Preview
FILED: RICHMOND CIVIL COURT - CIVIL 07/24/2023 02:00 INDEX
PM NO. CV-723461-22/RI
NYSCEF DOC. NO. 7 RECEIVED NYSCEF: 07/24/2023
Re: Atlantic Medical & Diagnostic, P.C./Malcolm Parker
v. State Farm Mutual Automobile Insurance Company
Index No./Venue: CV-723461-22/RI – Civil Richmond
Amt. in Dispute: $1,156.80
Claim No.: 32-34B5-76L
Date of Loss: 05/14/2022
Policy No.: 2281-949-32B
Insured: Malcolm J Parker
Matter ID No.: 3234B576L-2
Plaintiff / File No.: Barshay, Rizzo, & Lopez, PLLC/44522-378719
FP&K File No.: 8000.0892
Amount Amount Amount Fee Schedule Bill NF-10/EOR
Exhibit Date of Service
Billed Paid Disputed Amount Received Generated
C 07/11/22 – 07/11/22 $1,563.21 $406.41 $1,156.80 $336.17 08/01/22 08/10/22
Total: $1,563.21 $406.41 $1,156.80 $336.17
Exhibit A Summons & Complaint
Exhibit B Answer
Exhibit C Bill / Medical / EOR / NF-10 - DOS: 07/11/22
Exhibit D Coder Affidavit
Exhibit E Request for Judicial Notice of the Fee Schedule
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Exhibit A 2 of 86
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KSB / ALL
Transmittal Number: 25925878
Notice of Service of Process Date Processed: 11/21/2022
Primary Contact: State Farm Enterprise SOP
Corporation Service Company- Wilmington, DELAWARE
251 Little Falls Dr
Wilmington, DE 19808-1674
Entity: State Farm Mutual Automobile Insurance Company
Entity ID Number 3461675
Entity Served: State Farm Mutual Automobile Insurance Company
Title of Action: Atlantic Medical & Diagnostic, P.C as assignee of Malcolm Parker vs. State Farm
Mutual Automobile Insurance Company
Matter Name/ID: Atlantic Medical & Diagnostic, P.C as assignee of Malcolm Parker vs. State Farm
Mutual Automobile Insurance Company (13238304)
Document(s) Type: Summons/Complaint
Nature of Action: Contract
Court/Agency: Richmond County Civil Court, NY
Case/Reference No: CV-723461-22/RI
Jurisdiction Served: New York
Date Served on CSC: 11/21/2022
Answer or Appearance Due: 30 Days
Originally Served On: CSC
How Served: Personal Service
Sender Information: Barshay, Rizzo & Lopez, PLLC
631-210-7272
Information contained on this transmittal form is for record keeping, notification and forwarding the attached document(s). It does not
constitute a legal opinion. The recipient is responsible for interpreting the documents and taking appropriate action.
To avoid potential delay, please do not send your response to CSC
251 Little Falls Drive, Wilmington, Delaware 19808-1674 (888) 690-2882 | sop@cscglobal.com
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RECEIVED CV-723461-22/RI
07/24/2023
,`NYSCEF DPC. NO. 1 RECEIVED NYSCEF: 11/01/2022
(CIVIL COURT OF THE CITY OF NLW YORK
COUNTY OF RICHMOND
ATLANTIC MEDICAL & DIAGNOSTIC, P.0 as assignee Index No:
of MALCOLM PARKER,
SUMMONS
Plaintiff,
Plaintiff resides at:
V. Po Box 4652
New York, New York 10185
STATE FARM MU INSURANCE
MMPAN ,9 The basis of the venue designated is:
NYCCCA § 301(a). Defendant resides in
Defendant. this County.
To the above-named defendant:
YOU ARE HEREBY SUMMONED to appear in the Civil Court of the City of New York, County
of RICHMOND, at the office of the Clerk of the said Court at 927 Castleton Avenue, Staten Island,
in the County of Richmond, City and State of New York, within the time provided by law as noted
below and to file your answer to the annexed complaint with the Clerk; upon your failure to answer,
judgment will be taken against you for the sum of $1,156.80, together with the costs of this action.
Dated: October 31, 2022
By: s~
Angelo zo, Esquire
BARsHAY, Rizzo & LoPEz, PLLC
reiii
111111111111111111111111
44522-378719
445 Broadhollow Road, Suite CL 18
Melville, New York 11747
Tel: (631) 210-7272
Defendant's Address: Fax: (631) 306-7441
State Farm Mutual Automobile Insurance Company Attorneysfor Plaintiff
80 State Street
Albany, New York 12207
NOTE: The law or rules of law provide that:
(a) if this summons is served by its delivery to you personally within the City of New York, you
must appear and answer within TWENTY days after such service; or (b) if this summons is served
by delivery to any person other than you personally, or is served outside the City of New York, or
by publication, or by any means other than personal delivery to you within the City of New York,
you are allowed THIRTY days after the proof of service thereof is filed with the Clerk of this
Court within which to appear and answer.
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FILEDDOC.
NYSCEF : RICHMOND
NO. 7 CIVIL COURT — CIVIL 11 O1 2022 12,53-npW NO.NYSCEF:
RECEIVED CV-723461-22/RI
07/24/2023
NYSCEF DOC. N0. 2 RECEIVED NYSCEF: 11/01/2022
CIVII. COURT OF THE CITY OF NEW YORK
COiJNTY OF Richmond
STATEMENT OF AUTHORIZATION FOR
ELECTRONIC FILING
(Single Attorney Authorizing Individual >FYling Agent)
I, Angelo Rizzo , Esq., ( Attorney Registration
No, 4194353 }am an authorized user of the New York 5tate Courts
Electronic Filing System ("NYSCEF") (User ID arizzo @ brffirm.com ). I hereby
authorize RNunez@brlfirm.com ("the filing agent") to utilize hi.s/her NYSCEF
filing agent ID to file documents on my behalf and at my directtion in any e-filed matter in which
I am counsel of record through the vYSCEF system, as provided in Section 2o2.5-b of the
Uniform Rules for the Trial Courts.
