Preview
FILED: NEW YORK COUNTY CLERK 01/31/2020 03:02 PM INDEX NO. 156986/2019
NYSCEF DOC. NO. 31 RECEIVED NYSCEF: 01/31/2020
REQUEST FOR JUDICIAL INTERVENTION 58,4g°g1,)
New York Supreme COURT, COUNTY OF New York
Index No: 156986/2019 Date Index Issued: 07/17/2019 For Court Use Only:
IAS EntryDate
STATE FARM FIRE AND CASUALTY COMPANY
Judge Assigned
-against- Plaintiff(s)/Petitioner(s)
MANUAL APPROACH PHYSCIAL THERAPY, P.C.,PROACT PHYSICAL THERAPY P.C.,UTR CHIROPRACTIC SERVICES P.C.,
NEW SENSE ACUPUNCTURE P.C.,ALL COUNTY, LLC, ATB SERVICES, INC.,THE MOUNT SINAI HOSPITAL a/k/a FPA RJIFiled Date
HOSPITAL BASED NON PAR MT, CHELSEA MOBILITY INC.,THE MOUNT SINAI HOSPITAL a/k/a MOUNT SINAl H...
Defancient(s)/Despondent(s)
COMMERCIAL MATRIMONIAL
O Contested
O BusinessEntity (includes corporations, partnerships, LLCs,LLPs,etc.)
NOTE: If there are children under the age of 18, complete and attach the
Contract MATRIMONIAL RJIAddendum (UCS-84OM).
O Insurance(where insurance company is a party, except arbitration)
For Uncuniesied Matrimonial actions, use the UncontestedDivorce RJi(UD-13).
O UCC(includes sales and neyutiabie instruments)
Other Commercial(specify):
TORTS
NOTE: For CommercialDivision assignment requests pursuant to 22 NYCRR202.70(d),
complete and attach the COMMERCIALDIVISION RJIADDENDUM (UCS-840C). Asbestos
O Child Victims Act
REAL PROPERTY: Specify how many properties the application includes: Env........
nta. (specify):
O Condemnation Medical,Dental, or Podiatric Malpractice
O O iiesiueniioi
Mortgage Foreclosure(specify): O Commercial O Motor Vehicle
Property Address: O Products Liability (specify):
Other Negligence(specify):
NOTE: For Mortgage Foreclosureactions involving a one to four-family, owner-
occupied residential property or owner-occupiedcondominium, complete and
O Other ProfessionalMalpractice (specify):
attach the FORECLOSURERJIADDENDUM (UCS-840F). Declaratory judgment
Other Tort (specify):
O Tax Certiorari - Section: Block: Lot:
Tax Foreclosure SPECIAL PROCEEDINGS
Other Real Property (specify): O CPLRArticle 75 (Arbitration)
[see NOTE in COMMERCIALsection]
O
O CPLRArticle 78 (Body or Officer)
OTHER MATTERS
O Election Law
O Certificate of Incorporaiius.,3;..v|st|on
[see NOTE in COMMERCIALsection] Extreme Risk ProtectionOrder
O Emergency MedicalTreatment MHLArticle 9.60 (Kendra's Law)
O HabeasCorpus O MHLArticle 10 (Sex Offender Confine=ant-Initial)
O LocalCourt Appeal MHLArticle 10 (Sex Offender Confinement-Review)
O Mechanic'sLien MHLArticle 81 (Guardianship)
O NameChange O Other Mental Hygiene (specify):
Pistol Permit Revocat!ce Hearing O Other Special Proceeding(specify):
O Saleor Financeof Religious/Not-for-ProfitProperty
O Other (specify):
STATUS OF ACTION OR PROCEEDING: AnswerYESor NOfor every question and enter additional information where indicated.
