Preview
FILED: NEW YORK COUNTY CLERK 10/25/2019 05:36 PM INDEX NO. 654092/2019
NYSCEF DOC. NO. 5 RECEIVED NYSCEF: 10/25/2019
SUPREME COURT OF THE STATE OF NEW YORK
COUNTY OF NEW YORK
i ÏBERÏY ÏViÜŸÜÄÏ-lÑSiifilÑCÈ Cõ1 ÄÑŸ, ET Al , INDEX No. 654092/19
Plaintiffs,
ATTORNEY'S VERIFICATION
-against-
AK GLOBAL SUPPLY CORP., FILE NO.: 37,475
Defendant.
._____________________________--------..--___-_________________________________.
Pursuant to 22 NYCRR §130-1.1, the undersigned, an attorney duly admined to practice in the courts of New York
rea-
State, certifiesthat, upon information and beliefand ble inquiry, the contentions and reqü©sts cor:tained in the
following documents are not frivolous:
O Verified Interrogatories
O Notice for Discovery and Inspection
O Expert Witness Discovery
O Fact (Lay) Witness Discovery
a Exam½ation Before Trial
Dated: Brooklyn, NY
October 23, 2019
KOPELEVICH & FELDSHEROVA, P.C.
Attorneys for Defendant
AK GLOBAL SUPPLY CORP.
37*
241 Street, Suite B439
Brooklyn, NY 11232
718-332-0577
By:
O Mikhail KOPELEVICH D GalinaFELDSHEROVA
DAVID LANDFAIR
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SUPREME COURT OF THE STATE OF NEW YORK
COUNTY OF NEW YORK
ÏBËÏÜŸ ÏüÜÏU1UiÑSÜÏÄÑ E UOÏüÏ-ÄÑŸ, ËfÄ .,
Index No.: 654092/19
Plaintiffs,
-against- DEMAND FOR VERIFIED
INTERROGATORIES
AK GLOBAL SUPPLY CORP.,
File No.: 37,475
Defendant.
____.
.____________________________......,____________________.._________________
PLEASE TAKE NOTICE THAT, pursuant to CPLR §3130 et seq., demand is hereby made that Plaintiff answer
under oath the interrogatories hereinafter set forth,PLEASE NOTE THAT, the word Eligible Injured Person ("EIP")
herein refers to the Defand an+'s and if the instant action involves more than one the
Assignors; EIP, following
interregatories must be separately answered for each EIP. TAKE FURTHER NOTICE THAT, in the following
"bill"
interrogatories, the word shall refer to a bill,Verification Form (NF-3), or any other form, however named,
containhg an itemized list of the services and/or supplies that EIP received from Defendant; the words "denial of
form," "denial,"
claim or shall refer to denial of claim forms (NF-10), explanation of benefits, or any other similar
form issued by Plaintiff or Plaintiff's agent(s), by which Plaintiff purported to reject Plaintiff's request(s) for
records"
reimbursement; the words "medical shall indicate medical reports, testresults, medical charts, prescriptions,
referrals, and any other document, however named, created by any licalthcare provider in the course, and for
EBT"
purposes of the EIP's diagnosis and/or treatment; the words "each shall referto an EBT ccñducted pursuant to
a notice for EBT, regardless of how many individuals are scheduled to be deposed in the notice,
1. State the name, job title,relationship with Plaintiff, and business address of the person answering these
interrogatories. Also state whether this person is authorized to answer on Plaintiff'sbehalf pursuant to the
laws of agency and the CPLR.
2. State whether Plaintiff has issued an insüiance policy under which EIP claimed benefits for the accident
underlying these proceedings:
a. If yes,state:
i. The state in which the policy was issued
ii. The dates when the policy was in effect
iii. Whether the policy complied with the New York Financial ResponsihiEty Act
iv. If the policy was cancelled or suspended at any time, prior or subsequent to the accident in
which EIP was injured, the specific reasons for such cancellation or suspension
b. If state whether -and if and to what extent- Plaintiff is otherwise liable for full
no, so,why, how,
or partial coverage with respect to such accident
3. State whether Plaintiffreceived EIP's Application for Benefits Form (NF-2). If so,state:
a. When
b. Whether Plaintiff questioned the validity and/or genuineness of such document -and, if so,which
steps were undertaken to obtain credible and reliableconfirmation thereof
4. State whether Plaintiff received a Motor Vehicle Accident Report (MV104) describing EIP's accident. If so,
state:
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a. When
b. Whether Plaintiff questioned the validity and/or genuincñcas of such document -and, if so,which
steps were undertaken to obtain credible and reliableconfirmation thereof
5. State whether Plaintiffreceived a Police Accident Report describing EIP's accident. If so,state:
a. When
b. Whether Plaintiff questioned the validity and/or genuirgness of such document -and, ifso, which
steps were undertaken to obtain credibic and reliableconfirmation thereof
6. State whether Plaintiff received an Assigñmcñ‡ of Benefits Form (AOB) signed by EIP or EIP's
representative in favor of Defendant. If so,state:
a. When
b. Whether Plaintiff questioned the validity and/or gcñuiñêñess of such document -and, if so, which
steps were undertaken to obtain credible and reliable confirmation thereof
7, State whether Plaintiff objected to the Assignment of Benefits Form (AOB) signed by EIP or EIP's
representative in favor of Defendant. If so:
a. State when the objection was communicated to Defendant and EIP, respectively
b. State with specificity the ground or grounds for the objection
8. State whether the records relating to the claims at issue in thiscase are kept in a file.If so,
a. State when the filewas created
b. State full time, job title,and business address of the custodian(s) of this file
c. State the date when the custodian was assigned
d. State whether the custodianship of the file has changed during the existence of the file-and, if so,
detail each change and the date itoccurred
9. State whether one or more claim representatives have been assigned to the claim or claims herein in dispute
a. If yes, statefor each such claim representative:
i. Full name, current job titleand current business address
ii. A detailed listof current duties and responsibilities. For example, and not limited to the
following, statewhether the claim representative had, or was supposed to have, a duty to:
1. Be thoroughly conversant with the Insurance Law and Regulations
2. Treat healthcare providers courteously and professionally
3. Avoid requesting factual information when not necessary
4. Process claims expeditiously
5. Request any material information necessary to expedite claim processing
6. Ensure that claim papers be complete before forwarding them to any other employee, agent, or representative of
Plaintiff
7. Receive documentation and information from healthcare providers. If so, state whether the claim representative
also had a duty to:
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a. Make a notation of such documentation and information in PlaintifF s files
and/or computer system(s)
b. Ensure that such documentation and information be complete, accurate,
truthful and/or genuine. Ifno, state:
i. Whether any other employee, agent or representative of Plaintiffhad
such duty
ii. Whether Plaintiffroutinely relies on the compictoness, accurateness,
truthfulness and/or genuineness of such documentation and
information
iii. The steps undertaken by Plaintiff when it believes that such
documentation and information isincomplete, inaccurate, untruthful
or not genuine
c. Further process such documentation and information. If so,state:
i. Accurately and indetails,what the further processing consisted of
ii. What such further processing, ifany, occurred in this case
iii. Dates of employment with Plaintiff
iv. Whether any material employment-related changed occurred from the date the claim
representative was firsthired. If so,state:
1. What the change was
2. When the change happened
3. Whether the change was temporary or permanent
4. If the change was temporary, statewhether the claim representative returned to a work-related status identical to
that which existed prior to such change
b. Ifno, state foreach individual who evaluated and processed such claim or claims:
i. Name, job titleand business address
ii. A detailed listof this individual's duties and responsibilities at the time the claim or claims
were processed. For example, and not limited to the fallawing, state whether this
individual had, or was supposed to have, a duty to:
1. Be thoroughly conversant with the Insurance Law and Regulations
2. Treat healthcare providers courteously and professionally
3. Avoid requesting factual information when not necessary
4. Process claims expeditiously
5. Request any material information necessary to expedite claim processing
6. Ensure that claim papers be complete before forwarding them to any other employee, agent, or representative of
Plaintiff
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7. Receive documentation and information from healthcare providers. If so, state whether the claim represcñtative
also had a duty to:
a. Make a notation of such deeümentation and information in Plaintiff's files
and/or computer system(s)
b. Ensure that such deementation and information be complete, accurate,
truthful and/or genuine. Ifno, state:
i. Whether any other employee, agent or representative of Plaintiff had
such duty
ii. Whether Plaintiffroutinely relies on the completeness, accurateness,
truthfulness and/or genineness of such documentation and
information
iii. The steps undertaken by Plaintiff when it bclicycs that such
documentation and information isincomplete, inaccurate, untruthful
or not genuine
c. Further process such documentation and information. If so,state:
i. Accurately and indetails, what the further processing consisted of
ii. What such further processing, ifany, occurred in thiscase
10. State whether Plaintiffmade any request for additional verification of any of Defendant's bills.If so,for each
verification request:
a. Identify the bill or billsto which the verification request related
b. State when the verification request was issued
c. State when the verification request was mailed
d. State which type of verification was requested and from which person or entity
e. State why the additional verification was necessary to process the bill or bills
f. State whether information responsive to the verification request could have been attained from any
other source.
i. Ifnot, state:
1. The basis or bases for this determination
2. Whether the material circumstances have since changed
ii. Ifyes, state:
1. WhetherPlaintiffdid in factsought itfrom such other source(s)
2. Why Plaintiffchose to seek such information directly from Defendant
g. State whethct Plaintiff issued one or more follow-up verification requests. If so, state for each
follow-up:
i. When itwas issued
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ii. When itwas mailed
iii. To which person or entity itwas sent
h. State whether Plaintiff has received informatica, in writing or by any other means, in response to the
verification request. If so,state:
i. Whether the information received was deemed by Plaintiff satisfactory and complete. If not,
state:
1. Whether additional verification requests were issued
2. Whether any denial was issued on the basis of the alleged failure to provide the requested verifieâtion
ii. When the information was received
11. With respect to each denial issued by Plaintiff against one or more of the bills subject to the instant dispute:
a. State whether itspecifically referred to one or more of these bills. If so:
i. Identify which specific billor bills have been denied
ii. State whether the reasons for the denial applied to allthe billslisted in the denial
b. State whether the information therein coñtaiñed was written manually or by printer
c. State the specific source of each item of information therein contaiñêd. With respect to each source,
also state:
i. Whether the person providing the information had any direct and personal knowledge of the
amounts, codes, facts, events, procedures, or any other foundation however named or
identified, or lack thereof, conveyed by such information
(e.g., how did the source know when received the bill or billsdenied the NF-
Plaintiff by
10?)
ii. Whether Plaintiff, or any of itsemployees or agents, checked the source of information for
accuracy and completeness
d. State the name of the person who generated it.With respect to thisperson, also state:
i. Whether this person was employed by Plaintiff at the time the denial was generâted. If
employed by another business entity,state:
1. The name of this person's employer
2. The nature of the business relationship between Plaintiff and this person's employer
3. Whether thisperson had access to Plaintiff'scomputer or paper files.Ifnot, state:
er--='
a. How Plaintiff --±-a to this person the information to
necessary
generate a denial
b. The specific procedure followed by this person to generate, print and mail
denials
ii. This person's current job titleand current business address
iii. This person's current duties and respnmibilities
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e. State in details how itwas generated
(e.g.: Was itautomatically -piled using information contained in a computer database and then
printed? Was the information cut and pasted from a database into word-processing software? Was .
the information manually typed/written by a person who obtained it from a database? Etc.)