This authorization extends to any consensual matter in which I have previously
consented to e-filing, to any mandatory matter in which I have recorded my representation, and
to any matter in which I may authorize the filing agent to record my consent or representation
in the NYSCEF system.
This authorization extends to any and aIl documents I generate and submit to the filing
agent for filing in any such matter. 'fhis authorization, posted once on the NYSCEF website as to
each matter in which I am counsel of record, shall be deemed to acwnipany any docunient filed
in that matter hy the filing agent.
This authorization also extends to matters of payuient, wliich the filing agent may make
either by debiting an account the filing agent maintains with the Clerk of the New York City Civil
Court of any authorized e-filing county or by debiting an account I maintain with the Clerk of
the New York City Civil Court of any authorized e-filing county.
This authorization regarding this filing agent sball continue until I revoke it in writing
on a presci7bed forni delivered to the E-P'iling Resource Center.
Dated: 11 /09/21
Melvilie, New York 11747
Signature City, State and Zip Code
-- Angelo 631-4fl2-9834
Barshay, Rizzo & Lopez, PLLC arizzo@brifirm.com
Firm/Department E-Mail Address
445 Broadhollow Road, Suite CL1F
Street Address
EFCIV-12
11/26%18
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07/24/2023
NYSCEF DPC. NO. 1 RECEIVED NYSCEF: 11/01/2022
V
CIVIL COURT OF THE CITY OF NEW YORK
COUNTY OF RICHMOND
ATLANTIC MEDICAL & DIAGNOSTIC, P.0 as assignee of
MALCOLM PAkKER, Index No:
Plaintiff,
COMPLAINT
V.
STATE FARM MUTUALAUTOMOBILE INSURANCE
COMPANY,
Defendant.
Plaintiff Atlantic Medical & Diagnostic, P.0 ("Plaintiff'), by and through the undersigned
iel, complains, states, and alleges against defendant State Farm Mutual Automobile Insurance
)any ("Defendant") as follows:
INTRODUCTION
1. This action seeks to recover for medical services rendered by Plaintiff under New York
State's No-Fault Insurance Law.
JURISDICTION
2. This Court has jurisdiction over Defendant pursuant to Insurance Law § 1212 (a) because
is authorized to do business in this state.
3. Venue is proper pursuant to NYCCCA § 301 (a) because Defendant resides in this County
as set forth in NYCCCA § 305 (b).
PARTIES
4. Plaintiff is a health service provider licensed to provide such services in the State of New
York.
5. Plaintiff is the assignee of Malcolm Parker, as further described herein.
6. Defendant is an automobile insurance company authorized to do business in the State of
New York.
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7. Defendant, for premiums paid, provides automobile insurance to residents of the State of
ew York and residents of this County.
8. At all times relevant herein, Defeiivant transacted business in County of RICHMOND,
and State of New York
FACTUAL ALLEGATIONS
9. Malcolrn Parker was /were injured in an automobile accident.
10. At the time of the accident there was an existing automobile insurance policy issued by
covering the injuries sustained by Malcolm Parker.
11. The insurance policy contained a mandatory Personal Injury Protection Endorsement
covering payment of inedical expenses under New York State's No-Fault Insurance Law.
12. Defendant received notice of Malcolm Parker's automobile accident.
13. Defendant received notice of the injuries sustained by Malcolm Parker in the accident.
14. Plaintiff rendered health services to Malcolm Parker for the injuries sustained in the
automobile accident.
15. The health services were reasonable and necessary.
16. The health services were causally related to the injuries sustained in the accident.
17. Malcolm Parker assigned payment for the health services to Plaintiff.
18. Plaintiff submitted a claim to Defendant for payment of the health services.
19. The claim was timely submitted by Plaintiff.
20. The claim was submitted by Plaintiff with the proper No Fault Verification Forms,
an assignment of benefits.
21. The claim and the proper No Fault Verification Forms, including an assignment of
was received by Defendant.
22. More than thirty (30) days have passed since the claim was submitted to Defendant.
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23. Defendant failed to properly deny the claim within thirty (30) days of receipt.
24. Defendant has not requested additional verification of the claim from Plaintiff in
with the New York State No-Fault Insurance law.
25. Defendant has not paid the claim in full.
26. There is a balance due of $1,156.80 on the claim.
AS AND'FOR A FIRST CAUSE OF ACTION
27. Plaintiff repeats and realleges the foregoing paragraphs as if fully restated herein.
28. For the foregoing reasons, Plaintiff is entitled to payment of the claim plus interest from
(30) days after the claim was submitted until the claim is paid in full, as provided for by 11
.Y.C.R.R.65-3.9.
AS AND FOR THE SECOND CAUSE OF ACTION
29. Plaintiff repeats and realleges the foregoing paragraphs as if fully restated herein.
30. Plaintiff retained Barshay, Rizzo & Lopez, PLLC, to collect the claim.
31. For the foregoing reasons, Plaintiff is entitled to attorneys' fees calculated at twenty
percent (20%) of the total of the claim plus statutory interest thereon, with a minimum and maximum
per claim as provided for by 11 N.Y.C.R.R. 65-3.10 and 11 N.Y.C.R.R. 65-4.6.
PRAYER FOR RELIEF
WHEREFORE, Plaintiffrespectfully requests judgment be entered as follows:
a. Awarding Plaintiff $1,156.80 for the services rendered, plus
interest as provided by law; and
b. Awarding Plaintiff's attorneys' fees calculated at twenty percent
(20%) of the total amount awarded plus statutory interest
thereon, with a minimum and maximum per claim as provided
for by 11 N.Y.C.R.R. 65-3.10 and 11 N.Y.C.R.R. 65-4.6; and
c. Awarding Plaintiff the costs and disbursements of this action;
and
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RECEIVED NYSCEF: 07/24/2023
t NYSCEF DPC. N0. 1 RECEIVED NYSCEF: 11/01/2022
d. Such other and further relief that the Court determines is just and
proper up to the jurisdictional limits of the Court.