YES NO
Hasa summons and complaint or summonswith notice been filed? O 07/17/2019
If yes, date filed:
Hasa summons and complaint or summonswith notice been served? O 08/31/2019
If yes, date served:
Is this action/proceeding being filed post-judgment? O If yes, judgment date:
NATURE OF JUDICIAL INTERVENTION: Checkone box only and enter additional info=2tion
where indicated.
O Infant's Compromise
O Extreme Risk ProtectionOrder Application
O Note of Issue/Certificateof Readiness
O Date Issuejoined:
Notice of Medical, Dental, or Podiatric Malpractice
|udgment - Default
Relief Requested: Return Date:O2/27/2020
Notice of Motion
Notice of Petition Relief Requested: Return Date:
O
Order to ShowCause Relief Requested: Return Date:
O
Other Ex ParteApplication Relief Requested:
O PoorPersonApplication
O Requestfor Preliminary Conference
O ResidentialMortgage ForeclosureSeM!eraentConference
O Writ of HabeasCorpus
O Other (specify):
1 of 3
FILED: NEW YORK COUNTY CLERK 01/31/2020 03:02 PM INDEX NO. 156986/2019
NYSCEF DOC. NO. 31 RECEIVED NYSCEF: 01/31/2020
RELATED CASES: List any related
actions.For Matrimonial
cases,list any
relatedcriminal
or FamilyCourtcases.If none,
leave blank.If additional
space
is required,
complete and attachthe RJI Addendum (UCS-840A).
Case Title Index/Case Number Court Judge (ifassigned) Relationship to instantcase
For parties
withoutan attorney,
check the"Un-Rep" box and enter
the party's phone number and emailin thespace
PARTIES: address,
provided.If additional
space is required,
completeand attachthe RJI Addendum (UCS-840A).
Un- Parties | Attorneys and/or Unrepresented Litigants Issue Joined | Insurance
Rep List parties in same order as listed in the
For represented parties, provide attorney's name, firm name, address, phone
For each defendant,
For each defendant,
caption and indicate roles (e.g., plaintiff,
and email. For unrepresented parties, provide party's address, phone and
indicate if issue has
indicate insurance
defendant; 3rdparty plaintiff, etC.) email. beenjoined. carrier, if applicable.
Name: STATE FARM FIRE AND LINDSAY ZUFLACHT, Rubin, Fiorella,Friedman & Mercante
CASUALTY COMPANY LLP, 630 Third Avenue , New York, NY 10017, (212) 953-
O YES E NO
Role(s):Plaintiff/Petitioner 2381, Ipadover@rubinfiorella.com
Name: MANUAL APPROACH 5 Rubenstein Street, Staten Island,NY 10305
PHYSCIAL THERAPY, P.C.
O YES E NO
Role(s):Defendant/Respondent
Name: PROACT PHYSICAL THERAPY 7807 18th Avenue, Apt. 2R, Brooklyn, NY 11214
P.C.
O YES O NO
Role(s):Defendant/Respondent
Name: UTR CHIROPRACTIC 135-06 Jamaica Avenue, Richmond NY
Hill, 11418
SERVICES P.C.
O YES E NO
Role(s):Defendant/Respondent
Name: NEW SENSE ACUPUNCTURE 21974 A 64th Avenue, Bayside, NY 11364
P.C.
