contributory negligence or assumption of risk, and not by the culpable
conduct or negligence of this(these) answering Defendant(s).
2 of 31AS AND FOR A SECOND AFFIRMATIVE DEFENSE
THIS(THESE) ANSWERING DEFENDANT(S) ALLEGE(S):
Upon information and belief, Plaintiff(s) failed to use or misused seat belis, and
AS AND FOR A THIRD AFFIRMATIVE DEFENSE,
THIS(THESE) ANSWERING DEFENDANT(S) ALLEGE(S):
That the Court lacks jurisdiction over the person of the Defendant(s) IRVING
SPITZER by reason of the non-service of the summons upon the Defendant(s) IRVING
SPITZER, either personally or by substituted service.
AS AND FOR A FOURTH AFFIRMATIVE DEFENSE
THIS(THESE) ANSWERING DEFENDANT(S) ALLEGE(S):
That to the extent plaintiff recovers any damages for the cost of medical care,
dental care, custodial care or rehabilitation services, loss of earnings and/or economic loss, the
amount of the award shall be reduced by the sum total of all collateral reimbursements, from
whatever source, whether it be insurance, social security payments, no fault payments, Workers
Compensation, employee benefits or other such programs, in accordance with the provisions of
the CPLR 4545.
AS AND FOR A FIFTH AFFIRMATIVE DEFENSE
THIS(THESE) ANSWERING DEFENDANT(S) ALLEGE(S):
In the event that any person or entity liable or claimed to be liable for the injury
alleged in this action has been given or may hereafter be given a release or covenant not to sue,
defendant will be entitled to protection under General Obligations Law 15-108 and the
corresponding reduction of any damages which may be determined to be due against this
answering defendant.
3 of 31
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|WHEREFORE, this answering Defendant(s) demand(s) judgment dismissing the
Complaint herein with costs.
DATED: Brooklyn, NY
TO:
Deceiber 19, 2016
MARK E. WEINBERGER, P.C.
Attorneys for the Plaintiff
50 Merrick Rd
Rockville Centre NY 11570
516-829-7270
Yours, etc.,
Law Offices of Karen L. Lawrence
CLAIRE MARTIN
Attomey for Defendant
IRVING SPITZER.
4 Metrotech Center, Suite 2000
Brooklyn, NY 11201
Telephone: (718) 451-7153
Our File No. 0413966292. 1-
4 of 31SUPREME COURT OF THE STATE OF NEW YORK
COUNTY OF KINGS
X
GILBERTO MORALES, COMBINED DEMAND FOR
DISCOVERY AND INSPECTION
Plainiiff,
Index No. 521396/16
-against-
IRVING SPITZER,
Defendant.
SIRS:
PLEASE TAKE NOTICE that pursuant to CPLR 3101 et seq., it is hereby
demanded that you serve upon the office of the undersigned, within thirty (30) days the
following:
1. The names and addresses of all witnesses known to the Plaintiff(s) and the
Plaintiff's representatives, who it will be claimed were witnesses to the following:
(a) The alleged occurrence in question.
(b) Any alleged defective condition.
(c) The site of the alleged occurrence immediately prior and
immediately subsequent to the alleged occurrence.
(d) The actions of any of the parties, or of any non-parties, before,
during, or after the alleged occurrence.
2. Any statements, oral, written or electronically recorded, from any party we
represent, in the possession of the Plaintiff(s) or the Plaintiff(s) representatives.
3. Any photographs of the following:
(a) The site of the alleged occurrence.
(b) Any instrumentalities involved.
4, Any accident reports made in the normal course of business. Pataki_v.
Kiseda, 80 A.D.2d 100, 437 N.Y.S.2d 692 (1981).
5. Any diagrams, drawings, notes, records, etc., made from any information
5 of 31
1provided by any client we represent.
6. Any notes, records, memoranda, diagrams, drawings, photographs made or
taken by any investigator employed by the Plaintiff(s) or the Plaintifi(s) representatives, even if
made in contemplation of litigation.
7. The name and address of each and every person you expect to call as an
expert witness at the trial of this action;
8. In reasonable detail, the subject matter on which each expert is expected to
testify;
9. The substance of the facts and opinions on which each expert is expected
to testify;
10. The qualification of each expert witness, and;
11. A summary of the grounds for each expert's opinion.
12. | Maintenance and repair records for the motor vehicle of the Plaintiff(s) for
one year prior to the alleged occurrence.
13. Copies of any letters or written communications from Plaintiff(s) to
Defendant(s) citing any alleged defective conditions.
14. Duly executed authorization allowing the undersigned to obtain the
employment records of the party seeking recovery for the period commencing one (1) year prior
to the date of the subject occurrence and continuing to the present date. This authorization shall
allow access to, but shall not be limited to records regarding the Plaintiff(s)' salary and
attendance.
(a) If Plaintiff is a student: duly executed authorization(s) allowing the
undersigned to obtain the school records of the Plaintiff for the
period commencing one (1) year prior to the date of the occurrence
and continuing to the present date.
15. Copies of the Plaintiffs)’ City, State and Federal Income Tax Records for
the period commencing two (2) years prior to the date of the subject occurrence and for all
subsequent years up to and including the present. If such records, or a portion thereof are
unavailable, authorizations to obtain such records from the Internal Revenue Service and/or New
York State Department of Taxation.” If income tax returns were not filed for such period or a
portion thereof, so state in reply to this demand.
16. Duly executed and acknowledged original authorizations permitting
this/these Defendant(s) to obtain and copy No-Fault medical and wage records for each Plaintiff
6 of 31
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|for the period from the date of occurrence to the present.
17. Ifa claim has or will be made pursuant to the terms of ARTICLE S51} of the
Insurance Law of the State of New York (Mo-Fault Law); with respect to each and every
application:
(a) Set forth the name, address, policy number and claim number of
each company to which a claim has been or will be made.
(b) Set forth duly executed and acknowledged written authorizations
enabling the undersigned to obtain the records relating to the
Plaintiff from each company identified in the response to paragraph
"(a)",
18. ‘If a claim has or will be made pursuant to the terms of the Workers!
Compensation Law, with respect to each and every application:
(a) Set forth the name, address, policy number and claim number to
which a claim has been or will be made, together with the Workers!
Compensation Board file number.
(b) Set forth duly executed and acknowledged written authorizations
enabling the undersigned to obtain the records relating to the
Plaintiff from each company identified in the response to paragraph
"(a)",
19. Ifa disability claim has or will be made pursuant to the terms of the Social
Security Laws, with respect to each and every application:
(a) Set forth the claim office, the address and the claim number
assigned.
(b) Set forth duly executed and acknowledged written authorizations
enabling the undersigned to obtain the records relating to the
Plaintiff.
20. Pursuant to CPLR Section 4545(a) produce and permit the undersigned
attorneys to inspect and copy the contents of:
(a) Each and every collateral source of payment, including but not
limited to, insurance agreements, Social Security, Workers'
Compensation or employee benefit programs, and any other
collateral source of payment for past or future costs or expenses
alleged to have been incurred by the Plaintiffs and for which
recovery is sought in the instant action and
(b) A written statement setting forth any and all such collateral sources
and their amounts.
(c) Duly executed written authorizations permitting the undersigned
7 of 31attorneys to obtain and make copies of all records relating to
collateral source information as set forth herein.
21. ‘if it is claimed that the Plaintiff husband/wife is married to Plaintiff
husband/wife. Please set forth a copy of their Marriage Certificate.
22. If it is claimed that the infant Plaintiff is the natural son/daughter of the
Plaintiff mother/father or natural guardian set forth a copy of the Birth Certificate of infant
Plaintiff.
23. Withholding statements, pay envelopes, deposit slips, or any other
evidence of income earned by Plaintiff(s) for the current calendar year.
24. Copies of any and all bills, statements or receipts relating to any non-
medical expense claimed as damages in this lawsuit which have not been produced in response to
any of the preceding paragraphs.
25. Copies of bills and/or estimates for the repair of Plaintiff(s) vehicle and
any other damaged property. If the vehicle was not repairable, in addition, attach estimates of the
value of the vehicle on the date of the alleged incident and estimates and/or receipts concerning
salvage value.
26. Any releases, and any other type of settlement agreements between
Plaintiff(s) and any other party which may have been responsible for the damages claimed by
Plaintiff(s).
27. Any and all photographs, blow-ups, recordings, charts, graphs, sketches
and.any other tangible items or documentary evidence which you intend to use during the trial of
this case and which have not been produced in response to any of the preceding paragraphs.