Dated: October 31, 2022
Melville, New York
By: s/
Angelo 16Mzzo, Esquire
BARsxaY, Rzzzo & LorEz, PLLC
445 Broadhollow Road, Suite CL 18
Melville, New York 11747
Tel: (631) 210-7272
Fax: (631) 306-7441
Attorneysfor Plaintiff
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NYSCEF DOC. NO. 7 NYSCEF: 07/24/2023
r NYSCEF DPC. N0. 1 RECEIVED NYSCEF: 11/01/2022
STATE FARM MUTUAi. AUTOMOBILE INSURANCE COMPANY
ATLANTIC MEDICAL & DIAGNOSTIC, P.0
File No Reference Claim No Date Of Outstanding Patient Name Date of Service
Case ID Accident Amount
44522- 3234B576L 05/14/2022 $1,156.80 MALCOLM 07/11/2022 -
378719 PARKER 07/11/2022
Total $1,156.80
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NYSCEF D . NO. 1 RECEIVED NYSCEF: 11/01/2022
r
Index No:
CIVIL COURT OF THE CITY OF NEW YORK
COUNTY OF RICHMOND
ATLANTIC MEDICAL & DIAGNOSTIC, P.0 as assignee of MALCOLM PARKER
Plaintiff,
V.
STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY,
Defendant.
SUMMONS AND COMPLAINT
BaxsxAY, Rizzo & LoPEz, PLLC
Attorneysfor Plaintiff
445 Broadhollow Road I Suite CL18
Melville, New York 11747
Tel: (631) 210-7272
I hereby certify pursuant to 22 NYCRR § 130-1.1-a that, to the best of my knowledge, information
and belief, formed after an inquiry reasonable under the circumstances, the presentation of the
papers listed below or the contentions therein are not frivolous as defzned in 22 NYCRR § 130-
1.1(c):
By:
Angelo F. Rizzo, Esquire
Dated: October 31, 2022
Service of the within is hereby admitted.
Dated: , 20
Attorneys for
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Exhibit B 12 of 86
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CIVIL COURT OF THE CITY OF NEW YORK
COUNTY OF RICHMOND
ATLANTIC MEDICAL & DIAGNOSTIC, P.C. Index No: CV-723461-22/RI
as assignee of MALCOLM PARKER,
Plaintiff; VERIFIED ANSWER
- against -
STATE FARM MUTUAL AUTOMOBILE INSURANCE
COMPANY,
Defendant.
The defendant, STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY
by and through its Attorneys, FREIBERG, PECK & KANG, LLP, as and for their answer to the
plaintiff's Complaint, denies each and every allegation contained in the plaintiffs Complaint and
directs all questions of law to the Court and questions of fact to the triers of fact.
AS AND FOR A FIRST, SEPARATE AND
COMPLETE AFFIRMATIVE DEFENSE
1. The Court has no jurisdiction over the answering defendant in that said answering
defendant has not been properly served with process.
AS AND FOR A SECOND, SEPARATE AND
COMPLETE AFFIRMATIVE DEFENSE
2. That in the event any judgment or verdict is rendered in favor of plaintiff, the answering
defendant is entitled to have such judgment or verdict reduced by the amounts of any
collateral payments made to the plaintiff assignee medical and/or other expenses and by
the amount of all such payments plaintiff assignee will receive in the future.
AS AND FOR A THIRD, SEPARATE AND
COMPLETE AFFIRMATIVE DEFENSE
3. That the Complaint fails to state a cause of action for which relief may be granted.
AS AND FOR A FOURTH, SEPARATE AND
COMPLETE AFFIRMATIVE DEFENSE
4. The plaintiff has failed to properly commence an action.
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AS AND FOR A FIFTH, SEPARATE AND
COMPLETE AFFIRMATIVE DEFENSE
5. The Court has no jurisdiction over the parties.
AS AND FOR A SIXTH, SEPARATE AND
COMPLETE AFFIRMATIVE DEFENSE
6. Plaintiff's assignee has not complied with New York State no-fault law.
AS AND FOR A SEVENTH, SEPARATE AND
COMPLETE AFFIRMATIVE DEFENSE
7. Plaintiff s assignor has failed to comply with requirements under New York no-fault law
and terms of insurance policy.
AS AND FOR AN EIGHTH, SEPARATE AND
COMPLETE AFFIRMATIVE DEFENSE
8. Medical treatment by plaintiff's assignee was for injuries not related to subject automobile
accident.
AS AND FOR A NINTII, SEPARATE AND
COMPLETE AFFIRMATIVE DEFENSE
9. The amount claimed by plaintiff has previously been paid by the defendant.
AS AND FOR A TENTH, SEPARATE AND
COMPLETE AFFIRMATIVE DEFENSE
10. The amount claimed by plaintiff is in excess of New York's Fee Schedule prescribed by
the Insurance Law of this State.
AS AND FOR AN EI EVENTH, SEPARATE AND
COMPLETE AFFIRMATIVE DEFENSE
11. The treatment rendered by plaintiff was in excess of reasonable prudent medical practice.
AS AND FOR A TWELFTH SEPARATE AND
COMPLETE AFFIRMATIVE DEFENSE
12. Plaintiff's assignee has violated a policy provision required by defendant to receive
benefits.
2
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AS AND FOR A THIRTEENTH, SEPARATE AND
COMPLETE AFFIRMATIVE DEFENSE
13. The plaintiff does not have standing to bring this action, because the assignment upon
which the action is based on is invalid.