O YES E NO
Role(s):Defendant/Respondent
Name: ALL COUNTY, LLC 161-05 Horace Expressway, Flushing,NY 11365
Harding
O YES E NO
Role(s):Defendant/Respondent
Name: ATB SERVICES, INC· 16216 Union Turnpike, Ste. 207, Flushing,NY 10087
O YES E NO
Role(s):Defendant/Respondent
Name: THE MOUNT SINAI HOSPITAL 25-10 30th Avenue, Astoria,NY 11102
a/k/a FPA HOSPITAL BASED NON
PAR MT O YES E NO
Role(s):Defendant/Respondent
Name: CHELSEA MOBILITY INC· tsirelman, Tsirelman, P.C.,129 LivingstonStreet
gary Gary
Second & Third Floors,Brooklyn, NY 11201, (718)438-
E YES O NO
Role(s):Defendant/Respondent 1200, gtsirelman@gtmdjd.com
Name: THE MOUNT SINAI HOSPITAL 25-10 30th Avenue, Astoria,NY 11102
a/k/a MOUNT SINAI HOSPITAL
QUEENS O YES E NO
Role(s):Defendant/Respondent
I AFFIRM UNDER THE PENALTY OF PERJURY THAT, UPON INFORMATION AND BELIEF, THERE ARE NO OTHER RELATED ACTIONS OR
PROCEEDINGS, EXCEPT AS NOTED ABOVE, NOR HAS A REQUEST FOR JUDICIAL INTERVENTION BEEN PREVIOUSLY FILED INTHIS
ACTION OR PROCEEDING.
Dated: 01/31/2020 LINDSAY ARIEL ZUFLACHT
Signature
4680369 LINDSAY ARIEL ZUFLACHT
Attorney Registration Number PrintName
This form was generated by NYSCEF
2 of 3
FILED: NEW YORK COUNTY CLERK 01/31/2020 03:02 PM INDEX NO. 156986/2019
Caption
NYSCEF Rider
DOC. Sheet31
NO. RECEIVED NYSCEF: 01/31/2020
Plaintiff(s)/Petitioner(s)
VS.
MANUAL APPROACH PHYSCIAL THERAPY, P.C., PROACT PHYSICAL THERAPY P.C.,UTR CHIROPRACTIC SERVICES P.C.,
NEW SENSE ACUPUNCTURE P.C.,ALL COUNTY, LLC, ATB SERVICES, INC., THE MOUNT SINAI HOSPITAL a/k/a FPA HOSPITAL
BASED NON PAR MT, CHELSEA MOBILITY INC., THE MOUNT SINAI HOSPITAL a/k/aMOUNT SINAI HOSPITAL QUEENS, BIRCH
MEDICAL & DIAGNOSTIC, P.C., KADHElJAH NOEL
Defendant(s)/Respondent(s)
3 of 3
Preview
FILED: NEW YORK COUNTY CLERK 01/31/2020 03:02 PM INDEX NO. 156986/2019 NYSCEF DOC. NO. 31 RECEIVED NYSCEF: 01/31/2020 REQUEST FOR JUDICIAL INTERVENTION 58,4g°g1,) New York Supreme COURT, COUNTY OF New York Index No: 156986/2019 Date Index Issued: 07/17/2019 For Court Use Only: IAS EntryDate STATE FARM FIRE AND CASUALTY COMPANY Judge Assigned -against- Plaintiff(s)/Petitioner(s) MANUAL APPROACH PHYSCIAL THERAPY, P.C.,PROACT PHYSICAL THERAPY P.C.,UTR CHIROPRACTIC SERVICES P.C., NEW SENSE ACUPUNCTURE P.C.,ALL COUNTY, LLC, ATB SERVICES, INC.,THE MOUNT SINAI HOSPITAL a/k/a FPA RJIFiled Date HOSPITAL BASED NON PAR MT, CHELSEA MOBILITY INC.,THE MOUNT SINAI HOSPITAL a/k/a MOUNT SINAl H... Defancient(s)/Despondent(s) COMMERCIAL MATRIMONIAL O Contested O BusinessEntity (includes corporations, partnerships, LLCs,LLPs,etc.) NOTE: If there are children under the age of 18, complete and attach the Contract MATRIMONIAL RJIAddendum (UCS-84OM). O Insurance(where insurance company is a party, except arbitration) For Uncuniesied Matrimonial actions, use the UncontestedDivorce RJi(UD-13). O UCC(includes sales and neyutiabie instruments) Other Commercial(specify): TORTS NOTE: For CommercialDivision assignment requests pursuant to 22 NYCRR202.70(d), complete and attach