f. State the date when itwas generated
g. State whether Plaintiffverified the accuracy of the denial or denials, regardless of who created them
before they were mailed -and, ifso, detail the scope and extent of each such verification
12. State whether Plaintiff, by its employees or agents, issued any document or correspondêñce to Defcadant,
other than a denial or a verification request. If so, also statefor each such correspondesce:
a. The date when itwas created and mailed, ifdifferent
b. The substance of itscontent
c. The name of Plaintiff s employee or agent authorizing and/or requesting itsmailing
d. Whether itsought documentation or information. If so,state:
i. What specific documentation or information was being sought
ii. Why the documentation or information was deemed necessary
iii. Whether the documentation or information was received. If so,also state:
1. When itwas received
2. Which employee or employees of Plaintiff itwas forwarded to
3. What further steps Plaintiffüñdertook in response thereto
13. IfPlaintiff issued one or more denials or otherwise refused to pay any of Defendant's billsbased, in whole or
oath"
in part, upon the failure to attend one or more "exembetions under (EUO) by EIP, EIP's assignees, or
any other person or entity (collectively, "Applient"), state for each scheduled EUO and for each Applicant
who allegedly failed to appear:
a. With respect to allcorrespondence relating to the EUO, whether or not purporting to schedule same,
state for each correspondence:
i. Whether itwas sent by Plaintiffor by one or more third-party vendor. If by a third-party
vendor, also state:
1. Itsname and address
2. The nature and details of the business relationship existing between itand Plaintiff
ii. Date of mailing -and an indication of how this date isknown to Plaintiff
iii. Name and address of every person or entity to which itwas sent
iv. The precise procedure followed for the creation and mailing of such correspondence,
providing details camparable to what Plaintiff is disclosing in response to the within
questions dealing with denials
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v. Whether Plaintiff or Plaintiff'sagent(s) received reliable confirmation of delivery -and if
so, precisely which confirmation
b. In details,how Plaintiff or Plaintiffs agent(s) came to know that Applicant failed to appear
c. Whether the EUO was scheduled to take place within 30 days after Plaintiff's receipt of a
verification form. If so,state:
i. Which verification form was received
!
ii. When the verification form was received by Plaintiff
iii. When the EUO was scheduled to take place
d. Whether Piâintiff determined that an EUO would be reasonable under the specific circumstances of
the case. If so,state in details:
i. Names, addresses and relationship with Plaintiffof each person or entity that coñtributed in
making the determination
ii. The specific procedure adopted in making the determination
e. In details, the objective standaitis relied upon by Plaintiffor Plaintiff s agent(s) in determining that
an EUO would be necessary to establish proof of claim
f. In details, the specific objective justification supporting the use of EUOs under the circumstances of
the case
g. Whether Plaintiff or Plaintiff's agent commtmicated with Applicant prior to the sheduling of the
EUO. Ifso, also statein details for each communication:
i. When, by whom, and by what means ittook place
ii. The substance thereof
h. In details, how Plaintiff or Plaintiff's agent(s) determined that the time and the location for the
scheduled EUO would be convenient for Applicant
14. IfPlaintiff issued one or more denials or otherwise refused to pay any of Defendant's bills based, in whole or
in part, upon one or more of the following: I) the results of Plaintiff's investigation(s); II) the allegation that
material misrepresentations were made by EIP and/or Defendant and/or any other person involved in the
accident underlying the within dispute; III)the allegation that the accident underlying theinstant dispute was
an "intentional act"; IV) the allegation that the accident underlying the instant dispute did not "occur as
claimed"; V) the allegation that EIP and/or any other person involved in the accident underlying the instant
provisions"
dispute and/or Defcñdañt "violated the fraud of Plaintiff's policy; VI) the allegation that "the
alleged injuries did not arise out of a covered accident"; VII) the allegation thatE1P and/or Defendant and/or
any other person involved in the accident underlying the within dispute failed to cooperate with Plaintiff
during the course of Plaintiff's investigatioñ of the claims arising out of such accident; VIII) the allegation
that Defendant failed to comply with any applicable licensing requirement; then state in details, to the
extent not already disclosed in response to the within Notice for Discovery and Inspection.
a. Who, when and how, made the ultimate determination, binding Plaintiff,that any or allof the above
grounds would justify Plaintiff's refusal to pay Defendant's bills.For example, and not limited to
the following, state:
i. Whether a claim representative was involved in such determination
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ii. Whether such deteiiiilñation was based on evideñce or reports collected or generated by
Plaintiff's employees or agents. Ifso, also state:
1. Whether any discretionary review of such evidence or reports was involved -and, if so, by whom, how and
when
2. Whether the person uldmately responsible for Plaintiff'sdetermination became acquainted with such evidence or
reports -and, ifso, when, how, and under what circumstances
b. For each person who participated, directly or indirectly, in any investigation affecting Defendant's
bills:
i. Name, address, and relationship with Plaintiff
ii. Qualifications and experience
iii. The relevant dates of thisperson's involvement with the investigation
iv. In details,the factors thatprompted this person to initiatethe investigation
v. The role covered in the investigation, including the weight that Plaintiff accorded to this
person's observations or conclusions
vi. In details, each observation or conclusion that this person reached in the course of the
investigation
vii. Whether this person, in the course of the investigation, was supposed to follow instructions,
guidelines, directives, checklists, or any other criterion, liowever named or qualified. If so,
also state:
1. In details, each of the criteria thatthis person followed
2. In details, who, when, where and how setthese critena
viii. Whether Plaintiff deems this person's portion of the investigation complete. If so,also state:
1. When the investigation was deemed completed
2. What factors determined the end of the investigation
ix. Whether this person worked alone or as part of a team. Ifpart of a team, also state:
1. Names, addresses and relationship with Plaintiff of each other acñiher of the team
2. This person's role within the team
3. Whether this person had a duty to report the progress of the investigation to any other individuals -and, if so,
also provide information relating to these other individuals consistently with the foregoing
"accident,"
c. If Plaintiff determined that the accident underlying theinstant dispute was not an or did
claimed," occurrence," act,"
not "occur as or was "a staged or an "intentional collusive and for any
other similar defense:
i. Whether Plaintiff or its employees or agents visited the site of the accident. If so, also state
for each such visit:
1. The date and precise location visited
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2. Name of each person who was present, including each person's job title,qualificadens, investigatory role,and
any other information thatwould justify this person's presence atthe site
3. The specific fmdings made at the site
4. Any other inferñ1stion or conclusion that Plaintiffdrew as a censequence of the visitto the site
ii. For each person thatcontributed in making the dctcrmiñation about the accident
1. Name, relationship with Plaintiff, area of expertise, and any other relevant information on this person's
educational and professional background
2. The information and evidence on which the person relied, including the source of such information and evidence
iii. Whether Plaintiffhas an alteniative theory of how the accident took place. If so,also state:
1. The basis or bases on which Plaintiff elaborated this theory
2. For any discrepañcy between Plaintiff's theory and the manner in which E1P or Defendant allege the accident
occurred
a. Why the discrepancy ismaterial and relevant
b. Whether Plaintiffbelieves that the discrepancy was intentional -and if so,
why
iv. when and for what reasons to Plaintiff- benefited from the
Who, how, -according
allegedly intentional accident
d. For each statement obtained Plaintiff -whether oral or under oath or not- that affects
by written,
Defendant's bills.