28. All documents, papers or evidence to be introduced at trial.
PLEASE TAKE FURTHER NOTICE that the within demands are continuing
demands. In the event any of the above items are obtained after service of this demand, they are
to be furnished to this office upon receipt.
DATED: Brooklyn, NY
December 19, 2016
8 of 31
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|TO:
MARK E. WEINBERGER, P.C.
Attorneys for the Plaintiff
50 Merrick Rd
Rockville Centre NY 11570
516-829-7270
Yours, etc.,
Law Offices of Karen L. Lawrence
CLAIRE MARTIN
Attorney for Defendant
IRVING SPITZER.
4 Metrotech Center, Suite 2000
Brooklyn, NY 11201
Telephone: (718) 451-7153
Our File No. 0413966292.1-
9 of 31SUPREME COURT OF THE STATE OF NEW YORK
COUNTY OF KINGS
x
GILBERTO MORALES, DEMAND FOR VERIFIED BELL OF
PARTICULARS WITH NOTICE
Plaintiff, PURSUANT 70 C.?.L.R. SECTION
3042(c)
-against-
Index No. 521396/16
IRVING SPITZER,
Defendant.
Xx
SIRS:
PLEASE TAKE NOTICE that your are hereby required to file and serve the
following Verified Bill of Particulars of Plaintiff's alleged cause of action herein, within thirty
(30) days from the date of service hereof.
1. The date and time of day of the occurrence.
2. State the location of the accident in sufficient detail to permit
identification, giving direction in which each vehicle was proceeding.
3. Statement of the acts of omissions constituting the negligence claimed.
4, State what part of each of the respective vehicles came in contact.
If property damages are being claimed, set forth:
5. Itemized statement of the alleged damage to Plaintiffs vehicle, together
with the costs of repair of each item.
6. State the make, model and year of manufacture of Plaintiff's vehicle and
the reasonable market value of same immediately prior to and immediately after the alleged
accident.
If personal injuries are being claimed, set forth:
7. The nature, extent, location and duration of each and every injury alleged
to have been sustained by the Plaintiff and which, if any are claimed to be permanent.
10 of 31
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|8. The length of time, giving specific dates, Plaintiff was confined to:
(a) the hospital,
(b) to bed and
(c) to home as a result of the alleged injuries.
9. The length of time incapacitated from employment and/or household
duties as a result of the alleged injuries. If Plaintiff is a student, the length of time incapacitated
from school as a result of the alleged injuries.
10. Total amounts claimed as special damages for:
(a) physician's services;
(b) medical supplies;
(c) loss of earnings;
(d) nurses’ services;
(e) hospital expenses;
( x-rays expenses;
(g) any other items of special damage;
(h) name and address of Plaintiff's employer at the time of the
accident. If Plaintiff is self-employed, please state nature of
business, business name and address. If Plaintiff is a student, name
and address of school attending at time of accident and designated
class or grade.
11. State in what respect Plaintiff has sustained a serious injury, as defined in
Subdivision (d) of Section 5102 of the Insurance Law, or economic loss greater than basic
economic loss, as defined in Subdivision (a) of 5102 of the Insurance Law.
12. If negligent entrustment is alleged, set forth, with specificity, each and
every fact which constitutes the basis of the claim.
13. Set forth the manner in which it is claimed the negligent entrustment
occurred.
14. If it is alleged that the owner of the vehicle had prior knowledge of some .
propensity to be alleged by the Plaintiff in regards to the operation of the vehicle, set forth:
(a) What propensities or actions it is alleged the owner of the vehicle
was aware of.
(b) Set forth if the owner of the vehicle had actual or constructive
notice.
(c) If actual notice is alleged:
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ql) Set forth the date, time and place which will be alleged that
the owner was made aware of the propensities, actions, or
traits.
(2) Set forth the names and addresses of the individuals it will
be alleged so advised the owner of our vehicle of the
propensities, actions, or traits of our operator.
15. If the Plaintiff prayed for general relief, state the total damages to which
all Plaintiff(s) deem himself/herself/themselves entitled.
16. ‘If the Plaintiff prayed for general relief, state the total damages that each
Plaintiff deems himself/herself entitled.
17. As regards paragraph 16, state each category of damages and the amount
demanded in each category.
If a cause of action is claimed Section 205(e) of The General Municipal Law:
8. Set forth by Section every statute, regulations, ordinance, rule, order and
requirement of the Federal, State, County, Village, Town or City government of any and all of
their departments, divisions and bureau it is alleged was violated by the Defendant.
9. Identify for each act or omission it will be claimed was committed by the
Defendant(s), the rule, regulation, statute, ordinance, order and requirement it is claimed said act
violated,
PLEASE TAKE FURTHER NOTICE that if a copy of the Verified Bill of
Particulars of the Plaintiffs' alleged cause of action is not served with thirty (30) days of receipt
of this notice, an appropriate motion to preclude will be made pursuant to this notice at the time
of trial of this action.
DATED: Brooklyn, NY
December 19, 2016
3
12 of 31 {TO:
MARK E. WEINBERGER, P.C.
Attorneys for the Plaintiff
50 Merrick Rd
Rockville Centre NY 11570
516-829-7270
Yours, etc.,
Law Offices of Karen L. Lawrence
CLAIRE MARTIN
Attorney for Defendant
IRVING SPITZER
4 Metrotech Center, Suite 2000
Brooklyn, NY 11201
Telephone: (718) 451-7153
Our File No. 0413966292.1-
4
13 of 31SUPREME COURT OF THE STATE OF NEW YORK
COUNTY OF KINGS
x
GILBERTO MORALES, DEMAND FOR COPIES OF
PLAINTIFF’S MEDICAL REPORTS
Plamtitt,
Index No. 521396/16
-against-
IRVING SPITZER,
Defendant.
SIRS:
PLEASE TAKE NOTICE that pursuant to the Uniform Rules for the New York
State Trial Courts, demand is hereby made upon the Plaintiff(s) or his attorney to:
1. Serve upon and deliver to the attorney for the Defendant(s) copies of the
medical reports of those physicians who have previously treated or
examined the Plaintiff(s) and who will testify on his behalf. These shall
include a detailed recital of the injuries and conditions as to which
testimony will be offered at the trial, referring to and identifying those x-
rays and technician's reports which will be offered at the trial.
2. Serve upon and deliver to the attorney for the Defendant(s) duly executed
and acknowledged written HIPAA compliant authorizations permitting all
parties to obtain and make copies of all hospital records and such other
records, including x-rays and technician's reports, as to be referred to and
identified in the statement of the Plaintiff(s) physicians.
3. Serve upon and deliver to the attorney for the Defendant(s) copies of all
graphic, numerical, symbolic, digital, film, video, computer generated,
computer enhanced or otherwise produced electronically and/or digitally,
photographic or pictorial representations regarding any procedures,
treatments, admissions, office visits, injuries, scene of the accident or the
vehicles or instrumentalities involved, disabilities, medical or diagnostic
procedures or tests, performed by or on behalf of the plaintiff(s) herein or
by any facility regarding the claims of the plaintiff(s) herein.
PLEASE TAKE FURTHER NOTICE that upon his failure to comply with this
14 of 31
|demand, the Plaintiff(s) will be precluded upon the trial of the within action from offering in
evidence or testifying as to any of the reports, records or examination demanded herein.
DATED: Brooklyn, NY
TO:
December i9, 2016
MARK E. WEINBERGER, P.C.
Attorneys for the Plaintiff
50 Merrick Rd
Rockville Centre NY 11570
516-829-7270
Yours, etc.,
Law Offices of Karen L. Lawrence
CLAIRE MARTIN
Attorney for Defendant
IRVING SPITZER
4 Metrotech Center, Suite 2000
Brooklyn, NY 11201
Telephone: (718) 451-7153
Our File No. 0413966292. 1-
2
15 of 31SUPREME COURT OF THE STATE OF NEW YORK
COUNTY OF KINGS
x
GILBERTO MORALES, NOTICE OF EXAMINATION
BEFORE TRIAL
Piaintiff,
Index No. 521396/16
-against-
IRVING SPITZER,
Defendant.
SIRS:
PLEASE TAKE NOTICE that pursuant to Article 31 of the Civil Practice Law
and Rules, the undersigned will take the testimony of, all Adverse Parties, in the manner
following:
TO BE DETERMINED AT THE PRELIMINARY CONFERENCE
upon all the relevant facts and circumstances surrounding the accident which is the subject of this
action, including negligence, contributory negligence and damages; and for the purposes
authorized by Rule 3111+ of the Civil Practice Law and Rules said Plaintiff(s) is required to
produce at such examination the following:
All books, papers and records relating to said action in the possession, custody or
control of said Plaintiff(s)/ Co-Defendant(s).