AS AND FOR
A FOURTEENTH, SEPARATE AND
COMPLETE AFFIRMATIVE DEFENSE
14. The assignment of insurance benefits is not a sufficient and valid assignment.
AS AND FOR A FIFTEENTH, SEPARATE AND
COMPLETE AFFIRMATIVE DEFENSE
15. Plaintiff lacks standing to bring this case.
AS AND FOR A SIXTEENTH, SEPARATE AND
COMPLETE AFFIRMATIVE DEFENSE
16. The claim is premature as Plaintiff has not responded to Defendant's request for
verification.
AS AND FOR
A SEVENTEENTH, SEPARATE AND
COMPLETE AFFIRMATIVE DEFENSE
17. The lawsuit is time barred because it has been filed after the applicable statute of limitations
has expired.
AS AND FOR
AN EIGHTEENTH, SEPARATE AND
COMPLETE AFFIRMATIVE DEFENSE
18. The services were not medically necessary.
AS AND FOR A NINETEENTH, SEPARATE AND
COMPLETE AFFIRMATIVE DEFENSE
19. Plaintiff s assignee is not covered under a valid policy issued by the defendant.
AS AND FOR A TWENTIETH, SEPARATE AND
COMPLETE AFFIRMATIVE DEFENSE
20. The facts of the underlying accident did not occur as reported by the assignor
3
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AS AND FOR
A TWENTY-FIRST, SEPARATE AND
COMPLETE AFFIRMATIVE DEFENSE
21. This suit is duplicative of a previously filed suit.
AS AND FOR A TWENTY-SECOND, SEPARATE AND
COMPLETE AFFIRMATIVE DEFENSE
22. This action is barred due to Collateral Estoppal and/or Res Judicata.
AS AND FOR A TWENTY-THIRD, SEPARATE AND
COMPLETE AFFIRMATIVE DEFENSE
23. Defendant pleads that the bill for medical services rendered exceeds the limitations in
accordance with New York State Insurance Law Section 5108, and the regulations of the
Superintendent of Insurance of the State of New York, and the medical fee schedule as set
forth by the chairman of the Workers Compensation Board.
AS AND FOR A TWENTY-FOURTH, SEPARATE AND
COMPLETE AFFIRMATIVE DEFENSE
24. Defendant pleads that the amount claimed for legal fees is limited to the amount as set forth
in the New York State Insurance Law Section 5101, et seq. and the regulations of the
Superintendent of Insurance of the State of New York.
AS AND FOR A TWENTY-FIFTH, SEPARATE AND
COMPLETE AFFIRMATIVE DEFENSE
25. That upon information and belief the plaintiff's charges exceed the prevailing fee in the
geographic location of the plaintiff in violation of the New York State Insurance Law and
the Worker's Compensation Fee Schedule.
AS AND FOR A TWENTY-SIXTH, SEPARATE AND
COMPI ETE AFFIRMATIVE DEFENSE
26. That upon information and belief the plaintiff's charges exceed the prevailing fee in the
geographic location of the plaintiff in violation of the New York State Insurance Law and
the Worker's Compensation Fee Schedule.
AS AND FOR A TWENTY-SEVENTH, SEPARATE AND
COMPLETE AFFIRMATIVE DEFENSE
27. That interest, if any, is accrued from the date of the institution of the lawsuit and not from
the date of denial or submission of the bill pursuant to the regulations promulgated by the
Superintendent of Insurance of the State of New York.
4
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AS AND FOR
A TWENTY-EIGHTH, SEPARATE AND
COMPLETE AFFIRMATIVE DEFENSE
28. The Plaintiff has engaged in fraudulent conduct and has made material misrepresentations
in regard to the billing that was submitted to the Defendant, and in regard to the direction
of the treatment and care of the eligible injured person. As a result, the Defendant has no
duty to pay the Plaintiff's claim that has been submitted.
AS AND FOR A TWENTY-NINTH, SEPARATE AND
COMPLETE AFFIRMATIVE DEFENSE
29. The Plaintiff has engaged in fraudulent conduct and has made material representations to
the Defendant concerning the necessity and the utility of the treatment and the services that
were allegedly provided to the eligible injured person. As a result, the Defendant has no
duty to pay the Plaintiff's claim that has been submitted.
AS AND FOR A THIRTIETH, SEPARATE AND
COMPLETE AFFIRMATIVE
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FILED: RICHMOND CIVIL COURT - CIVIL 07/24/2023 02:00 INDEX PM NO. CV-723461-22/RI NYSCEF DOC. NO. 7 RECEIVED NYSCEF: 07/24/2023 Re: Atlantic Medical & Diagnostic, P.C./Malcolm Parker v. State Farm Mutual Automobile Insurance Company Index No./Venue: CV-723461-22/RI – Civil Richmond Amt. in Dispute: $1,156.80 Claim No.: 32-34B5-76L Date of Loss: 05/14/2022 Policy No.: 2281-949-32B Insured: Malcolm J Parker Matter ID No.: 3234B576L-2 Plaintiff / File No.: Barshay, Rizzo, & Lopez, PLLC/44522-378719 FP&K File No.: 8000.0892 Amount Amount Amount Fee Schedule Bill NF-10/EOR Exhibit Date of Service Billed Paid Disputed Amount Received Generated C 07/11/22 – 07/11/22 $1,563.21 $406.41 $1,156.80 $336.17 08/01/22 08/10/22 Total: $1,563.21 $406.41 $1,156.80 $336.17 Exhibit A Summons & Complaint Exhibit B Answer Exhibit C Bill / Medical / EOR / NF-10 - DOS: 07/11/22 Exhibit D Coder Affidavit Exhibit E Request for Judicial Notice of the Fee Schedule 1 of 86 FILED: RICHMOND CIVIL COURT - CIVIL 07/24/2023 02:00 INDEX PM NO. CV-723461-22/RI NYSCEF DOC. NO. 7 RECEIVED NYSCEF: 07/24/2023 Exhibit A 2 of 86 INDEX FILED: RICHMOND CIVIL COURT - CIVIL 