i. Who took the statement, when and where
ii. Which part of the statement was used and relied upon by Plaintiff to substantiate Plaintiff's
contentions
iii. In details,to what extent and why Plaintiff determiñcd that the statement relied upon -or
portion thereof- supports Plaintiff's contentions. For and not limited to the
example,
following, state:
1. Whether --and if on which basis- Plaintiff believes the statement to be
so, false, misleading, deceitful,
fraudulent or inaccurate
2. Whether Plaintiff believes that any alleged infirmness in the statement was deliberate or casual -and if so, on
which basis
3. Whether Plaintiff believes that any alleged infirmness in the statescat was material to the point of affecting
Plaintiff's bills--and on which basis
e. For each alleged violation of Plaintiff'spolicy:
i. The specific policy clause or clauses alleged to have been violated
ii. The person or entity that violated the policy clause or clauses
iii. The time, place, and other identifying clemcñt of the alleged violation
iv. The materiality of the policy clause or clauses alleged to have been violated
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v. Whether Plaintiff believes that the alleged violation was intentional -and, if so, on which
basis
vi. Whether Plaintiff received any explanation, justification or excuse for the alleged violation
-and, ifso, the specifies thereof and by whom itwas proffered
vii. Whether Plaintiff has in place any policy or procedure to review the determination that a
policy violation occurred -and, ifso, the details thereof
f. For each hetam of non-couperation alleged by Phintiff, and with respect to each person or entity
alleged to have failed to cooperate:
i. Name
ii. Specific dates and circumstances of the alleged non-cooperation
iii. Whether an obligation to cooperate existed upon the person or entity.If so:
1. Specify the extent and scope of the obligation
2. Specify the legal source ofthe obligation
3. Specify whether clear notice exists of the consequences of a failure to cooperate
iv. Whether Plaintiff, itsemployees or agents, have a duty to take affirmative steps to secure
cooperation. If so:
1. Specify the nature and extent of the duty and/or of the corresponding steps
2. whether -and if how- these steps were followed in thiscase
Specify so,
3. Specify whether Plaintiffhas a policy obligation to offer one or more opportunities to correct any alleged failure
to cooperate. Ifso, also state:
a. The details of thispolicy obligation
b. How many opportunities Plaintiff is supposed to offer, together with an
explanation of who, when, where and how determined that this n=nber
would generally be reasonable
c. Whether such offer was extended in thiscase
d. Whether either why- Plaintiff believes under the instant
-and, way, that,
circumstances, a deviation from such ordinary policy obligation should be
warranted
g. For each alleged violation of any licensing requirement:
i. Name of each person and/or entity alleged to have committed the violation
ii. Dates and cimumstances of each alleged violation
iii. The legal source alleged to have been violated
iv. The specific reasons why Plaintiff believes that the liceñsiñg requirements apply to the
person and/or entity alleged to have violated them
v. The specific reasons why Plaintiff believes that a violation of the applicable licensig
requirements has taken place
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vi. Dates and circumstances in which Plaintifffirst learned of the alleged violation
vii. Specific steps üñdertaken by Plaintiff upon firstlearning of the alleged viviation
viii. Whether Plaintiff sought clarifications by enmmunicating with the person and/or entity
alleged to have committed the alleged violation. If so, also state:
1. Dates, names and circumstances of each such communicâtion
2. Substance of each communication
3. Whether --and, either way, why-Plaintiffdecñied satisfactory the clarifications obtaiñêd
h. Any other information relating to Plaintiff's investigations, conelüsions, or fouñdaticüs of any
evñelusion or belief,upon which Plaintiff will rely to anhatantiate any of itsdefciiscs at any stage of
these proceedings
PLEASE TAKE FURTHER NOTICE that a copy of the answers to these interrogatories must be served
upon the undersigned within twenty (20) days hereof. ALSO TAKE NOTICE that, pursuant to CPLR 3101(h), your
responses to these questinns MUST be amended or supplemcated when the circumstances are such that a failure to
do so would be materially misleading.
Dated: Brooklyn, NY
October 23, 2019
KOPELEVICH & FELDSHEROVA, P.C.
Attorneys for Defendant
AK GLOBAL SUPPLY CORP.