DATED: Brooklyn, NY
December 19, 2016
16 of 31TO:
MARK E, WEINBERGER, P.C,
Attorneys for the Plaintiff
50 Merrick Rd
Rockville Centre NY 11570
516-829-7270
Yours, etc.,
Law Offices of Karen L. Lawrence
CLAIRE MARTIN
Attomey for Defendant
IRVING SPITZER
4 Metrotech Center, Suite 2000
Brooklyn, NY 11201
Telephone: (718) 451-7153
Our File No. 0413966292.1-
2
17 of 31SUPREME COURT OF THE STATE OF NEW YORK
COUNTY OF KINGS
x
GILBERTO MORALES, DEMAND PURSUANT TO
SECTION 306(a)
Plaintiit,
Index No. 521396/16
-against-
IRVING SPITZER,
Defendant.
x
SIRS:
IT IS HEREBY DEMANDED that you serve upon the undersigned, either a
copy of the receipt for the Index Number purchased or the date the Index Number was purchased
as per said receipt.
DATED: Brooklyn, NY
December 19, 2016
Yours, etc.,
Law Offices of Karen L. Lawrence
CLAIRE MARTIN
Attorney for Defendant
IRVING SPITZER
4 Metrotech Center, Suite 2000
Brooklyn, NY 11201
Telephone: (718) 451-7153
Our File No. 0413966292.1-
TO: MARK E. WEINBERGER, P.C.
Attomeys for the Plaintiff
50 Merrick Rd
Rockville Centre NY 11570
516-829-7270
18 of 31SUPREME COURT OF THE STATE OF NEW YORK.
COUNTY OF KINGS
xX
GILBERTO MORALES, NOTICE DECLINING SERVICE BY
MEANS OF ELECTRONIC OR FAX
Piaintiif, TRANSMITTALS
-against- Index No. 521396/16
IRVING SPITZER,
Defendant.
x
SIRS:
PLEASE TAKE NOTICE that pursuant to C.P.L.R. 2103(5) Law Offices of
Karen L. Lawrence., will not accept service of papers, notices, motions, etc., by facsimile (fax)
transmittal or by any other electronic means.
DATED: Brooklyn, NY
December 19, 2016
Yours, etc.,
Law Offices of Karen L. Lawrence
CLAIRE MARTIN
Attorney for Defendant
IRVING SPITZER
4 Metrotech Center, Suite 2000
Brooklyn, NY 11201
Telephone: (718) 451-7153
Our File No. 0413966292.1-
TO: MARK E. WEINBERGER, P.C.
Attorneys for the Plaintiff
50 Merrick Rd
Rockville Centre NY 11570
516-829-7270
19 of 31SUPREME COURT OF THE STATE OF NEW YORK
COUNTY OF KINGS
xX
GILBERTO MORALES, DEMAND FOR MEDICARE
REIMBURSEMENT INFORMATION
Plaintitt,
Index No. 521396/16
-against-
IRVING SPITZER,
Defendant.
x
PLEASE TAKE NOTICE that pursuant to 42 U.S.C. 1395y(b)(8), 42 C.P.R
411.23 and CPLR 3101 et seq,, it is hereby demanded that you serve upon the office of the
undersigned, within thirty (30) days the following:
1. Plaintiff's Social Security Number
2. Plaintiff's date of birth
3. Plaintiff's Medicare and Health Insurance Claim Numbers
4. A statement as to whether the plaintiff has received benefits from
Medicare at any time, for any reason, not limited to the injuries alleged in
the instant action.
5. A statement as to whether the plaintiff has received benefits from
Medicare claimed to be related to this instant action and an itemization of
those benefits.
6. If the answer to request “4” or “5” above is “yes”, please state or provide:
a) Whether Medicare has asserted a Medicare Secondary Payer right
of reimbursement and the amount of any such reimbursement;
b) Copies of any and all documents, records, memoranda, notes,
correspondence etc., in plaintiff's possession pertaining to
plaintiff's receipt of Medicare benefits, including, but not limited
to, copies of all documents provided to or received from the
Medicare Center for Medicare/Medicaid Services (CMS),
20 of 31
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Secondary Payer Recovery Contractor (MSPRC);
c) A duly executed and acknowledged HIPAA-compliant
authorization permitting Defendant to obtain copies of plaintiff's
Medicare records. A copy of the authorizaiion required by
Medicare is attached hereto;
d) If any Medicare Secondary Payer claims exist, please provide a
copy of such claims. If no Medicare Secondary Payer claims exist,
kindly provide a letter from Medicare attesting to that fact.
Please state whether the plaintiff is Medicare-cligible by reason of:
a) Being age 65 or older;
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b) Being entitled to receive Social Security Disability for the previous |
24 months; /
c) Having received a disability pension from the Railroad Retirement
Board,
d) Having received benefits for amyotrophic lateral sclerosis;
e) Having a government job where Medicare taxes were paid and the
claimant meets the requirements of the Social Security Disability
program.
f) Being the child or widow(er), age 50 or older, including divorced
widow(ers) of someone who has been in a government job where
edicare taxes were paid and who meets the eligibility
requirements of the Social Security Disability program;
g) Has had permanent kidney failure, a kidney transplant or receives
maintenance dialysis or and:
i) Is eligible to or receive monthly benefits under Social
Security or the Railroad Retirement System; or
ii) Has worked in a Medicare covered government job; or is
the child or spouse (including divorced spouse) of a worker
who has worked long enough under Social Security or in a
Medicare-covered government job.
21 of 31PLEASE TAKE FURTHER NOTICE that this demand is made pursuant to the
Medicare, Medicaid and State Children’s Health Insurance program (SCHIP) Act of 2007.
Federal Law mandates that the foregoing information be provided to the Centers for Medicare
and Medicaid Services following resolution of the instant litigation.
PLEASE TAKE FURTHER NOTICE that failure to comply with this Demand
in contravention of 42 C.F.R 411.23 may result in direct recovery by the centers for Medicare
and Medicaid Services against the plaintiff herein.
PLEASE TAKE FURTHER NOTICE that the within demands are continuing
demands. In the event any of the above items are obtained after service of this demand, they are
to be furnished to this office upon receipt.
DATED: Brooklyn, NY
December 19, 2016
Yours, etc.,
Law Offices of Karen L. Lawrence
CLAIRE MARTIN
Attorney for Defendant
IRVING SPITZER
4 Metrotech Center, Suite 2000
Brooklyn, NY 11201
Telephone: (718) 451-7153
Our File No. 0413966292.1-
TO: MARK E. WEINBERGER, P.C.
Attorneys for the Plaintiff
50 Merrick Rd
Rockville Centre NY 11570
516-829-7270
3
22 of 31AUTHORIZATION FOR RELEASE OF MEDICAID PROTECTED INFORMATION FROM THE NEW YORK
STATE DEPARTMENT OF HEALTH, OFFICE OF HEALTH INSURANCE PROGRAMS TO A THIRD PARTY
OTHER THAN A MEDICAID ENROLLEE/PATIENT
Enrollee/Client Name:
Date of Birth:
Client Identification Number (CIN):
By signing this form, I understand that I am allowing the New York State Department of Health to use or disclose all of
my payment information as indicated below. This may include data on certain conditions such as HIV/AIDS, Mental
Health and Alcohol and Substance Abuse.
Persons/Organizations authorized to receive or use the information:
‘Name:
Address:
City: State: Zip:
Phone Number:
1. Purpose of the use/disclosure:
2. Will the person/program requesting the authorization receive financial or in-kind compensation in exchange for using or
disclosing the health information described above? Yes [_] No
3, L understand that my health care and the payments for my health care will not be affected if I do not sign this form except in
some situations when information is needed for the health plan’s eligibility or enrollment determinations relating to the
individual,
4, Lunderstand, with few exceptions, that I may see and copy the information described on this form if I ask for it, and that I may
get a copy of this form after I sign it,
5. Imay revoke this authorization at any time by notifying the Department of Health in writing at the address below, but, if I do,
it will nat have any effect on actions that the Department took before they received the revocations. If not previously revoked,
this authorization will expire upon completion of this request.