07/24/2023 02:00 PMNO. CV-723461-22/RI NYSCEF DOC. NO. 7 RECEIVED NYSCEF: 07/24/2023 KSB / ALL Transmittal Number: 25925878 Notice of Service of Process Date Processed: 11/21/2022 Primary Contact: State Farm Enterprise SOP Corporation Service Company- Wilmington, DELAWARE 251 Little Falls Dr Wilmington, DE 19808-1674 Entity: State Farm Mutual Automobile Insurance Company Entity ID Number 3461675 Entity Served: State Farm Mutual Automobile Insurance Company Title of Action: Atlantic Medical & Diagnostic, P.C as assignee of Malcolm Parker vs. State Farm Mutual Automobile Insurance Company Matter Name/ID: Atlantic Medical & Diagnostic, P.C as assignee of Malcolm Parker vs. State Farm Mutual Automobile Insurance Company (13238304) Document(s) Type: Summons/Complaint Nature of Action: Contract Court/Agency: Richmond County Civil Court, NY Case/Reference No: CV-723461-22/RI Jurisdiction Served: New York Date Served on CSC: 11/21/2022 Answer or Appearance Due: 30 Days Originally Served On: CSC How Served: Personal Service Sender Information: Barshay, Rizzo & Lopez, PLLC 631-210-7272 Information contained on this transmittal form is for record keeping, notification and forwarding the attached document(s). It does not constitute a legal opinion. The recipient is responsible for interpreting the documents and taking appropriate action. To avoid potential delay, please do not send your response to CSC 251 Little Falls Drive, Wilmington, Delaware 19808-1674 (888) 690-2882 | sop@cscglobal.com 3 of 86 INDEX FILED: RICHMOND CIVIL COURT - CIVIL 07/24/2023 02:00 PM NO. CV-723461-22/RI NYSCEF DOC. NO. 7 N0.NYSCEF: RECEIVED CV-723461-22/RI 07/24/2023 ,`NYSCEF DPC. NO. 1 RECEIVED NYSCEF: 11/01/2022 (CIVIL COURT OF THE CITY OF NLW YORK COUNTY OF RICHMOND ATLANTIC MEDICAL & DIAGNOSTIC, P.0 as assignee Index No: of MALCOLM PARKER, SUMMONS Plaintiff, Plaintiff resides at: V. Po Box 4652 New York, New York 10185 STATE FARM MU INSURANCE MMPAN ,9 The basis of the venue designated is: NYCCCA § 301(a). Defendant resides in Defendant. this County. To the above-named defendant: YOU ARE HEREBY SUMMONED to appear in the Civil Court of the City of New York, County of RICHMOND, at the office of the Clerk of the said Court at 927 Castleton Avenue, Staten Island, in the County of Richmond, City and State of New York, within the time provided by law as noted below and to file your answer to the annexed complaint with the Clerk; upon your failure to answer, judgment will be taken against you for the sum of $1,156.80, together with the costs of this action. Dated: October 31, 2022 By: s~ Angelo zo, Esquire BARsHAY, Rizzo & LoPEz, PLLC reiii 111111111111111111111111 44522-378719 445 Broadhollow Road, Suite CL 18 Melville, New York 11747 Tel: (631) 210-7272 Defendant's Address: Fax: (631) 306-7441 State Farm Mutual Automobile Insurance Company Attorneysfor Plaintiff 80 State Street Albany, New York 12207 NOTE: The law or rules of law provide that: (a) if this summons is served by its delivery to you personally within the City of New York, you must appear and answer within TWENTY days after such service; or (b) if this summons is served by delivery to any person other than you personally, or is served outside the City of New York, or by publication, or by any means other than personal delivery to you within the City of New York, you are allowed THIRTY days after the proof of service thereof is filed with the Clerk of this Court within which to appear and answer. 1 of 7 4 of 86 INDEX FILED: RICHMOND CIVIL COURT - CIVIL 07/24/2023 02:00 PM NO. CV-723461-22/RI FILEDDOC. NYSCEF : RICHMOND NO. 7 CIVIL COURT — CIVIL 11 O1 2022 12,53-npW NO.NYSCEF: RECEIVED CV-723461-22/RI 07/24/2023 NYSCEF DOC. N0. 2 RECEIVED NYSCEF: 11/01/2022 CIVII. COURT OF THE CITY OF NEW YORK COiJNTY OF Richmond STATEMENT OF AUTHORIZATION FOR ELECTRONIC FILING (Single Attorney Authorizing Individual >FYling Agent) I, Angelo Rizzo , Esq., ( Attorney Registration No, 4194353 }am an authorized user of the New York 5tate Courts Electronic Filing System ("NYSCEF") (User ID arizzo @ brffirm.com ). I hereby authorize RNunez@brlfirm.com ("the filing agent") to utilize hi.s/her NYSCEF filing agent ID to file documents on my behalf and at my directtion in any e-filed matter in which I am counsel of record through the vYSCEF system, as provided in Section 2o2.5-b of the Uniform Rules for the Trial Courts. This authorization extends to any consensual matter in which I have previously consented to e-filing, to any mandatory matter in which I have recorded my representation, and to any matter in which I may authorize the filing agent to record my consent or representation in the NYSCEF system. This authorization extends to any and aIl documents I generate and submit to the filing agent for filing in any such matter. 