On March 26, 2024 a
Exhibit,Appendix
was filed
involving a dispute between
Rachid Belhaj,
and
Government Employees Insurance Company,
for Torts - Motor Vehicle
in the District Court of Dutchess County.
Preview
FILED: DUTCHESS COUNTY CLERK 03/26/2024 02:24 PM INDEX NO. 2024-51285
NYSCEF DOC. NO. 6 RECEIVED NYSCEF: 03/26/2024
EXHIBIT “A”
EXHIBIT “A”
FILED: DUTCHESS COUNTY CLERK 03/26/2024 02:24 PM INDEX NO. 2024-51285
NYSCEF DOC. NO. 6 MMP&S RECEIVED NYSCEF: 03/26/2024
MILBER MAKRIS PLOUSADIS & SEIDEN, LLP
ATTORNEYSAT LAW
1000 WooDBURY ROAD
SUITE 402 WOODBURY, NY 11797
TELEPHONE: 516. 712.4000 FAx: 516.712.4013
HTTP://WWW.MILBERMAKRIS.COM
June 15, 2023
VlA REGULAR MAIL
PR1VILEGED AND CONF IDENTIAL
ATTORNEY-CLIENT COMMUNICATION
Mr. Rachid Belhaj
57 Cannon Lane
Hopewell Junction, NY 12533-6339
Re: an infant by his parent and legal guardian, Rachid Belhaj
Date of Accident: 05/13/2022
Qur File No. : OS98ICO-144
Dear Mr. Belhaj:
This law firm has been requested by GEICO to submit an a lication before the Court seeking Court approval
of the settlement of the claims of your infant/minor son,
Enclosed, please find a written retainer agreement between you on behalf of your infant/minor son O
and this law firm. As you will see, there is no cost to you or your son whatsoever for these services being
provided in this matter.
However, in order to move forward with seeking Court approval of the settlement, your cooperation and the
cooperation of our son will be required. Additionally, we have enclosed HIPAA-compliant authorization forms to
obtain medical records, which will need to be submitted with the Application for Infant Compromise Order.
GEICO cannot release the settlement proceeds without you first obtaining Court approval of the settlement.
Kindly execute this retainer agreement, HIPAA compliant authorization forms, and return same to my
attention in the pre-paid self-addressed envelope which is enclosed with this letter. This retainer agreement is being
provided to you in duplicate for your convenience. Please schedule an appointment with O ediatrician within
45 days.
In the meantime, please provide us with the following:
" Name and address of hospitals, doctors (specialist and/or pediatrician your son has seen since the
accident/alleged injuries.
" Name and address for the Bank where the settlement check will be deposited until your son turns 18 years
old.
" of any medical expenses incurred, and payments.
Copy
" of your son's Certificate of Birth.
Copy
"
WOODBURY, NEw YORK PURCHASE, NEw YoRK
NEW JERSEY "
CONNECTICUT FLORIDA PENNSYLVANIA
FILED: DUTCHESS COUNTY CLERK 03/26/2024 02:24 PM INDEX NO. 2024-51285
.
NYSCEF DOC. NO. 6 RECEIVED NYSCEF: 03/26/2024
We will be in contact with you to discuss this matter as we receive additional information in furtherance of our
application to the Court requesting Court approval of the settlement. My direct dial is (516) 870-1193.
Very truly yours,
MILBER, MAKRIS, PLOUSADIS
& SE1DEN, LLP
lumbenhpPienne
Paralegal
Enc. Duplicate retainer agreement
Self addressed envelope
"
WOODBURY, NEW YORK PURCHASE, NEw YORK
" "
NEW JERSEY CONNECTICUT FLORIDA PENNSYLVANIA
FILED: DUTCHESS COUNTY CLERK 03/26/2024 02:24 PM INDEX NO. 2024-51285
.