6. I understand that this authorization is voluntazy. I understand that if the organization authorized to receive the information is
not a health plan, health care provider or clearinghouse, the released information may no longer be protected by federal privacy
regulations, and therefore the recipient of the confidential data may re-disclose the confidential data,
7. This authorization will expire upon use or one year from the data this form is signed, whichever comes first.
Signature of Medicaid Enrollee Daie
Please return fo:
NYS Department of Health
Office of Health Insurance Programs
Division of Systems-Bureau of Data Warehouse
Data Access Unit
800 N. Pearl Street
3" Floor-Room 322
Albany, NY 12204
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|Information to Help You Fill Out the
«1-800-MEDICARE Authorization to Disclose Personal Health Information” Form
By law, Medicare must have your written permission (an “authorization”) to use or give
out your personal medical information for any purpose that isn’t set out in the privacy
notice contained in the Medicare & Your handbook. You may take back (“revoke”) your
written permission at any time, except if Medicare has already acted based on your
permission.
If you want 1-800-MEDICARE to give your personal health information to someone other
than you, you need to let Medicare know in writing.
If you are requesting personal health information for a deceased beneficiary, please include
a copy of the legal documentation which indicates your authority to make a request for
information. (For example: Executor/Executrix papers, next of Kin attested by court
documents with a court stamp and a judge’s signature, a Letter of Testamentary or
Administration with a court stamp and judge’s signature, or personal representative
papers with a court stamp and judge’s signature.) Also, please explain your relationship to
the beneficiary.
Please use this step by step instruction sheet when completing your “1-800-MEDICARE”
Authorization to Disclose Personal Health Information” Form. Be sure to complete all
sections of the form to ensure timely processing.
1. Print the name of the person with Medicare.
Print the Medicare Member exactly as it is shown on the red, white, and blue
Medicare card, including any letters (for example, 123456789A).
Print the birthday in month, day, and year (mm/dd/yyyy) of the person with
Medicare.
2. This section tells Medicare what personal health information to give out. Please
check a box in 2a to indicate how much information Medicare can disclose. If you
only want Medicare to give out limited information (for example, Medicare
eligibility), also check the box(es) in 2b that apply to the type of information you
want Medicare to give out.
3. This section tells Medicare when to start and/or when to stop giving out your
personal health information. Check the box that applies and fill in dates, if
necessary.
4. Medicare will give your personal health information to the person(s) or
organization(s) you fill in here. You may fill in more than one person or
organization. If you designate an organization, you must also identify one of more
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individuals in that organization to whom Medicare may disclose your personal
health information.
wn
The person with Medicare er personal representative must sign their name, fill in
the date, and provide the phone number and address of the person with Medicare. |
If you are a personal representative of the person with Medicare, check the box,
provide your address and phone number, and attach a copy of the paperwork that
shows you can act for that person (for example, Power of Attorney).
6. Send your completed, signed authorization to Medicare at the address shown here
on your authorization form.
7. If you change your mind and don’t want Medicare to give out your personal health
information, write to the address shown under number six on the authorization
form and tell Medicare. Your letter will revoke your authorization and Medicare
will no longer give out your personal health information (except for the personal |
health information Medicare has already given out based on your permission). |
You should make a copy of your signed authorization for your records before mailing it to
Medicare.
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25 of 31 |1-800-MEDICARE Authorization to Disclose Personal Health Information
Use this form if you want 1-800-MEDICARE ¢o give your personal health information to 5
other than you.
maeone
1, Print Name Medicare Numbcr Date of Birth
(First & last name of the person with Medicare) (Exactly as shown on the Medicare Card) (mm/dd/yyyy)
2. Medicare will only disclose the personal health information you want disclosed.
2A: Check only one box below to tell Medicare the specific personal health information you
want disclosed:
Limited Information (go to question 2b)
Any information (go to question 3)
2B: Complete only if you selected “limited information”. Check all that apply:
Information about your Medicare eligibility
Information about your Medicare claims
Information about plan enrollment (e.g. drug or MA Plan)
Information about premium payments
Other Specific Information (please write below; for example, payment
information)
3. Check only one box below indicating how long Medicare can use this authorization to disclose
your personal health information (subject to applicable law, for example, your State may limit how
long Medicare may give out your personal health information):
Disclose my personal health information indefinitely
Disclose my personal health information for a specified period only beginning:
(mm/dd/yyyy) and ending: (mm/dd/yyyy)
26 of 314, Fill in the name and address of the person(s) or organization(s) to whom you want Medicare to
disclose your personal health information. Please provide the specific name of the person(s) for
any organization you list below: |
1. Name: |
Address: |
2. Name:
Address: |
3. Name: j
Address:
27 of 315, I authorize 1-800-MEDICARE to disclose my personal health information listed above to the
person(s) or organization(s) I have named on this form. I understand that my personal health
information may be re-disclosed by the person(s) or organization(s) and may no longer be
protected by law.
Signature Telephone Number Date (mm/dd/yyyy)
Print the address of the person with Medicarc (Strect Address, City, State and ZIP)
Check here if you are signing as a personal representative and complete below. Please
attach the appropriate documentation (for example, Power of Attorney). This only applies if
someone other than the person with Medicare signed above.
Print the Personal Representative’s Address (Street Address, City, State, and ZIP)
Telephone Number of Personal Representative:
Personal Representative’s Relationship to the Beneficiary:
6. Send the completed, signed authorization to:
Medicare BCC, Written Authorization Dept.
PO BOX 1270
Lawrence, KS 66044
7. Note:
You have the right to take back (“revoke”) your authorization at any time, in writing,
except to the extent that Medicare has already acted based on your permission. If you
would like to revoke your authorization, send a written request to the address shown
above.
Your authorization or refusal to authorize disclosure of your personal health information
will have no effect on your enrollment, cligibility for benefits, or the amount Medicare pays
for the health services you receive.
28 of 31According to the Paperwork Reduction Act of 1995, no persons are required to respond to
a collection of information unless it displays a valid OMB contro! number. The valid OMB
control number for this information collection is 0938-0930, The time required to complete
this information collection is estimated to average 15 minutes per response, including the
time to review instructions, search existing date resources, gather the data needed, and
complete and review the information collection. if you have commenis concerning the
accuracy of the time estimate(s) or suggestions for improving this form, please write to:
CMS, 7500 Security Boulevard, Att: PRA Reports Clearance Officer, Mail Stop C4-26-05,
Baltimore, Maryland 21244-1850.
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|CERTIFICATION
December 19, 2016
Morales vs. Spitzer
Index No. 521396/16
Our File No. 0413966292.1
The following documents are hereby certified:
ANSWER, COMBINED DEMAND, DEMAND FOR VERIFIED BILL OF PARTICULARS,
MEDICAL REPORTS, NOTICE OF EXAMINATION BEFORE TRIAL, DEMAND
PURSUANT TO C.P.L.R. 306(a), NOTICE DECLINING SERVICE BY FAX, DEMAND
FOR MEDICARE REIMBURSEMENT INFORMATION, MEDICARE AUTHORIZATION,
AND MEDICARE AUTHORIZATION TO DISCLOSE PERSONAL HEALTH
INFORMATION FORM.
By: Ww UL Mes Dt?
CLAIRE MARTIN
Attorney for Defendant
IRVING SPITZER
4 Metrotech Center, Suite 2000
Brooklyn, NY 11201
Telephone: (718) 451-7153
Our File No. 0413966292. 1-
30 of 31INDIVIDUAL VERIFICATION
STATE OF NY )
) ss
COUNTY OF KINGS )
Irving Spitzer being duly sworn deposes and says, that he/she is the Answer in the within action;
that he/she has read and knows the contents of the foregoing Answer; that the same is/are true to
his/her own knowledge, except as to the matters therein stated to be alleged on information and
belief, and that as to those matters, he/she believes them to be true.
IRVING SPITZER,
Subscribed and sworn to before me this
day of , 2016.