'fhis authorization, posted once on the NYSCEF website as to each matter in which I am counsel of record, shall be deemed to acwnipany any docunient filed in that matter hy the filing agent. This authorization also extends to matters of payuient, wliich the filing agent may make either by debiting an account the filing agent maintains with the Clerk of the New York City Civil Court of any authorized e-filing county or by debiting an account I maintain with the Clerk of the New York City Civil Court of any authorized e-filing county. This authorization regarding this filing agent sball continue until I revoke it in writing on a presci7bed forni delivered to the E-P'iling Resource Center. Dated: 11 /09/21 Melvilie, New York 11747 Signature City, State and Zip Code -- Angelo 631-4fl2-9834 Barshay, Rizzo & Lopez, PLLC arizzo@brifirm.com Firm/Department E-Mail Address 445 Broadhollow Road, Suite CL1F Street Address EFCIV-12 11/26%18 1 of 1 5 of 86 FILED: RICHMOND CIVIL COURT - CIVIL 07/24/2023 02:00 PMINDEX NO. CV-723461-22/RI NYSCEF DOC. NO. 7 NO.NYSCEF: :53RECEIVED CV-723461-22/RI 07/24/2023 NYSCEF DPC. NO. 1 RECEIVED NYSCEF: 11/01/2022 V CIVIL COURT OF THE CITY OF NEW YORK COUNTY OF RICHMOND ATLANTIC MEDICAL & DIAGNOSTIC, P.0 as assignee of MALCOLM PAkKER, Index No: Plaintiff, COMPLAINT V. STATE FARM MUTUALAUTOMOBILE INSURANCE COMPANY, Defendant. Plaintiff Atlantic Medical & Diagnostic, P.0 ("Plaintiff'), by and through the undersigned iel, complains, states, and alleges against defendant State Farm Mutual Automobile Insurance )any ("Defendant") as follows: INTRODUCTION 1. This action seeks to recover for medical services rendered by Plaintiff under New York State's No-Fault Insurance Law. JURISDICTION 2. This Court has jurisdiction over Defendant pursuant to Insurance Law § 1212 (a) because is authorized to do business in this state. 3. Venue is proper pursuant to NYCCCA § 301 (a) because Defendant resides in this County as set forth in NYCCCA § 305 (b). PARTIES 4. Plaintiff is a health service provider licensed to provide such services in the State of New York. 5. Plaintiff is the assignee of Malcolm Parker, as further described herein. 6. Defendant is an automobile insurance company authorized to do business in the State of New York. 2 of 7 6 of 86 INDEX FILED: RICHMOND CIVIL COURT - CIVIL 07/24/2023 02:00 PM NO. CV-723461-22/RI NYSCEF DOC. NO. 7 N0. CV-723461-22/RI RECEIVED NYSCEF: 07/24/2023 r NYSCEF DPC. N0. 1 RECEIVED NYSCEF: 11/01/2022 7. Defendant, for premiums paid, provides automobile insurance to residents of the State of ew York and residents of this County. 8. At all times relevant herein, Defeiivant transacted business in County of RICHMOND, and State of New York FACTUAL ALLEGATIONS 9. Malcolrn Parker was /were injured in an automobile accident. 10. At the time of the accident there was an existing automobile insurance policy issued by covering the injuries sustained by Malcolm Parker. 11. The insurance policy contained a mandatory Personal Injury Protection Endorsement covering payment of inedical expenses under New York State's No-Fault Insurance Law. 12. Defendant received notice of Malcolm Parker's automobile accident. 13. Defendant received notice of the injuries sustained by Malcolm Parker in the accident. 14. Plaintiff rendered health services to Malcolm Parker for the injuries sustained in the automobile accident. 15. The health services were reasonable and necessary. 16. The health services were causally related to the injuries sustained in the accident. 17. Malcolm Parker assigned payment for the health services to Plaintiff. 18. Plaintiff submitted a claim to Defendant for payment of the health services. 19. The claim was timely submitted by Plaintiff. 20. The claim was submitted by Plaintiff with the proper No Fault Verification Forms, an assignment of benefits. 21. The claim and the proper No Fault Verification Forms, including an assignment of was received by Defendant. 22. More than thirty (30) days have passed since the claim was submitted to Defendant. 3 of 7 7 of 86 INDEX FILED: RICHMOND CIVIL COURT - CIVIL 07/24/2023 02:00 PM NO. CV-723461-22/RI NYSCEF DOC. NO. 7 N0. CV-723461-22/RI RECEIVED NYSCEF: 07/24/2023 'r NYSCEF M9001=1 RECEIVED NYSCEF: 11/01/2022 23. Defendant failed to properly deny the claim within thirty (30) days of receipt. 24. Defendant has not requested additional verification of the claim from Plaintiff in with the New York State No-Fault Insurance law. 25. Defendant has not paid the claim in full. 26. There is a balance due of $1,156.80 on the claim. AS AND'FOR A FIRST CAUSE OF ACTION 27. Plaintiff repeats and realleges the foregoing paragraphs as if fully restated herein. 28. For the foregoing reasons, Plaintiff is entitled to payment of the claim plus interest from (30) days after the claim was submitted until the claim is paid in full, as provided for by 11 .Y.C.R.R.65-3.9. AS AND FOR THE SECOND CAUSE OF ACTION 29. Plaintiff repeats and realleges the foregoing paragraphs as if fully restated herein. 30. Plaintiff retained Barshay, Rizzo & Lopez, PLLC, to collect the claim. 