37th
241 street, Suite B439
Brooklyn, NY 11232
718-332-0577
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FILED: NEW YORK COUNTY CLERK 10/25/2019 05:36 PM INDEX NO. 654092/2019 NYSCEF DOC. NO. 5 RECEIVED NYSCEF: 10/25/2019 SUPREME COURT OF THE STATE OF NEW YORK COUNTY OF NEW YORK i ÏBERÏY ÏViÜŸÜÄÏ-lÑSiifilÑCÈ Cõ1 ÄÑŸ, ET Al , INDEX No. 654092/19 Plaintiffs, ATTORNEY'S VERIFICATION -against- AK GLOBAL SUPPLY CORP., FILE NO.: 37,475 Defendant. ._____________________________--------..--___-_________________________________. Pursuant to 22 NYCRR §130-1.1, the undersigned, an attorney duly admined to practice in the courts of New York rea- State, certifiesthat, upon information and beliefand ble inquiry, the contentions and reqü©sts cor:tained in the following documents are not frivolous: O Verified Interrogatories O Notice for Discovery and Inspection O Expert Witness Discovery O Fact (Lay) Witness Discovery a Exam½ation Before Trial Dated: Brooklyn, NY October 23, 2019 KOPELEVICH & FELDSHEROVA, P.C. Attorneys for Defendant AK GLOBAL SUPPLY CORP. 37* 241 Street, Suite B439 Brooklyn, NY 11232 718-332-0577 By: O Mikhail KOPELEVICH D GalinaFELDSHEROVA DAVID LANDFAIR 1 of 19 FILED: NEW YORK COUNTY CLERK 10/25/2019 05:36 PM INDEX NO. 654092/2019 NYSCEF DOC. NO. 5 RECEIVED NYSCEF: 10/25/2019 SUPREME COURT OF THE STATE OF NEW YORK COUNTY OF NEW YORK ÏBËÏÜŸ ÏüÜÏU1UiÑSÜÏÄÑ E UOÏüÏ-ÄÑŸ, ËfÄ ., Index No.: 654092/19 Plaintiffs, -against- DEMAND FOR VERIFIED INTERROGATORIES AK GLOBAL SUPPLY CORP., File No.: 37,475 Defendant. ____. .____________________________......,____________________.._________________ PLEASE TAKE NOTICE THAT, pursuant to CPLR §3130 et seq., demand is hereby made that Plaintiff answer under oath the interrogatories hereinafter set forth,PLEASE NOTE THAT, the word Eligible Injured Person ("EIP") herein refers to the Defand an+'s and if the instant action involves more than one the Assignors; EIP, following interregatories must be separately answered for each EIP. TAKE FURTHER NOTICE THAT, in the following "bill" interrogatories, the word shall refer to a bill,Verification Form (NF-3), or any other form, however named, containhg an itemized list of the services and/or supplies that EIP received from Defendant; the words "denial of form," "denial," claim or shall refer to denial of claim forms (NF-10), explanation of benefits, or any other similar form issued by Plaintiff or Plaintiff's agent(s), by which Plaintiff purported to reject Plaintiff's request(s) for records" reimbursement; the words "medical shall indicate medical reports, testresults, medical charts, prescriptions, referrals, and any other document, however named, created by any licalthcare provider in the course, and for EBT" purposes of the EIP's diagnosis and/or treatment; the words "each shall referto an EBT ccñducted pursuant to a notice for EBT, regardless of how many individuals are scheduled to be deposed in the notice, 1. State the name, job title,relationship with Plaintiff, and business address of the person answering these interrogatories. Also state whether this person is authorized to answer on Plaintiff'sbehalf pursuant to the laws of agency and the CPLR. 2. State whether Plaintiff has issued an insüiance policy under which EIP claimed benefits for the accident underlying these proceedings: a. If yes,state: i. The state in which the policy was issued ii. The dates when the policy was in effect iii. Whether the policy complied with the New York Financial ResponsihiEty Act iv. If the policy was cancelled or suspended at any time, prior or subsequent to the accident in which EIP was injured, the specific reasons for such cancellation or suspension b. If state whether -and if and to what extent- Plaintiff is otherwise liable for full no, so,why, how, or partial coverage with respect to such accident 3. State whether Plaintiffreceived EIP's Application for Benefits Form (NF-2). If so,state: a. When b. Whether Plaintiff questioned the validity and/or genuineness of such document -and, if so,which steps were undertaken to obtain credible and reliableconfirmation thereof 4. State whether Plaintiff received a Motor Vehicle Accident Report (MV104) describing EIP's accident. If so, state: 1 2 of 19 FILED: NEW YORK COUNTY CLERK 10/25/2019 05:36 PM INDEX NO. 654092/2019 NYSCEF DOC. NO. 5 RECEIVED NYSCEF: 10/25/2019 a. When b. Whether Plaintiff questioned the validity and/or genuincñcas of such document -and, if so,which steps were undertaken to obtain credible and reliableconfirmation thereof 5. State whether Plaintiffreceived a Police Accident Report describing EIP's accident. If so,state: a. When b. Whether Plaintiff questioned the validity and/or genuirgness of such document -and, ifso, which steps were undertaken to obtain credibic and reliableconfirmation thereof 6. State whether Plaintiff received an Assigñmcñ‡ of Benefits Form (AOB) signed by EIP or EIP's representative in favor of Defendant. If so,state: a. When b. Whether Plaintiff questioned the validity and/or gcñuiñêñess of such document -and, if so, which steps were undertaken to obtain credible and reliable confirmation thereof 7, State whether Plaintiff objected to the Assignment of Benefits Form (AOB) signed by EIP or EIP's representative in favor of Defendant. If so: a. State when the objection was communicated to Defendant and EIP, respectively b. State with specificity the ground or grounds for the objection 8. State whether the records relating to the claims at issue in thiscase are kept in a file.If so, a. State when the filewas created b. State full time, job title,and business address of the custodian(s) of this file c. State the date when the custodian was assigned d. State whether the custodianship of the file has changed during the existence of the file-and, if so, detail each change and the date itoccurred 9. State whether one or more claim representatives have been assigned to the claim or claims herein in dispute a. If yes, statefor each such claim representative: i. Full name, current job titleand current business address ii. A detailed listof current duties and responsibilities. For example, and not limited to the following, statewhether the claim representative had, or was supposed to have, a duty to: 1. Be thoroughly conversant with the Insurance Law and Regulations 2. Treat healthcare providers courteously and professionally 3. Avoid requesting factual information when not necessary 4. Process claims expeditiously 5. Request any material information necessary to expedite claim processing 6. Ensure that claim papers be complete before forwarding them to any other employee, agent, or representative of Plaintiff 7. Receive documentation and information from healthcare providers. If so, state whether the claim representative also had a duty to: 2 3 of 19 FILED: NEW YORK COUNTY CLERK 10/25/2019 05:36 PM INDEX NO. 654092/2019 NYSCEF DOC. NO. 5 RECEIVED NYSCEF: 10/25/2019 a. Make a notation of such documentation