Notary Public
My Commission Expires:
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Preview
(FILED: KINGS COUNTY CLERK 1272272016 05:17 PM INDEX NO. 521396/2016 | NYSCEF DOC. NO. 2 RECEIVED NYSCEF: 12/22/2016 | | | AFFIDAVIT OF SERVICE BY MAIL STATE OF NY ) ) ss: COUNTY OF KINGS ) Sheron L. Robinson, being duly sworn, deposes and says, that he/she is not a party to the action herein, and that he/she is an administrative assistant for the Law Offices of Karen L. Lawrence, the attorney for the within named Defendant(s), IRVING SPITZER. That on the December, 2016, he/she served the within ANSWER, COMBINED DEMAND, DEMAND FOR | VERIFIED BILL OF PARTICULARS, MEDICAL REPORTS, NOTICE OF . | EXAMINATION BEFORE TRIAL, DEMAND PURSUANT TO C.P.L.R. 306(a), NOTICE — DECLINING SERVICE BY FAX, CERTIFICATION, DEMAND FOR MEDICARE | REIMBURSEMENT INFORMATION, MEDICARE AUTHORIZATION, AND MEDICARE | AUTHORIZATION TO DISCLOSE PERSONAL HEALTH INFORMATION FORM. by | depositing a true copy of the same securely enclosed in a post-paid wrapper in a Post Office Box regularly maintained by the United States Government at 4 Metrotech Center, Suite 2000, Brooklyn, in the County of KINGS, State of NY, directed to: MARK. E. WEINBERGER, P.C. Attorneys for the Plaintiff 50 Merrick Rd Rockville Centre NY 11570 516-829-7270 that being the address(es) within the state designated by him/her for that purpose upon the preceding papers in this action, or the place where he/she then kept an office, between which places there then was and now is a regular communication by mail. a | Deponent is over the age of eighteen (18) years. i L— > 1 “7 Sheron L. Robinson Subscribed and sworn to before me this AA day ot 2 , 2016. _ a DOLSKA Fotery Putt aaa rete ot jew York Notary Public No.02R06313338 / Qualified In Richmond County My ommiséi on Expires: My Commlesion Explras: October 20, 2018 Morales vs. Spitzer Index No. 521396/16 Our File No. 0413966292. 1- 1 of 31SUPREME COURT OF THE STATE OF NEW YORK COUNTY OF KINGS x GILBERTO MORALES, ANSWER Dot etce Plaintirt, -against- Index No. 521396/16 IRVING SPITZER, Defendant. x The Defendant(s) IRVING SPITZER by Law Offices of Karen L. Lawrence, as and for his/her/their Answer to the Complaint herein, allege(s) as follows: FIRST: Denies/deny any knowledge or information sufficient to form a belief as to the allegation(s) contained in paragraph(s) designated as “1, 3,.4, 5, 6, 7, 8, 9, 10 and 19” of the Complaint herein. SECOND: Upon information and belief, denies/deny each and every allegation contained in paragraphs designated as “11, 12, 13, 14, 15, 16, 17, 18 and 20” of the Complaint herein. AS AND FOR A FIRST AFFIRMATIVE DEFENSE THIS (THESE) ANSWERING DEFENDANT(S) ALLEGE(S): Any damages sustained by the Plaintiff(s) were caused by the culpable conduct of the Plaintiff(s), including contributory negligence or assumption of risk, and not by the culpable conduct or negligence of this(these) answering Defendant(s). 2 of 31AS AND FOR A SECOND AFFIRMATIVE DEFENSE THIS(THESE) ANSWERING DEFENDANT(S) ALLEGE(S): Upon information and belief, Plaintiff(s) failed to use or misused seat belis, and AS AND FOR A THIRD AFFIRMATIVE DEFENSE, THIS(THESE) ANSWERING DEFENDANT(S) ALLEGE(S): That the Court lacks jurisdiction over the person of the Defendant(s) IRVING SPITZER by reason of the non-service of the summons upon the Defendant(s) IRVING SPITZER, either personally or by substituted service. AS AND FOR A FOURTH AFFIRMATIVE DEFENSE THIS(THESE) ANSWERING DEFENDANT(S) ALLEGE(S): That to the extent plaintiff recovers any damages for the cost of medical care, dental care, custodial care or rehabilitation services, loss of earnings and/or economic loss, the amount of the award shall be reduced by the sum total of all collateral reimbursements, from whatever source, whether it be insurance, social security payments, no fault payments, Workers Compensation, employee benefits or other such programs, in accordance with the provisions of the CPLR 4545. AS AND FOR A FIFTH AFFIRMATIVE DEFENSE THIS(THESE) ANSWERING DEFENDANT(S) ALLEGE(S): In the event that any person or entity liable or claimed to be liable for the injury alleged in this action has been given or may hereafter be given a release or covenant not to sue, defendant will be entitled to protection under General Obligations Law 15-108 and the corresponding reduction of any damages which may be determined to be due against this answering defendant. 3 of 31 | { |WHEREFORE, this answering Defendant(s) demand(s) judgment dismissing the Complaint herein with costs. DATED: Brooklyn, NY TO: Deceiber 19, 2016 MARK E. WEINBERGER, P.C. Attorneys for the Plaintiff 50 Merrick Rd Rockville Centre NY 11570 516-829-7270 Yours, etc., Law Offices of Karen L. Lawrence CLAIRE MARTIN Attomey for Defendant IRVING SPITZER. 4 Metrotech Center, Suite 2000 Brooklyn, NY 11201 Telephone: (718) 451-7153 Our File No. 0413966292. 1- 4 of 31SUPREME COURT OF THE STATE OF NEW YORK COUNTY OF KINGS X GILBERTO MORALES, COMBINED DEMAND FOR DISCOVERY AND INSPECTION Plainiiff, Index No. 521396/16 -against- IRVING SPITZER, Defendant. SIRS: PLEASE TAKE NOTICE that pursuant to CPLR 3101 et seq., it is hereby demanded that you serve upon the office of the undersigned, within thirty (30) days the following: 1. The names and addresses of all witnesses known to the Plaintiff(s) and the Plaintiff's representatives, who it will be claimed were witnesses to the following: (a) The alleged occurrence in question. (b) Any alleged defective condition. (c) The site of the alleged occurrence immediately prior and immediately subsequent to the alleged occurrence. (d) The actions of any of the parties, or of any non-parties, before, during, or after the alleged occurrence. 2. Any statements, oral, written or electronically recorded, from any party we represent, in the possession of the Plaintiff(s) or the Plaintiff(s) representatives. 3. Any photographs of the following: (a) The site of the alleged occurrence. (b) Any instrumentalities involved. 4, Any accident reports made in the normal course of business. Pataki_v. Kiseda, 80 A.D.2d 100, 437 N.Y.S.2d 692 (1981). 5. Any diagrams, drawings, notes, records, etc., made from any information 5 of 31 1provided by any client we represent. 6. Any notes, records, memoranda, diagrams, drawings, photographs made or taken by any investigator employed by the Plaintiff(s) or the Plaintifi(s) representatives, even if made in contemplation of litigation. 7. The name and address of each and every person you expect to call as an expert witness at the trial of this action; 8. In reasonable detail, the subject matter on which each expert is expected to testify; 9. The substance of the facts and opinions on which each expert is expected to testify; 10. The qualification of each expert witness, and; 11. A summary of the grounds for each expert's opinion. 12. | Maintenance and repair records for the motor vehicle of the Plaintiff(s) for one year prior to the alleged occurrence. 13. Copies of any letters or written communications from Plaintiff(s) to Defendant(s) citing any alleged defective conditions. 14. Duly executed authorization allowing the undersigned to obtain the employment records of the party seeking recovery for the period commencing one (1) year prior to the date of the subject occurrence and continuing to the present date. This authorization shall allow access to, but shall not be limited to records regarding the Plaintiff(s)' salary and attendance. (a) If Plaintiff is a student: duly executed authorization(s) allowing the undersigned to obtain the school records of the Plaintiff for the period commencing one (1) year prior to the date of the occurrence and continuing to the present date. 15. Copies of the Plaintiffs)’ City, State and Federal Income Tax Records for the period commencing two (2) years prior to the date of the subject occurrence and for all subsequent years up to and including the present. If such records, or a portion thereof are unavailable, authorizations to obtain such records from the Internal Revenue Service and/or New York State Department of Taxation.” If income tax returns were not filed for such period or a portion thereof, so state in reply to this demand. 16. Duly executed and acknowledged original authorizations permitting this/these Defendant(s) to obtain and copy No-Fault medical and wage records for each Plaintiff 6 of 31 | |for the period from the date of occurrence to the present. 17. Ifa claim has or will be made pursuant to the terms of ARTICLE S51} of the Insurance Law of the State of New York (Mo-Fault Law); with respect to each and every application: (a) Set forth the name, address, policy number and claim number of each company to which a claim has been or will be made. (b) Set forth duly executed and acknowledged written authorizations enabling the undersigned to obtain the records relating to the Plaintiff from each company identified in the response to paragraph "(a)", 18. ‘If a claim has or will be made pursuant to the terms of the Workers! Compensation Law, with respect to each and every application: (a) Set forth the name, address, policy number and claim number to which a claim has been or will be made, together with the Workers! Compensation Board file number. (b) Set forth duly executed and acknowledged written authorizations enabling the undersigned to obtain the records relating to the Plaintiff from each company identified in the response to paragraph "(a)", 19. Ifa disability claim has or will be made pursuant to the terms of the Social Security Laws, with respect to each and every application: (a) Set forth the claim office, the address and the claim number assigned. (b) Set forth duly executed and acknowledged written authorizations enabling the undersigned to obtain the records relating to the Plaintiff. 