the COMMERCIALDIVISION RJIADDENDUM (UCS-840C). Asbestos O Child Victims Act REAL PROPERTY: Specify how many properties the application includes: Env........ nta. (specify): O Condemnation Medical,Dental, or Podiatric Malpractice O O iiesiueniioi Mortgage Foreclosure(specify): O Commercial O Motor Vehicle Property Address: O Products Liability (specify): Other Negligence(specify): NOTE: For Mortgage Foreclosureactions involving a one to four-family, owner- occupied residential property or owner-occupiedcondominium, complete and O Other ProfessionalMalpractice (specify): attach the FORECLOSURERJIADDENDUM (UCS-840F). Declaratory judgment Other Tort (specify): O Tax Certiorari - Section: Block: Lot: Tax Foreclosure SPECIAL PROCEEDINGS Other Real Property (specify): O CPLRArticle 75 (Arbitration) [see NOTE in COMMERCIALsection] O O CPLRArticle 78 (Body or Officer) OTHER MATTERS O Election Law O Certificate of Incorporaiius.,3;..v|st|on [see NOTE in COMMERCIALsection] Extreme Risk ProtectionOrder O Emergency MedicalTreatment MHLArticle 9.60 (Kendra's Law) O HabeasCorpus O MHLArticle 10 (Sex Offender Confine=ant-Initial) O LocalCourt Appeal MHLArticle 10 (Sex Offender Confinement-Review) O Mechanic'sLien MHLArticle 81 (Guardianship) O NameChange O Other Mental Hygiene (specify): Pistol Permit Revocat!ce Hearing O Other Special Proceeding(specify): O Saleor Financeof Religious/Not-for-ProfitProperty O Other (specify): STATUS OF ACTION OR PROCEEDING: AnswerYESor NOfor every question and enter additional information where indicated. YES NO Hasa summons and complaint or summonswith notice been filed? O 07/17/2019 If yes, date filed: Hasa summons and complaint or summonswith notice been served? O 08/31/2019 If yes, date served: Is this action/proceeding being filed post-judgment? O If yes, judgment date: NATURE OF JUDICIAL INTERVENTION: Checkone box only and enter additional info=2tion where indicated. O Infant's Compromise O Extreme Risk ProtectionOrder Application O Note of Issue/Certificateof Readiness O Date Issuejoined: Notice of Medical, Dental, or Podiatric Malpractice |udgment - Default Relief Requested: Return Date:O2/27/2020 Notice of Motion Notice of Petition Relief Requested: Return Date: O Order to ShowCause Relief Requested: Return Date: O Other Ex ParteApplication Relief Requested: O PoorPersonApplication O Requestfor Preliminary Conference O ResidentialMortgage ForeclosureSeM!eraentConference O Writ of HabeasCorpus O Other (specify): 1 of 3 FILED: NEW YORK COUNTY CLERK 01/31/2020 03:02 PM INDEX NO. 156986/2019 NYSCEF DOC. NO. 31 RECEIVED NYSCEF: 01/31/2020 RELATED CASES: List any related actions.For Matrimonial cases,list any relatedcriminal or FamilyCourtcases.If none, leave blank.If additional space is required, complete and attachthe RJI Addendum (UCS-840A). Case Title Index/Case Number Court Judge (ifassigned) Relationship to instantcase For parties withoutan attorney, check the"Un-Rep" box and enter the party's phone number and