and information in PlaintifF s files and/or computer system(s) b. Ensure that such documentation and information be complete, accurate, truthful and/or genuine. Ifno, state: i. Whether any other employee, agent or representative of Plaintiffhad such duty ii. Whether Plaintiffroutinely relies on the compictoness, accurateness, truthfulness and/or genuineness of such documentation and information iii. The steps undertaken by Plaintiff when it believes that such documentation and information isincomplete, inaccurate, untruthful or not genuine c. Further process such documentation and information. If so,state: i. Accurately and indetails,what the further processing consisted of ii. What such further processing, ifany, occurred in this case iii. Dates of employment with Plaintiff iv. Whether any material employment-related changed occurred from the date the claim representative was firsthired. If so,state: 1. What the change was 2. When the change happened 3. Whether the change was temporary or permanent 4. If the change was temporary, statewhether the claim representative returned to a work-related status identical to that which existed prior to such change b. Ifno, state foreach individual who evaluated and processed such claim or claims: i. Name, job titleand business address ii. A detailed listof this individual's duties and responsibilities at the time the claim or claims were processed. For example, and not limited to the fallawing, state whether this individual had, or was supposed to have, a duty to: 1. Be thoroughly conversant with the Insurance Law and Regulations 2. Treat healthcare providers courteously and professionally 3. Avoid requesting factual information when not necessary 4. Process claims expeditiously 5. Request any material information necessary to expedite claim processing 6. Ensure that claim papers be complete before forwarding them to any other employee, agent, or representative of Plaintiff 3 4 of 19 FILED: NEW YORK COUNTY CLERK 10/25/2019 05:36 PM INDEX NO. 654092/2019 NYSCEF DOC. NO. 5 RECEIVED NYSCEF: 10/25/2019 7. Receive documentation and information from healthcare providers. If so, state whether the claim represcñtative also had a duty to: a. Make a notation of such deeümentation and information in Plaintiff's files and/or computer system(s) b. Ensure that such deementation and information be complete, accurate, truthful and/or genuine. Ifno, state: i. Whether any other employee, agent or representative of Plaintiff had such duty ii. Whether Plaintiffroutinely relies on the completeness, accurateness, truthfulness and/or genineness of such documentation and information iii. The steps undertaken by Plaintiff when it bclicycs that such documentation and information isincomplete, inaccurate, untruthful or not genuine c. Further process such documentation and information. If so,state: i. Accurately and indetails, what the further processing consisted of ii. What such further processing, ifany, occurred in thiscase 10. State whether Plaintiffmade any request for additional verification of any of Defendant's bills.If so,for each verification request: a. Identify the bill or billsto which the verification request related b. State when the verification request was issued c. State when the verification request was mailed d. State which type of verification was requested and from which person or entity e. State why the additional verification was necessary to process the bill or bills f. State whether information responsive to the verification request could have been attained from any other source. i. Ifnot, state: 1. The basis or bases for this determination 2. Whether the material circumstances have since changed ii. Ifyes, state: 1. WhetherPlaintiffdid in factsought itfrom such other source(s) 2. Why Plaintiffchose to seek such information directly from Defendant g. State whethct Plaintiff issued one or more follow-up verification requests. If so, state for each follow-up: i. When itwas issued 4 5 of 19 FILED: NEW YORK COUNTY CLERK 10/25/2019 05:36 PM INDEX NO. 654092/2019 NYSCEF DOC. NO. 5 RECEIVED NYSCEF: 10/25/2019 ii. When itwas mailed iii. To which person or entity itwas sent h. State whether Plaintiff has received informatica, in writing or by any other means, in response to the verification request. If so,state: i. Whether the information received was deemed by Plaintiff satisfactory and complete. If not, state: 1. Whether additional verification requests were issued 2. Whether any denial was issued on the basis of the alleged failure to provide the requested verifieâtion ii. When the information was received 11. With respect to each denial issued by Plaintiff against one or more of the bills subject to the instant dispute: a. State whether itspecifically referred to one or more of these bills. If so: i. Identify which specific billor bills have been denied ii. State whether the reasons for the denial applied to allthe billslisted in the denial b. State whether the information therein coñtaiñed was written manually or by printer c. State the specific source of each item of information therein contaiñêd. With respect to each source, also state: i. Whether the person providing the information had any direct and personal knowledge of the amounts, codes, facts, events, procedures, or any other foundation however named or identified, or lack thereof, conveyed by such information (e.g., how did the source know when received the bill or billsdenied the NF- Plaintiff by 10?) ii. Whether Plaintiff, or any of itsemployees or agents, checked the source of information for accuracy and completeness d. State the name of the person who generated it.With respect to thisperson, also state: i. Whether this person was employed by Plaintiff at the time the denial was generâted. If employed by another business entity,state: 1. The name of this person's employer 2. The nature of the business relationship between Plaintiff and this person's employer 3. Whether thisperson had access to Plaintiff'scomputer or paper files.Ifnot, state: er--=' a. How Plaintiff --±-a to this person the information to necessary generate a denial b. The specific procedure followed by this person to generate, print and mail denials ii. This person's current job titleand current business address iii. This person's current duties and respnmibilities 5 6 of 19 FILED: NEW YORK COUNTY CLERK 10/25/2019 05:36 PM INDEX NO. 654092/2019 NYSCEF DOC. NO. 5 RECEIVED NYSCEF: 10/25/2019 e. State in details how itwas generated (e.g.: Was itautomatically -piled using information contained in a computer database and then printed? Was the information cut and pasted from a database into word-processing software? Was . the information manually typed/written by a person who obtained it from a database? Etc.) f. State the date when itwas generated g. State whether Plaintiffverified the accuracy of the denial or denials, regardless of who created them before they were mailed -and, ifso, detail the scope