20. Pursuant to CPLR Section 4545(a) produce and permit the undersigned attorneys to inspect and copy the contents of: (a) Each and every collateral source of payment, including but not limited to, insurance agreements, Social Security, Workers' Compensation or employee benefit programs, and any other collateral source of payment for past or future costs or expenses alleged to have been incurred by the Plaintiffs and for which recovery is sought in the instant action and (b) A written statement setting forth any and all such collateral sources and their amounts. (c) Duly executed written authorizations permitting the undersigned 7 of 31attorneys to obtain and make copies of all records relating to collateral source information as set forth herein. 21. ‘if it is claimed that the Plaintiff husband/wife is married to Plaintiff husband/wife. Please set forth a copy of their Marriage Certificate. 22. If it is claimed that the infant Plaintiff is the natural son/daughter of the Plaintiff mother/father or natural guardian set forth a copy of the Birth Certificate of infant Plaintiff. 23. Withholding statements, pay envelopes, deposit slips, or any other evidence of income earned by Plaintiff(s) for the current calendar year. 24. Copies of any and all bills, statements or receipts relating to any non- medical expense claimed as damages in this lawsuit which have not been produced in response to any of the preceding paragraphs. 25. Copies of bills and/or estimates for the repair of Plaintiff(s) vehicle and any other damaged property. If the vehicle was not repairable, in addition, attach estimates of the value of the vehicle on the date of the alleged incident and estimates and/or receipts concerning salvage value. 26. Any releases, and any other type of settlement agreements between Plaintiff(s) and any other party which may have been responsible for the damages claimed by Plaintiff(s). 27. Any and all photographs, blow-ups, recordings, charts, graphs, sketches and.any other tangible items or documentary evidence which you intend to use during the trial of this case and which have not been produced in response to any of the preceding paragraphs. 28. All documents, papers or evidence to be introduced at trial. PLEASE TAKE FURTHER NOTICE that the within demands are continuing demands. In the event any of the above items are obtained after service of this demand, they are to be furnished to this office upon receipt. DATED: Brooklyn, NY December 19, 2016 8 of 31 | { | | 1 | |TO: MARK E. WEINBERGER, P.C. Attorneys for the Plaintiff 50 Merrick Rd Rockville Centre NY 11570 516-829-7270 Yours, etc., Law Offices of Karen L. Lawrence CLAIRE MARTIN Attorney for Defendant IRVING SPITZER. 4 Metrotech Center, Suite 2000 Brooklyn, NY 11201 Telephone: (718) 451-7153 Our File No. 0413966292.1- 9 of 31SUPREME COURT OF THE STATE OF NEW YORK COUNTY OF KINGS x GILBERTO MORALES, DEMAND FOR VERIFIED BELL OF PARTICULARS WITH NOTICE Plaintiff, PURSUANT 70 C.?.L.R. SECTION 3042(c) -against- Index No. 521396/16 IRVING SPITZER, Defendant. Xx SIRS: PLEASE TAKE NOTICE that your are hereby required to file and serve the following Verified Bill of Particulars of Plaintiff's alleged cause of action herein, within thirty (30) days from the date of service hereof. 1. The date and time of day of the occurrence. 2. State the location of the accident in sufficient detail to permit identification, giving direction in which each vehicle was proceeding. 3. Statement of the acts of omissions constituting the negligence claimed. 4, State what part of each of the respective vehicles came in contact. If property damages are being claimed, set forth: 5. Itemized statement of the alleged damage to Plaintiffs vehicle, together with the costs of repair of each item. 6. State the make, model and year of manufacture of Plaintiff's vehicle and the reasonable market value of same immediately prior to and immediately after the alleged accident. If personal injuries are being claimed, set forth: 7. The nature, extent, location and duration of each and every injury alleged to have been sustained by the Plaintiff and which, if any are claimed to be permanent. 10 of 31 { | | | | | | | | |8. The length of time, giving specific dates, Plaintiff was confined to: (a) the hospital, (b) to bed and (c) to home as a result of the alleged injuries. 9. The length of time incapacitated from employment and/or household duties as a result of the alleged injuries. If Plaintiff is a student, the length of time incapacitated from school as a result of the alleged injuries. 10. Total amounts claimed as special damages for: (a) physician's services; (b) medical supplies; (c) loss of earnings; (d) nurses’ services; (e) hospital expenses; ( x-rays expenses; (g) any other items of special damage; (h) name and address of Plaintiff's employer at the time of the accident. If Plaintiff is self-employed, please state nature of business, business name and address. If Plaintiff is a student, name and address of school attending at time of accident and designated class or grade. 11. State in what respect Plaintiff has sustained a serious injury, as defined in Subdivision (d) of Section 5102 of the Insurance Law, or economic loss greater than basic economic loss, as defined in Subdivision (a) of 5102 of the Insurance Law. 12. If negligent entrustment is alleged, set forth, with specificity, each and every fact which constitutes the basis of the claim. 13. Set forth the manner in which it is claimed the negligent entrustment occurred. 14. If it is alleged that the owner of the vehicle had prior knowledge of some . propensity to be alleged by the Plaintiff in regards to the operation of the vehicle, set forth: (a) What propensities or actions it is alleged the owner of the vehicle was aware of. (b) Set forth if the owner of the vehicle had actual or constructive notice. (c) If actual notice is alleged: 2 11 of 31 | | || | | | | | | ql) Set forth the date, time and place which will be alleged that the owner was made aware of the propensities, actions, or traits. (2) Set forth the names and addresses of the individuals it will be alleged so advised the owner of our vehicle of the propensities, actions, or traits of our operator. 15. If the Plaintiff prayed for general relief, state the total damages to which all Plaintiff(s) deem himself/herself/themselves entitled. 16. ‘If the Plaintiff prayed for general relief, state the total damages that each Plaintiff deems himself/herself entitled. 17. As regards paragraph 16, state each category of damages and the amount demanded in each category. If a cause of action is claimed Section 205(e) of The General Municipal Law: 8. Set forth by Section every statute, regulations, ordinance, rule, order and requirement of the Federal, State, County, Village, Town or City government of any and all of their departments, divisions and bureau it is alleged was violated by the Defendant. 9. Identify for each act or omission it will be claimed was committed by the Defendant(s), the rule, regulation, statute, ordinance, order and requirement it is claimed said act violated, PLEASE TAKE FURTHER NOTICE that if a copy of the Verified Bill of Particulars of the Plaintiffs' alleged cause of action is not served with thirty (30) days of receipt of this notice, an appropriate motion to preclude will be made pursuant to this notice at the time of trial of this action. DATED: Brooklyn, NY December 19, 2016 3 12 of 31 {TO: MARK E. WEINBERGER, P.C. Attorneys for the Plaintiff 50 Merrick Rd Rockville Centre NY 11570 516-829-7270 Yours, etc., Law Offices of Karen L. Lawrence CLAIRE MARTIN Attorney for Defendant IRVING SPITZER 4 Metrotech Center, Suite 2000 Brooklyn, NY 11201 Telephone: (718) 451-7153 Our File No. 0413966292.1- 4 13 of 31SUPREME COURT OF THE STATE OF NEW YORK COUNTY OF KINGS x GILBERTO MORALES, DEMAND FOR COPIES OF PLAINTIFF’S MEDICAL REPORTS Plamtitt, Index No. 521396/16 -against- IRVING SPITZER, Defendant. SIRS: PLEASE TAKE NOTICE that pursuant to the Uniform Rules for the New York State Trial Courts, demand is hereby made upon the Plaintiff(s) or his attorney to: 1. Serve upon and deliver to the attorney for the Defendant(s) copies of the medical reports of those physicians who have previously treated or examined the Plaintiff(s) and who will testify on his behalf. These shall include a detailed recital of the injuries and conditions as to which testimony will be offered at the trial, referring to and identifying those x- rays and technician's reports which will be offered at the trial. 2. Serve upon and deliver to the attorney for the Defendant(s) duly executed and acknowledged written HIPAA compliant authorizations permitting all parties to obtain and make copies of all hospital records and such other records, including x-rays and technician's reports, as to be referred to and identified in the statement of the Plaintiff(s) physicians. 