31. For the foregoing reasons, Plaintiff is entitled to attorneys' fees calculated at twenty percent (20%) of the total of the claim plus statutory interest thereon, with a minimum and maximum per claim as provided for by 11 N.Y.C.R.R. 65-3.10 and 11 N.Y.C.R.R. 65-4.6. PRAYER FOR RELIEF WHEREFORE, Plaintiffrespectfully requests judgment be entered as follows: a. Awarding Plaintiff $1,156.80 for the services rendered, plus interest as provided by law; and b. Awarding Plaintiff's attorneys' fees calculated at twenty percent (20%) of the total amount awarded plus statutory interest thereon, with a minimum and maximum per claim as provided for by 11 N.Y.C.R.R. 65-3.10 and 11 N.Y.C.R.R. 65-4.6; and c. Awarding Plaintiff the costs and disbursements of this action; and 4 of 7 8 of 86 INDEX FILED: RICHMOND CIVIL COURT - CIVIL 07/24/2023 02:00 PM NO. CV-723461-22/RI NYSCEF DOC. NO. 7 T — NO. CV-723461-22/RI RECEIVED NYSCEF: 07/24/2023 t NYSCEF DPC. N0. 1 RECEIVED NYSCEF: 11/01/2022 d. Such other and further relief that the Court determines is just and proper up to the jurisdictional limits of the Court. Dated: October 31, 2022 Melville, New York By: s/ Angelo 16Mzzo, Esquire BARsxaY, Rzzzo & LorEz, PLLC 445 Broadhollow Road, Suite CL 18 Melville, New York 11747 Tel: (631) 210-7272 Fax: (631) 306-7441 Attorneysfor Plaintiff 5 of 7 9 of 86 FILED: RICHMOND CIVIL COURT - CIVIL 07/24/2023 02:00 PMINDEX NO. CV-723461-22/RI NO. CV-723461-22/RI _ CIVIL 11 01 2022 12:53RECEIVED NYSCEF DOC. NO. 7 NYSCEF: 07/24/2023 r NYSCEF DPC. N0. 1 RECEIVED NYSCEF: 11/01/2022 STATE FARM MUTUAi. AUTOMOBILE INSURANCE COMPANY ATLANTIC MEDICAL & DIAGNOSTIC, P.0 File No Reference Claim No Date Of Outstanding Patient Name Date of Service Case ID Accident Amount 44522- 3234B576L 05/14/2022 $1,156.80 MALCOLM 07/11/2022 - 378719 PARKER 07/11/2022 Total $1,156.80 6 of 7 10 of 86 INDEX FILED: RICHMOND CIVIL COURT - CIVIL 07/24/2023 02:00 PM NO. CV-723461-22/RI FILED: NYSCEF DOC. NO. 7 — CIVIL N0. CV-723461-22/RI :53RECEIVED NYSCEF: 07/24/2023 NYSCEF D . NO. 1 RECEIVED NYSCEF: 11/01/2022 r Index No: CIVIL COURT OF THE CITY OF NEW YORK COUNTY OF RICHMOND ATLANTIC MEDICAL & DIAGNOSTIC, P.0 as assignee of MALCOLM PARKER Plaintiff, V. STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Defendant. SUMMONS AND COMPLAINT BaxsxAY, Rizzo & LoPEz, PLLC Attorneysfor Plaintiff 445 Broadhollow Road I Suite CL18 Melville, New York 11747 Tel: (631) 210-7272 I hereby certify pursuant to 22 NYCRR § 130-1.1-a that, to the best of my knowledge, information and belief, formed after an inquiry reasonable under the circumstances, the presentation of the papers listed below or the contentions therein are not frivolous as defzned in 22 NYCRR § 130- 1.1(c): By: Angelo F. Rizzo, Esquire Dated: October 31, 2022 Service of the within is hereby admitted. Dated: , 20 Attorneys for 7 of 7 11 of 86 FILED: RICHMOND CIVIL COURT - CIVIL 07/24/2023 02:00 INDEX PM NO. CV-723461-22/RI NYSCEF DOC. NO. 7 RECEIVED NYSCEF: 07/24/2023 Exhibit B 12 of 86 FILED: RICHMOND CIVIL COURT - CIVIL 07/24/2023 02:00 INDEX PM NO. CV-723461-22/RI NYSCEF DOC. NO. 7 RECEIVED NYSCEF: 07/24/2023 CIVIL COURT OF THE CITY OF NEW YORK COUNTY OF RICHMOND ATLANTIC MEDICAL & DIAGNOSTIC, P.C. Index No: CV-723461-22/RI as assignee of MALCOLM PARKER, Plaintiff; VERIFIED ANSWER - against - STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Defendant. The defendant, STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY by and through its Attorneys, FREIBERG, PECK & KANG, LLP, as and for their answer to the plaintiff's Complaint, denies each and every allegation contained in the plaintiffs Complaint and directs all questions of law to the Court and questions of fact to the triers of fact. AS AND FOR A FIRST, SEPARATE AND COMPLETE AFFIRMATIVE DEFENSE 1. The Court has no jurisdiction over the answering defendant in that said answering defendant has not been properly served with process. AS AND FOR A SECOND, SEPARATE AND COMPLETE AFFIRMATIVE DEFENSE 2. That in the event any judgment or verdict is rendered in favor of plaintiff, the answering defendant is entitled to have such judgment or verdict reduced by the amounts of any collateral payments made to the plaintiff assignee medical and/or other expenses and by the amount of all such payments plaintiff assignee will receive in the future. AS AND FOR A THIRD, SEPARATE AND COMPLETE AFFIRMATIVE DEFENSE 3. That the Complaint fails to state a cause of action for which relief may be granted. AS AND FOR A FOURTH, SEPARATE AND COMPLETE AFFIRMATIVE DEFENSE 4. The plaintiff has failed to properly commence an action. 