and extent of each such verification 12. State whether Plaintiff, by its employees or agents, issued any document or correspondêñce to Defcadant, other than a denial or a verification request. If so, also statefor each such correspondesce: a. The date when itwas created and mailed, ifdifferent b. The substance of itscontent c. The name of Plaintiff s employee or agent authorizing and/or requesting itsmailing d. Whether itsought documentation or information. If so,state: i. What specific documentation or information was being sought ii. Why the documentation or information was deemed necessary iii. Whether the documentation or information was received. If so,also state: 1. When itwas received 2. Which employee or employees of Plaintiff itwas forwarded to 3. What further steps Plaintiffüñdertook in response thereto 13. IfPlaintiff issued one or more denials or otherwise refused to pay any of Defendant's billsbased, in whole or oath" in part, upon the failure to attend one or more "exembetions under (EUO) by EIP, EIP's assignees, or any other person or entity (collectively, "Applient"), state for each scheduled EUO and for each Applicant who allegedly failed to appear: a. With respect to allcorrespondence relating to the EUO, whether or not purporting to schedule same, state for each correspondence: i. Whether itwas sent by Plaintiffor by one or more third-party vendor. If by a third-party vendor, also state: 1. Itsname and address 2. The nature and details of the business relationship existing between itand Plaintiff ii. Date of mailing -and an indication of how this date isknown to Plaintiff iii. Name and address of every person or entity to which itwas sent iv. The precise procedure followed for the creation and mailing of such correspondence, providing details camparable to what Plaintiff is disclosing in response to the within questions dealing with denials 6 7 of 19 FILED: NEW YORK COUNTY CLERK 10/25/2019 05:36 PM INDEX NO. 654092/2019 NYSCEF DOC. NO. 5 RECEIVED NYSCEF: 10/25/2019 v. Whether Plaintiff or Plaintiff'sagent(s) received reliable confirmation of delivery -and if so, precisely which confirmation b. In details,how Plaintiff or Plaintiffs agent(s) came to know that Applicant failed to appear c. Whether the EUO was scheduled to take place within 30 days after Plaintiff's receipt of a verification form. If so,state: i. Which verification form was received ! ii. When the verification form was received by Plaintiff iii. When the EUO was scheduled to take place d. Whether Piâintiff determined that an EUO would be reasonable under the specific circumstances of the case. If so,state in details: i. Names, addresses and relationship with Plaintiffof each person or entity that coñtributed in making the determination ii. The specific procedure adopted in making the determination e. In details, the objective standaitis relied upon by Plaintiffor Plaintiff s agent(s) in determining that an EUO would be necessary to establish proof of claim f. In details, the specific objective justification supporting the use of EUOs under the circumstances of the case g. Whether Plaintiff or Plaintiff's agent commtmicated with Applicant prior to the sheduling of the EUO. Ifso, also statein details for each communication: i. When, by whom, and by what means ittook place ii. The substance thereof h. In details, how Plaintiff or Plaintiff's agent(s) determined that the time and the location for the scheduled EUO would be convenient for Applicant 14. IfPlaintiff issued one or more denials or otherwise refused to pay any of Defendant's bills based, in whole or in part, upon one or more of the following: I) the results of Plaintiff's investigation(s); II) the allegation that material misrepresentations were made by EIP and/or Defendant and/or any other person involved in the accident underlying the within dispute; III)the allegation that the accident underlying theinstant dispute was an "intentional act"; IV) the allegation that the accident underlying the instant dispute did not "occur as claimed"; V) the allegation that EIP and/or any other person involved in the accident underlying the instant provisions" dispute and/or Defcñdañt "violated the fraud of Plaintiff's policy; VI) the allegation that "the alleged injuries did not arise out of a covered accident"; VII) the allegation thatE1P and/or Defendant and/or any other person involved in the accident underlying the within dispute failed to cooperate with Plaintiff during the course of Plaintiff's investigatioñ of the claims arising out of such accident; VIII) the allegation that Defendant failed to comply with any applicable licensing requirement; then state in details, to the extent not already disclosed in response to the within Notice for Discovery and Inspection. a. Who, when and how, made the ultimate determination, binding Plaintiff,that any or allof the above grounds would justify Plaintiff's refusal to pay Defendant's bills.For example, and not limited to the following, state: i. Whether a claim representative was involved in such determination 7 8 of 19 FILED: NEW YORK COUNTY CLERK 10/25/2019 05:36 PM INDEX NO. 654092/2019 NYSCEF DOC. NO. 5 RECEIVED NYSCEF: 10/25/2019 ii. Whether such deteiiiilñation was based on evideñce or reports collected or generated by Plaintiff's employees or agents. Ifso, also state: 1. Whether any discretionary review of such evidence or reports was involved -and, if so, by whom, how and when 2. Whether the person uldmately responsible for Plaintiff'sdetermination became acquainted with such evidence or reports -and, ifso, when, how, and under what circumstances b. For each person who participated, directly or indirectly, in any investigation affecting Defendant's bills: i. Name, address, and relationship with Plaintiff ii. Qualifications and experience iii. The relevant dates of thisperson's involvement with the investigation iv. In details,the factors thatprompted this person to initiatethe investigation v. The role covered in the investigation, including the weight that Plaintiff accorded to this person's observations or conclusions vi. In details, each observation or conclusion that this person reached in the course of the investigation vii. Whether this person, in the course of the investigation, was supposed to follow instructions, guidelines, directives, checklists, or any other criterion, liowever named or qualified. If so, also state: 1. In details, each of the criteria thatthis person followed 2. In details, who, when, where and how setthese critena viii. Whether Plaintiff deems this person's portion of the investigation complete. If so,also state: 1. When the investigation was deemed completed 2. What factors determined the end of the investigation ix. Whether this person worked alone or as part of a team. Ifpart of a team, also state: 1. Names, addresses and relationship with Plaintiff of each other acñiher of the team 2. This person's role within the team 3. Whether this person had