3. Serve upon and deliver to the attorney for the Defendant(s) copies of all graphic, numerical, symbolic, digital, film, video, computer generated, computer enhanced or otherwise produced electronically and/or digitally, photographic or pictorial representations regarding any procedures, treatments, admissions, office visits, injuries, scene of the accident or the vehicles or instrumentalities involved, disabilities, medical or diagnostic procedures or tests, performed by or on behalf of the plaintiff(s) herein or by any facility regarding the claims of the plaintiff(s) herein. PLEASE TAKE FURTHER NOTICE that upon his failure to comply with this 14 of 31 |demand, the Plaintiff(s) will be precluded upon the trial of the within action from offering in evidence or testifying as to any of the reports, records or examination demanded herein. DATED: Brooklyn, NY TO: December i9, 2016 MARK E. WEINBERGER, P.C. Attorneys for the Plaintiff 50 Merrick Rd Rockville Centre NY 11570 516-829-7270 Yours, etc., Law Offices of Karen L. Lawrence CLAIRE MARTIN Attorney for Defendant IRVING SPITZER 4 Metrotech Center, Suite 2000 Brooklyn, NY 11201 Telephone: (718) 451-7153 Our File No. 0413966292. 1- 2 15 of 31SUPREME COURT OF THE STATE OF NEW YORK COUNTY OF KINGS x GILBERTO MORALES, NOTICE OF EXAMINATION BEFORE TRIAL Piaintiff, Index No. 521396/16 -against- IRVING SPITZER, Defendant. SIRS: PLEASE TAKE NOTICE that pursuant to Article 31 of the Civil Practice Law and Rules, the undersigned will take the testimony of, all Adverse Parties, in the manner following: TO BE DETERMINED AT THE PRELIMINARY CONFERENCE upon all the relevant facts and circumstances surrounding the accident which is the subject of this action, including negligence, contributory negligence and damages; and for the purposes authorized by Rule 3111+ of the Civil Practice Law and Rules said Plaintiff(s) is required to produce at such examination the following: All books, papers and records relating to said action in the possession, custody or control of said Plaintiff(s)/ Co-Defendant(s). DATED: Brooklyn, NY December 19, 2016 16 of 31TO: MARK E, WEINBERGER, P.C, Attorneys for the Plaintiff 50 Merrick Rd Rockville Centre NY 11570 516-829-7270 Yours, etc., Law Offices of Karen L. Lawrence CLAIRE MARTIN Attomey for Defendant IRVING SPITZER 4 Metrotech Center, Suite 2000 Brooklyn, NY 11201 Telephone: (718) 451-7153 Our File No. 0413966292.1- 2 17 of 31SUPREME COURT OF THE STATE OF NEW YORK COUNTY OF KINGS x GILBERTO MORALES, DEMAND PURSUANT TO SECTION 306(a) Plaintiit, Index No. 521396/16 -against- IRVING SPITZER, Defendant. x SIRS: IT IS HEREBY DEMANDED that you serve upon the undersigned, either a copy of the receipt for the Index Number purchased or the date the Index Number was purchased as per said receipt. DATED: Brooklyn, NY December 19, 2016 Yours, etc., Law Offices of Karen L. Lawrence CLAIRE MARTIN Attorney for Defendant IRVING SPITZER 4 Metrotech Center, Suite 2000 Brooklyn, NY 11201 Telephone: (718) 451-7153 Our File No. 0413966292.1- TO: MARK E. WEINBERGER, P.C. Attomeys for the Plaintiff 50 Merrick Rd Rockville Centre NY 11570 516-829-7270 18 of 31SUPREME COURT OF THE STATE OF NEW YORK. COUNTY OF KINGS xX GILBERTO MORALES, NOTICE DECLINING SERVICE BY MEANS OF ELECTRONIC OR FAX Piaintiif, TRANSMITTALS -against- Index No. 521396/16 IRVING SPITZER, Defendant. x SIRS: PLEASE TAKE NOTICE that pursuant to C.P.L.R. 2103(5) Law Offices of Karen L. Lawrence., will not accept service of papers, notices, motions, etc., by facsimile (fax) transmittal or by any other electronic means. DATED: Brooklyn, NY December 19, 2016 Yours, etc., Law Offices of Karen L. Lawrence CLAIRE MARTIN Attorney for Defendant IRVING SPITZER 4 Metrotech Center, Suite 2000 Brooklyn, NY 11201 Telephone: (718) 451-7153 Our File No. 0413966292.1- TO: MARK E. WEINBERGER, P.C. Attorneys for the Plaintiff 50 Merrick Rd Rockville Centre NY 11570 516-829-7270 19 of 31SUPREME COURT OF THE STATE OF NEW YORK COUNTY OF KINGS xX GILBERTO MORALES, DEMAND FOR MEDICARE REIMBURSEMENT INFORMATION Plaintitt, Index No. 521396/16 -against- IRVING SPITZER, Defendant. x PLEASE TAKE NOTICE that pursuant to 42 U.S.C. 1395y(b)(8), 42 C.P.R 411.23 and CPLR 3101 et seq,, it is hereby demanded that you serve upon the office of the undersigned, within thirty (30) days the following: 1. Plaintiff's Social Security Number 2. Plaintiff's date of birth 3. Plaintiff's Medicare and Health Insurance Claim Numbers 4. A statement as to whether the plaintiff has received benefits from Medicare at any time, for any reason, not limited to the injuries alleged in the instant action. 5. A statement as to whether the plaintiff has received benefits from Medicare claimed to be related to this instant action and an itemization of those benefits. 6. If the answer to request “4” or “5” above is “yes”, please state or provide: a) Whether Medicare has asserted a Medicare Secondary Payer right of reimbursement and the amount of any such reimbursement; b) Copies of any and all documents, records, memoranda, notes, correspondence etc., in plaintiff's possession pertaining to plaintiff's receipt of Medicare benefits, including, but not limited to, copies of all documents provided to or received from the Medicare Center for Medicare/Medicaid Services (CMS), 20 of 31 | | | |Coordination of Benefits Contractor (COBC), and Medicare Secondary Payer Recovery Contractor (MSPRC); c) A duly executed and acknowledged HIPAA-compliant authorization permitting Defendant to obtain copies of plaintiff's Medicare records. A copy of the authorizaiion required by Medicare is attached hereto; d) If any Medicare Secondary Payer claims exist, please provide a copy of such claims. If no Medicare Secondary Payer claims exist, kindly provide a letter from Medicare attesting to that fact. Please state whether the plaintiff is Medicare-cligible by reason of: a) Being age 65 or older; | b) Being entitled to receive Social Security Disability for the previous | 24 months; / c) Having received a disability pension from the Railroad Retirement Board, d) Having received benefits for amyotrophic lateral sclerosis; e) Having a government job where Medicare taxes were paid and the claimant meets the requirements of the Social Security Disability program. f) Being the child or widow(er), age 50 or older, including divorced widow(ers) of someone who has been in a government job where edicare taxes were paid and who meets the eligibility requirements of the Social Security Disability program; g) Has had permanent kidney failure, a kidney transplant or receives maintenance dialysis or and: i) Is eligible to or receive monthly benefits under Social Security or the Railroad Retirement System; or ii) Has worked in a Medicare covered government job; or is the child or spouse (including divorced spouse) of a worker who has worked long enough under Social Security or in a Medicare-covered government job. 21 of 31PLEASE TAKE FURTHER NOTICE that this demand is made pursuant to the Medicare, Medicaid and State Children’s Health Insurance program (SCHIP) Act of 2007. Federal Law mandates that the foregoing information be provided to the Centers for Medicare and Medicaid Services following resolution of the instant litigation. PLEASE TAKE FURTHER NOTICE that failure to comply with this Demand in contravention of 42 C.F.R 411.23 may result in direct recovery by the centers for Medicare and Medicaid Services against the plaintiff herein. PLEASE TAKE FURTHER NOTICE that the within demands are continuing demands. In the event any of the above items are obtained after service of this demand, they are to be furnished to this office upon receipt. DATED: Brooklyn, NY December 19, 2016 Yours, etc., Law Offices of Karen L. Lawrence CLAIRE MARTIN Attorney for Defendant IRVING SPITZER 4 Metrotech Center, Suite 2000 Brooklyn, NY 11201 Telephone: (718) 451-7153 Our File No. 0413966292.1- TO: MARK E. WEINBERGER, P.C. Attorneys for the Plaintiff 50 Merrick Rd Rockville Centre NY 11570 516-829-7270 3 22 of 31AUTHORIZATION FOR RELEASE OF MEDICAID PROTECTED INFORMATION FROM THE NEW YORK STATE DEPARTMENT OF HEALTH, OFFICE OF HEALTH INSURANCE PROGRAMS TO A THIRD PARTY OTHER THAN A MEDICAID ENROLLEE/PATIENT Enrollee/Client Name: Date of Birth: Client Identification Number (CIN): By signing this form, I understand that I am allowing the New York State Department of Health to use or disclose all of my payment information as indicated below. This may include data on certain conditions such as HIV/AIDS, Mental Health and Alcohol and Substance Abuse. Persons/Organizations authorized to receive or use the information: ‘Name: Address: City: State: Zip: Phone Number: 1. Purpose of the use/disclosure: 2. Will the person/program requesting the authorization receive financial or in-kind compensation in exchange for using or disclosing the health information described above? Yes [_] No 3, L understand that my health care and the payments for my health care will not be affected if I do not sign this form except in some situations when information is needed for the health plan’s eligibility or enrollment determinations relating to the individual, 4, Lunderstand, with few exceptions, that I may see and copy the information described on this form if I ask for it, and that I may get a copy of this form after I sign it, 5. Imay revoke this authorization at any time by notifying the Department of Health in writing at the address below, but, if I do, it will nat have any effect on actions that the Department took before they received the revocations. If not previously revoked, this authorization will expire upon completion of this request. 