13 of 86 FILED: RICHMOND CIVIL COURT - CIVIL 07/24/2023 02:00 INDEX PM NO. CV-723461-22/RI NYSCEF DOC. NO. 7 RECEIVED NYSCEF: 07/24/2023 AS AND FOR A FIFTH, SEPARATE AND COMPLETE AFFIRMATIVE DEFENSE 5. The Court has no jurisdiction over the parties. AS AND FOR A SIXTH, SEPARATE AND COMPLETE AFFIRMATIVE DEFENSE 6. Plaintiff's assignee has not complied with New York State no-fault law. AS AND FOR A SEVENTH, SEPARATE AND COMPLETE AFFIRMATIVE DEFENSE 7. Plaintiff s assignor has failed to comply with requirements under New York no-fault law and terms of insurance policy. AS AND FOR AN EIGHTH, SEPARATE AND COMPLETE AFFIRMATIVE DEFENSE 8. Medical treatment by plaintiff's assignee was for injuries not related to subject automobile accident. AS AND FOR A NINTII, SEPARATE AND COMPLETE AFFIRMATIVE DEFENSE 9. The amount claimed by plaintiff has previously been paid by the defendant. AS AND FOR A TENTH, SEPARATE AND COMPLETE AFFIRMATIVE DEFENSE 10. The amount claimed by plaintiff is in excess of New York's Fee Schedule prescribed by the Insurance Law of this State. AS AND FOR AN EI EVENTH, SEPARATE AND COMPLETE AFFIRMATIVE DEFENSE 11. The treatment rendered by plaintiff was in excess of reasonable prudent medical practice. AS AND FOR A TWELFTH SEPARATE AND COMPLETE AFFIRMATIVE DEFENSE 12. Plaintiff's assignee has violated a policy provision required by defendant to receive benefits. 2 14 of 86 FILED: RICHMOND CIVIL COURT - CIVIL 07/24/2023 02:00 INDEX PM NO. CV-723461-22/RI NYSCEF DOC. NO. 7 RECEIVED NYSCEF: 07/24/2023 AS AND FOR A THIRTEENTH, SEPARATE AND COMPLETE AFFIRMATIVE DEFENSE 13. The plaintiff does not have standing to bring this action, because the assignment upon which the action is based on is invalid. AS AND FOR A FOURTEENTH, SEPARATE AND COMPLETE AFFIRMATIVE DEFENSE 14. The assignment of insurance benefits is not a sufficient and valid assignment. AS AND FOR A FIFTEENTH, SEPARATE AND COMPLETE AFFIRMATIVE DEFENSE 15. Plaintiff lacks standing to bring this case. AS AND FOR A SIXTEENTH, SEPARATE AND COMPLETE AFFIRMATIVE DEFENSE 16. The claim is premature as Plaintiff has not responded to Defendant's request for verification. AS AND FOR A SEVENTEENTH, SEPARATE AND COMPLETE AFFIRMATIVE DEFENSE 17. The lawsuit is time barred because it has been filed after the applicable statute of limitations has expired. AS AND FOR AN EIGHTEENTH, SEPARATE AND COMPLETE AFFIRMATIVE DEFENSE 18. The services were not medically necessary. AS AND FOR A NINETEENTH, SEPARATE AND COMPLETE AFFIRMATIVE DEFENSE 19. Plaintiff s assignee is not covered under a valid policy issued by the defendant. AS AND FOR A TWENTIETH, SEPARATE AND COMPLETE AFFIRMATIVE DEFENSE 20. The facts of the underlying accident did not occur as reported by the assignor 3 15 of 86 FILED: RICHMOND CIVIL COURT - CIVIL 07/24/2023 02:00 INDEX PM NO. CV-723461-22/RI NYSCEF DOC. NO. 7 RECEIVED NYSCEF: 07/24/2023 AS AND FOR A TWENTY-FIRST, SEPARATE AND COMPLETE AFFIRMATIVE DEFENSE 21. This suit is duplicative of a previously filed suit. AS AND FOR A TWENTY-SECOND, SEPARATE AND COMPLETE AFFIRMATIVE DEFENSE 22. This action is barred due to Collateral Estoppal and/or Res Judicata. AS AND FOR A TWENTY-THIRD, SEPARATE AND COMPLETE AFFIRMATIVE DEFENSE 23. Defendant pleads that the bill for medical services rendered exceeds the limitations in accordance with New York State Insurance Law Section 5108, and the regulations of the Superintendent of Insurance of the State of New York, and the medical fee schedule as set forth by the chairman of the Workers Compensation Board. AS AND FOR A TWENTY-FOURTH, SEPARATE AND COMPLETE AFFIRMATIVE DEFENSE 24. Defendant pleads that the amount claimed for legal fees is limited to the amount as set forth in the New York State Insurance Law Section 5101, et seq. and the regulations of the Superintendent of Insurance of the State of New York. AS AND FOR A TWENTY-FIFTH, SEPARATE AND COMPLETE AFFIRMATIVE DEFENSE 25. That upon information and belief the plaintiff's charges exceed the prevailing fee in the geographic location of the plaintiff in violation of the New York State Insurance Law and the Worker's Compensation Fee Schedule. AS AND FOR A TWENTY-SIXTH, SEPARATE AND COMPI ETE AFFIRMATIVE DEFENSE 26. That upon information and belief the plaintiff's charges exceed the prevailing fee in the geographic location of the plaintiff in violation of the New York State Insurance Law and the Worker's Compensation Fee Schedule. AS AND FOR A TWENTY-SEVENTH, SEPARATE AND COMPLETE AFFIRMATIVE DEFENSE 27. That interest, if any, is accrued from the date of the institution of the lawsuit and not from the date of denial or submission of the bill pursuant to the regulations promulgated by the Superintendent of Insurance of the State of New York. 4 16 of 86 FILED: RICHMOND CIVIL COURT - CIVIL 07/24/2023 02:00 INDEX PM NO. CV-723461-22/RI NYSCEF DOC. NO. 7 RECEIVED NYSCEF: 07/24/2023 AS AND FOR A TWENTY-EIGHTH, SEPARATE AND COMPLETE AFFIRMATIVE DEFENSE 28. The Plaintiff has engaged in fraudulent conduct and has made material misrepresentations in regard to the billing that was submitted to the Defendant, and in regard to the direction of the treatment and care of the eligible injured person. As a result, the Defendant has no duty to pay the Plaintiff's claim that has been submitted. AS AND FOR A TWENTY-NINTH, SEPARATE AND COMPLETE AFFIRMATIVE DEFENSE 29. The Plaintiff has engaged in fraudulent conduct and has made material representations to the Defendant concerning the necessity and the utility of the treatment and the services that were allegedly provided to the eligible injured person. As a result, the Defendant has no duty to pay the Plaintiff's claim that has been submitted. AS AND FOR A THIRTIETH, SEPARATE AND COMPLETE AFFIRMATIVE