NYSCEF DOC. NO. 6 RECEIVED NYSCEF: 03/26/2024
File NO. 0898ICO-144
THE ABOVE IS ACKNOWLEDGED AND ACCEPTED:
BY:
Rachid lhaj, as parent and natural guardian of O B an infant
-
Dated: 07 Q |-
8,
WOODBURY, NEW YORK PURCHASE, NEWYORK
"
NEW JERSEY CONNECTICUT FLORIDA PENNSYLVANIA
Document Filed Date
March 26, 2024
Case Filing Date
March 26, 2024
Category
Torts - Motor Vehicle
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Preview
FILED: DUTCHESS COUNTY CLERK 03/26/2024 02:24 PM INDEX NO. 2024-51285 NYSCEF DOC. NO. 6 RECEIVED NYSCEF: 03/26/2024 EXHIBIT “A” EXHIBIT “A” FILED: DUTCHESS COUNTY CLERK 03/26/2024 02:24 PM INDEX NO. 2024-51285 NYSCEF DOC. NO. 6 MMP&S RECEIVED NYSCEF: 03/26/2024 MILBER MAKRIS PLOUSADIS & SEIDEN, LLP ATTORNEYSAT LAW 1000 WooDBURY ROAD SUITE 402 WOODBURY, NY 11797 TELEPHONE: 516. 712.4000 FAx: 516.712.4013 HTTP://WWW.MILBERMAKRIS.COM June 15, 2023 VlA REGULAR MAIL PR1VILEGED AND CONF IDENTIAL ATTORNEY-CLIENT COMMUNICATION Mr. Rachid Belhaj 57 Cannon Lane Hopewell Junction, NY 12533-6339 Re: an infant by his parent and legal guardian, Rachid Belhaj Date of Accident: 05/13/2022 Qur File No. : OS98ICO-144 Dear Mr. Belhaj: This law firm has been requested by GEICO to submit an a lication before the Court seeking Court approval of the settlement of the claims of your infant/minor son, Enclosed, please find a written retainer agreement between you on behalf of your infant/minor son O and this law firm. As you will see, there is no cost to you or your son whatsoever for these services being provided in this matter. However, in order to move forward with seeking Court approval of the settlement, your cooperation and the cooperation of our son will be required. Additionally, we have enclosed HIPAA-compliant authorization forms to obtain medical records, which will need to be submitted with the Application for Infant Compromise Order. GEICO cannot release the settlement proceeds without you first obtaining Court approval of the settlement. Kindly execute this retainer agreement, HIPAA compliant authorization forms, and return same to my attention in the pre-paid self-addressed envelope which is enclosed with this letter. This retainer agreement is being provided to you in duplicate for your convenience. Please schedule an appointment with O ediatrician within 45 days. In the meantime, please provide us with the following: " Name and address of hospitals, doctors (specialist and/or pediatrician your son has seen since the accident/alleged injuries. " Name and address for the Bank where the settlement check will be deposited until your son turns 18 years old. " of any medical expenses incurred, and payments. Copy " of your son's Certificate of Birth. Copy " WOODBURY, NEw YORK PURCHASE, NEw YoRK NEW JERSEY " CONNECTICUT FLORIDA PENNSYLVANIA FILED: DUTCHESS COUNTY CLERK 03/26/2024 02:24 PM INDEX NO. 2024-51285 . NYSCEF DOC. NO. 6 RECEIVED NYSCEF: 03/26/2024 We will be in contact with you to discuss this matter as we receive additional information in furtherance of our application to the Court requesting Court approval of the settlement. My direct dial is (516) 870-1193. Very truly yours, MILBER, MAKRIS, PLOUSADIS & SE1DEN, LLP lumbenhpPienne Paralegal Enc. Duplicate retainer agreement Self addressed envelope " WOODBURY, NEW YORK PURCHASE, NEw YORK " " NEW JERSEY CONNECTICUT FLORIDA PENNSYLVANIA FILED: DUTCHESS COUNTY CLERK 03/26/2024 02:24 PM INDEX NO. 2024-51285 . NYSCEF DOC. NO. 6 RECEIVED NYSCEF: 03/26/2024 File NO. 0898ICO-144 THE ABOVE IS ACKNOWLEDGED AND ACCEPTED: BY: Rachid lhaj, as parent and natural guardian of O B an infant - Dated: 07 Q |- 8, WOODBURY, NEW YORK PURCHASE, NEWYORK " NEW JERSEY CONNECTICUT FLORIDA PENNSYLVANIA