a duty to report the progress of the investigation to any other individuals -and, if so, also provide information relating to these other individuals consistently with the foregoing "accident," c. If Plaintiff determined that the accident underlying theinstant dispute was not an or did claimed," occurrence," act," not "occur as or was "a staged or an "intentional collusive and for any other similar defense: i. Whether Plaintiff or its employees or agents visited the site of the accident. If so, also state for each such visit: 1. The date and precise location visited 8 9 of 19 FILED: NEW YORK COUNTY CLERK 10/25/2019 05:36 PM INDEX NO. 654092/2019 NYSCEF DOC. NO. 5 RECEIVED NYSCEF: 10/25/2019 2. Name of each person who was present, including each person's job title,qualificadens, investigatory role,and any other information thatwould justify this person's presence atthe site 3. The specific fmdings made at the site 4. Any other inferñ1stion or conclusion that Plaintiffdrew as a censequence of the visitto the site ii. For each person thatcontributed in making the dctcrmiñation about the accident 1. Name, relationship with Plaintiff, area of expertise, and any other relevant information on this person's educational and professional background 2. The information and evidence on which the person relied, including the source of such information and evidence iii. Whether Plaintiffhas an alteniative theory of how the accident took place. If so,also state: 1. The basis or bases on which Plaintiff elaborated this theory 2. For any discrepañcy between Plaintiff's theory and the manner in which E1P or Defendant allege the accident occurred a. Why the discrepancy ismaterial and relevant b. Whether Plaintiffbelieves that the discrepancy was intentional -and if so, why iv. when and for what reasons to Plaintiff- benefited from the Who, how, -according allegedly intentional accident d. For each statement obtained Plaintiff -whether oral or under oath or not- that affects by written, Defendant's bills. i. Who took the statement, when and where ii. Which part of the statement was used and relied upon by Plaintiff to substantiate Plaintiff's contentions iii. In details,to what extent and why Plaintiff determiñcd that the statement relied upon -or portion thereof- supports Plaintiff's contentions. For and not limited to the example, following, state: 1. Whether --and if on which basis- Plaintiff believes the statement to be so, false, misleading, deceitful, fraudulent or inaccurate 2. Whether Plaintiff believes that any alleged infirmness in the statement was deliberate or casual -and if so, on which basis 3. Whether Plaintiff believes that any alleged infirmness in the statescat was material to the point of affecting Plaintiff's bills--and on which basis e. For each alleged violation of Plaintiff'spolicy: i. The specific policy clause or clauses alleged to have been violated ii. The person or entity that violated the policy clause or clauses iii. The time, place, and other identifying clemcñt of the alleged violation iv. The materiality of the policy clause or clauses alleged to have been violated 9 10 of 19 FILED: NEW YORK COUNTY CLERK 10/25/2019 05:36 PM INDEX NO. 654092/2019 NYSCEF DOC. NO. 5 RECEIVED NYSCEF: 10/25/2019 v. Whether Plaintiff believes that the alleged violation was intentional -and, if so, on which basis vi. Whether Plaintiff received any explanation, justification or excuse for the alleged violation -and, ifso, the specifies thereof and by whom itwas proffered vii. Whether Plaintiff has in place any policy or procedure to review the determination that a policy violation occurred -and, ifso, the details thereof f. For each hetam of non-couperation alleged by Phintiff, and with respect to each person or entity alleged to have failed to cooperate: i. Name ii. Specific dates and circumstances of the alleged non-cooperation iii. Whether an obligation to cooperate existed upon the person or entity.If so: 1. Specify the extent and scope of the obligation 2. Specify the legal source ofthe obligation 3. Specify whether clear notice exists of the consequences of a failure to cooperate iv. Whether Plaintiff, itsemployees or agents, have a duty to take affirmative steps to secure cooperation. If so: 1. Specify the nature and extent of the duty and/or of the corresponding steps 2. whether -and if how- these steps were followed in thiscase Specify so, 3. Specify whether Plaintiffhas a policy obligation to offer one or more opportunities to correct any alleged failure to cooperate. Ifso, also state: a. The details of thispolicy obligation b. How many opportunities Plaintiff is supposed to offer, together with an explanation of who, when, where and how determined that this n=nber would generally be reasonable c. Whether such offer was extended in thiscase d. Whether either why- Plaintiff believes under the instant -and, way, that, circumstances, a deviation from such ordinary policy obligation should be warranted g. For each alleged violation of any licensing requirement: i. Name of each person and/or entity alleged to have committed the violation ii. Dates and cimumstances of each alleged violation iii. The legal source alleged to have been violated iv. The specific reasons why Plaintiff believes that the liceñsiñg requirements apply to the person and/or entity alleged to have violated them v. The specific reasons why Plaintiff believes that a violation of the applicable licensig requirements has taken place 10 11 of 19 FILED: NEW YORK COUNTY CLERK 10/25/2019 05:36 PM INDEX NO. 654092/2019 NYSCEF DOC. NO. 5 RECEIVED NYSCEF: 10/25/2019 vi. Dates and circumstances in which Plaintifffirst learned of the alleged violation vii. Specific steps üñdertaken by Plaintiff upon firstlearning of the alleged viviation viii. Whether Plaintiff sought clarifications by enmmunicating with the person and/or entity alleged to have committed the alleged violation. If so, also state: 1. Dates, names and circumstances of each such communicâtion 2. Substance of each communication 3. Whether --and, either way, why-Plaintiffdecñied satisfactory the clarifications obtaiñêd h. Any other information relating to Plaintiff's investigations, conelüsions, or fouñdaticüs of any evñelusion or belief,upon which Plaintiff will rely to anhatantiate any of itsdefciiscs at any stage of these proceedings PLEASE TAKE FURTHER NOTICE that a copy of the answers to these interrogatories must be served upon the undersigned within twenty (20) days hereof. ALSO TAKE NOTICE that, pursuant to CPLR 3101(h), your responses to these questinns MUST be amended or supplemcated when the circumstances are such that a failure to do so would be materially misleading. Dated: Brooklyn, NY October 23, 2019 KOPELEVICH & FELDSHEROVA, P.C. Attorneys for Defendant AK GLOBAL SUPPLY CORP. 37th 241 street, Suite B439 Brooklyn, NY 11232 718-332-0577 11 12 of 19 FILED: NEW YORK COUNTY CLERK 10/25/2019 05:36 PM INDEX NO. 654092/2019 NYSCEF DOC. NO. 5