emailin thespace PARTIES: address, provided.If additional space is required, completeand attachthe RJI Addendum (UCS-840A). Un- Parties | Attorneys and/or Unrepresented Litigants Issue Joined | Insurance Rep List parties in same order as listed in the For represented parties, provide attorney's name, firm name, address, phone For each defendant, For each defendant, caption and indicate roles (e.g., plaintiff, and email. For unrepresented parties, provide party's address, phone and indicate if issue has indicate insurance defendant; 3rdparty plaintiff, etC.) email. beenjoined. carrier, if applicable. Name: STATE FARM FIRE AND LINDSAY ZUFLACHT, Rubin, Fiorella,Friedman & Mercante CASUALTY COMPANY LLP, 630 Third Avenue , New York, NY 10017, (212) 953- O YES E NO Role(s):Plaintiff/Petitioner 2381, Ipadover@rubinfiorella.com Name: MANUAL APPROACH 5 Rubenstein Street, Staten Island,NY 10305 PHYSCIAL THERAPY, P.C. O YES E NO Role(s):Defendant/Respondent Name: PROACT PHYSICAL THERAPY 7807 18th Avenue, Apt. 2R, Brooklyn, NY 11214 P.C. O YES O NO Role(s):Defendant/Respondent Name: UTR CHIROPRACTIC 135-06 Jamaica Avenue, Richmond NY Hill, 11418 SERVICES P.C. O YES E NO Role(s):Defendant/Respondent Name: NEW SENSE ACUPUNCTURE 21974 A 64th Avenue, Bayside, NY 11364 P.C. O YES E NO Role(s):Defendant/Respondent Name: ALL COUNTY, LLC 161-05 Horace Expressway, Flushing,NY 11365 Harding O YES E NO Role(s):Defendant/Respondent Name: ATB SERVICES, INC· 16216 Union Turnpike, Ste. 207, Flushing,NY 10087 O YES E NO Role(s):Defendant/Respondent Name: THE MOUNT SINAI HOSPITAL 25-10 30th Avenue, Astoria,NY 11102 a/k/a FPA HOSPITAL BASED NON PAR MT O YES E NO Role(s):Defendant/Respondent Name: CHELSEA MOBILITY INC· tsirelman, Tsirelman, P.C.,129 LivingstonStreet gary Gary Second & Third Floors,Brooklyn, NY 11201, (718)438- E YES O NO Role(s):Defendant/Respondent 1200, gtsirelman@gtmdjd.com Name: THE MOUNT SINAI HOSPITAL 25-10 30th Avenue, Astoria,NY 11102 a/k/a MOUNT SINAI HOSPITAL QUEENS O YES E NO Role(s):Defendant/Respondent I AFFIRM UNDER THE PENALTY OF PERJURY THAT, UPON INFORMATION AND BELIEF, THERE ARE NO OTHER RELATED ACTIONS OR PROCEEDINGS, EXCEPT AS NOTED ABOVE, NOR HAS A REQUEST FOR JUDICIAL INTERVENTION BEEN PREVIOUSLY FILED INTHIS ACTION OR PROCEEDING. Dated: 01/31/2020 LINDSAY ARIEL ZUFLACHT Signature 4680369 LINDSAY ARIEL ZUFLACHT Attorney Registration Number PrintName This form was generated by NYSCEF 2 of 3 FILED: NEW YORK COUNTY CLERK 01/31/2020 03:02 PM INDEX NO. 156986/2019 Caption NYSCEF Rider DOC. Sheet31 NO. RECEIVED NYSCEF: 01/31/2020 Plaintiff(s)/Petitioner(s) VS. MANUAL APPROACH PHYSCIAL THERAPY, P.C., PROACT PHYSICAL THERAPY P.C.,UTR CHIROPRACTIC SERVICES P.C., NEW SENSE ACUPUNCTURE P.C.,ALL COUNTY, LLC, ATB SERVICES, INC., THE MOUNT SINAI HOSPITAL a/k/a FPA HOSPITAL BASED NON PAR MT, CHELSEA MOBILITY INC., THE MOUNT SINAI HOSPITAL a/k/aMOUNT SINAI HOSPITAL QUEENS, BIRCH MEDICAL & DIAGNOSTIC, P.C., KADHElJAH NOEL Defendant(s)/Respondent(s) 3 of 3