6. I understand that this authorization is voluntazy. I understand that if the organization authorized to receive the information is not a health plan, health care provider or clearinghouse, the released information may no longer be protected by federal privacy regulations, and therefore the recipient of the confidential data may re-disclose the confidential data, 7. This authorization will expire upon use or one year from the data this form is signed, whichever comes first. Signature of Medicaid Enrollee Daie Please return fo: NYS Department of Health Office of Health Insurance Programs Division of Systems-Bureau of Data Warehouse Data Access Unit 800 N. Pearl Street 3" Floor-Room 322 Albany, NY 12204 23 of 31 | | | | | | | |Information to Help You Fill Out the «1-800-MEDICARE Authorization to Disclose Personal Health Information” Form By law, Medicare must have your written permission (an “authorization”) to use or give out your personal medical information for any purpose that isn’t set out in the privacy notice contained in the Medicare & Your handbook. You may take back (“revoke”) your written permission at any time, except if Medicare has already acted based on your permission. If you want 1-800-MEDICARE to give your personal health information to someone other than you, you need to let Medicare know in writing. If you are requesting personal health information for a deceased beneficiary, please include a copy of the legal documentation which indicates your authority to make a request for information. (For example: Executor/Executrix papers, next of Kin attested by court documents with a court stamp and a judge’s signature, a Letter of Testamentary or Administration with a court stamp and judge’s signature, or personal representative papers with a court stamp and judge’s signature.) Also, please explain your relationship to the beneficiary. Please use this step by step instruction sheet when completing your “1-800-MEDICARE” Authorization to Disclose Personal Health Information” Form. Be sure to complete all sections of the form to ensure timely processing. 1. Print the name of the person with Medicare. Print the Medicare Member exactly as it is shown on the red, white, and blue Medicare card, including any letters (for example, 123456789A). Print the birthday in month, day, and year (mm/dd/yyyy) of the person with Medicare. 2. This section tells Medicare what personal health information to give out. Please check a box in 2a to indicate how much information Medicare can disclose. If you only want Medicare to give out limited information (for example, Medicare eligibility), also check the box(es) in 2b that apply to the type of information you want Medicare to give out. 3. This section tells Medicare when to start and/or when to stop giving out your personal health information. Check the box that applies and fill in dates, if necessary. 4. Medicare will give your personal health information to the person(s) or organization(s) you fill in here. You may fill in more than one person or organization. If you designate an organization, you must also identify one of more 24 of 31 i || | individuals in that organization to whom Medicare may disclose your personal health information. wn The person with Medicare er personal representative must sign their name, fill in the date, and provide the phone number and address of the person with Medicare. | If you are a personal representative of the person with Medicare, check the box, provide your address and phone number, and attach a copy of the paperwork that shows you can act for that person (for example, Power of Attorney). 6. Send your completed, signed authorization to Medicare at the address shown here on your authorization form. 7. If you change your mind and don’t want Medicare to give out your personal health information, write to the address shown under number six on the authorization form and tell Medicare. Your letter will revoke your authorization and Medicare will no longer give out your personal health information (except for the personal | health information Medicare has already given out based on your permission). | You should make a copy of your signed authorization for your records before mailing it to Medicare. 2 | | 25 of 31 |1-800-MEDICARE Authorization to Disclose Personal Health Information Use this form if you want 1-800-MEDICARE ¢o give your personal health information to 5 other than you. maeone 1, Print Name Medicare Numbcr Date of Birth (First & last name of the person with Medicare) (Exactly as shown on the Medicare Card) (mm/dd/yyyy) 2. Medicare will only disclose the personal health information you want disclosed. 2A: Check only one box below to tell Medicare the specific personal health information you want disclosed: Limited Information (go to question 2b) Any information (go to question 3) 2B: Complete only if you selected “limited information”. Check all that apply: Information about your Medicare eligibility Information about your Medicare claims Information about plan enrollment (e.g. drug or MA Plan) Information about premium payments Other Specific Information (please write below; for example, payment information) 3. Check only one box below indicating how long Medicare can use this authorization to disclose your personal health information (subject to applicable law, for example, your State may limit how long Medicare may give out your personal health information): Disclose my personal health information indefinitely Disclose my personal health information for a specified period only beginning: (mm/dd/yyyy) and ending: (mm/dd/yyyy) 26 of 314, Fill in the name and address of the person(s) or organization(s) to whom you want Medicare to disclose your personal health information. Please provide the specific name of the person(s) for any organization you list below: | 1. Name: | Address: | 2. Name: Address: | 3. Name: j Address: 27 of 315, I authorize 1-800-MEDICARE to disclose my personal health information listed above to the person(s) or organization(s) I have named on this form. I understand that my personal health information may be re-disclosed by the person(s) or organization(s) and may no longer be protected by law. Signature Telephone Number Date (mm/dd/yyyy) Print the address of the person with Medicarc (Strect Address, City, State and ZIP) Check here if you are signing as a personal representative and complete below. Please attach the appropriate documentation (for example, Power of Attorney). This only applies if someone other than the person with Medicare signed above. Print the Personal Representative’s Address (Street Address, City, State, and ZIP) Telephone Number of Personal Representative: Personal Representative’s Relationship to the Beneficiary: 6. Send the completed, signed authorization to: Medicare BCC, Written Authorization Dept. PO BOX 1270 Lawrence, KS 66044 7. Note: You have the right to take back (“revoke”) your authorization at any time, in writing, except to the extent that Medicare has already acted based on your permission. If you would like to revoke your authorization, send a written request to the address shown above. Your authorization or refusal to authorize disclosure of your personal health information will have no effect on your enrollment, cligibility for benefits, or the amount Medicare pays for the health services you receive. 28 of 31According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB contro! number. The valid OMB control number for this information collection is 0938-0930, The time required to complete this information collection is estimated to average 15 minutes per response, including the time to review instructions, search existing date resources, gather the data needed, and complete and review the information collection. if you have commenis concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Att: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850. 29 of 31 | | | |CERTIFICATION December 19, 2016 Morales vs. Spitzer Index No. 521396/16 Our File No. 0413966292.1 The following documents are hereby certified: ANSWER, COMBINED DEMAND, DEMAND FOR VERIFIED BILL OF PARTICULARS, MEDICAL REPORTS, NOTICE OF EXAMINATION BEFORE TRIAL, DEMAND PURSUANT TO C.P.L.R. 306(a), NOTICE DECLINING SERVICE BY FAX, DEMAND FOR MEDICARE REIMBURSEMENT INFORMATION, MEDICARE AUTHORIZATION, AND MEDICARE AUTHORIZATION TO DISCLOSE PERSONAL HEALTH INFORMATION FORM. By: Ww UL Mes Dt? CLAIRE MARTIN Attorney for Defendant IRVING SPITZER 4 Metrotech Center, Suite 2000 Brooklyn, NY 11201 Telephone: (718) 451-7153 Our File No. 0413966292. 1- 30 of 31INDIVIDUAL VERIFICATION STATE OF NY ) ) ss COUNTY OF KINGS ) Irving Spitzer being duly sworn deposes and says, that he/she is the Answer in the within action; that he/she has read and knows the contents of the foregoing Answer; that the same is/are true to his/her own knowledge, except as to the matters therein stated to be alleged on information and belief, and that as to those matters, he/she believes them to be true. IRVING SPITZER, Subscribed and sworn to before me this day of , 2016. Notary Public My Commission Expires: 31 of 31 | |