XAVIER KING v. CITY OF NEW YORK et al, 150721/2024, 9 (N.Y. Sup. Ct., New York County May. 8, 2024) (2024)

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`FILED: NEW YORK COUNTY CLERK 05/08/2024 06:35 PM
`NYSCEF DOC. NO. 9
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`INDEX NO. 150721/2024
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`RECEIVED NYSCEF: 05/08/2024
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`1. Accident and/or incident report and attachments, if any.
`2. Custodian reports.
`3. Teacher(s) statements/reports.
`4. Witness statements.
`ALLEGED POLICE MISCONDUCT
`1. Any police reports in your possession.
`2. Arrest Report, Complaint report, follow-up reports and photographs.
`3. Certified copy of the disposition of any criminal proceedings.
`4. If entitlement to reimbursem*nt of legal fees is claimed, copies of any bills incurred.
`ALLEGED PROPERTY DAMAGE
`1. Photographs (duplicates, color or laser copies preferred) depicting the items alleged to have
`been damaged, prior and subsequent to the damage.
`2. Original purchase receipts, cancelled checks, and/or charge slips for the items alleged to
`have been damaged.
`3. Appraisals, warranties, etc.
`4. Copies of any insurance agreements pertaining to property damages and/or loss.
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`Please be advised that all of the above materials must be sent in order to have your case considered
`for possible early settlement - incomplete cases cannot be considered. Within 30 days after receipt
`of the above materials via email, you will be contacted to discuss the case further. Counsel
`appearing at the conference must have settlement authority and be prepared to establish liability
`and damages. If you have any questions, you may contact Nancy A. Goldbach directly by email to
`ngoldbac@law.nyc.gov.
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`Very truly yours,
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`Nancy A. Goldbach
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`FILED: NEW YORK COUNTY CLERK 05/08/2024 06:35 PM
`NYSCEF DOC. NO. 9
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`INDEX NO. 150721/2024
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`RECEIVED NYSCEF: 05/08/2024
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`HON. SYLVIA O. HINDS-RADIX
`Corporation Counsel
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`GREENBERG & STEIN, PC
`420 Lexington Avenue, Suite 2450
`New York, NY 10170
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`Dear Counselor:
`
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`The City of New York
`LAW DEPARTMENT
`Office of the Corporation Counsel
`Ethics and Compliance Division
`Medicare Compliance and Recovery Unit
`100 Church Street, 20th Floor
`New York, NY 10007-2668
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`medicare@law.nyc.gov
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`Re:
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`May 8, 2024
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`XAVIER KING v. CITY OF NEW YORK,
`MUHAMMAD AMIR, RYAN COFFARO and
`RYAN BARBER
`Law Dept. File No: 2024-010771
`
`We write to request that you provide us with certain personal identifying information about
`each plaintiff you represent in this lawsuit in order for us to determine whether they are a Medicare
`recipient(s). Specifically, we need each plaintiff’s date of birth, gender, and Social Security
`number or Health Insurance Claim Number (HICN), also known as the Medicare number. This
`information will be used by the Law Department to obtain plaintiff’s Medicare status via a database
`established by the Centers for Medicare & Medicaid Services ("CMS") for this purpose.1
`Information about a plaintiff’s Medicare status is required by the City in order to comply
`with federal Medicare laws. Self-insured liability entities (such as the City of New York) are
`considered “primary plans” under the Medicare laws and are, therefore, required to report to CMS
`all monetary recoveries obtained by Medicare-eligible plaintiffs in personal injury lawsuits. See
`Medicare Secondary Payer Act (MSPA) 42 U.S.C. 1395y(b)(8)(A)(i); Seger v. Tank Connection,
`LLC, 2010 U.S. Dist. LEXIS 49013 (D. Neb. Apr. 22, 2010) ) (“the Extension Act adds new
`mandatory reporting obligations to the Medicare Secondary Payer Act ("MSPA") requiring . . .
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`1 CMS has developed a "query process" under which a responsible reporting entity (RRE) (such as the City in this
`case) can determine a claimant's Medicare status electronically, as long as the RRE has access to the claimant's
`name, date of birth, gender and social security number. Seger v. Tank Connection, LLC, 2010 U.S. Dist. LEXIS
`49013 at *13 (D. Neb. Apr. 22, 2010).
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`FILED: NEW YORK COUNTY CLERK 05/08/2024 06:35 PM
`NYSCEF DOC. NO. 9
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`INDEX NO. 150721/2024
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`RECEIVED NYSCEF: 05/08/2024
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`self-insurers to provide detailed information regarding all liability settlements or open claims with
`ongoing responsibility for medical treatment with Medicare beneficiaries to the Centers for
`Medicare and Medicaid Services ("CMS")”). Torres v Visto Realty Corp., 2015 N.Y. App. Div.
`LEXIS 3216, 1-2 (1st Dep't 2015) (“plaintiff did not satisfy his obligations under CPLR 5003-a,
`since he failed to provide defendant with the information relating to his Medicare status that
`defendant requires to comply with its reporting obligations under 42 USC § 1395y”) (citations
`omitted); Bey v. City of New York, 2013 U.S. Dist. LEXIS 15597, at *5-6 (E.D.N.Y. Feb. 5, 2013)
`(same.). Thus, the City needs to ascertain plaintiff’s Medicare status for the purposes of satisfying
`its reporting obligations.
`Additionally, the City also requires the personal identifying information to resolve any
`outstanding Medicare claims before issuing payment on settlements. See MSPA, 42 U.S.C.
`1395y(b)(2)(B)(ii) (“a primary plan’s responsibility for such payment may be demonstrated by a
`judgment [or settlement] . . . for items or services included in a claim against the primary plan . .
`. .”); see also Torres v. Hirsch Park, LLC, 91 AD.3d 942 (2nd Dep’t 2012) (“the authorizations that
`the Supreme Court directed the plaintiff to provide are necessary for the defendant to comply with
`its statutory duty to report the identity of a claimant who is entitled to Medicare benefits (see 42
`USC 1395y[b][8]) and to determine the existence of potential subrogation claims [under federal
`law]”) (citations omitted); Liss v. Brigham Park Coop Apts., 264 A.D.2d 717 (2d Dep’t 1999)
`(because the Federal government has a right of action directly against the defendant for recovery
`of its lien, it was “incumbent upon plaintiff to resolve the lien and give the defendant a release.”)
`Indeed, the responsibility of assuring reimbursem*nt of Medicare claims extends to all
`entities involved in the underlying liability action, including the plaintiff’s counsel. CFR §
`411.24(g); United States v. Harris, 2009 U.S. Dist. LEXIS 23956 (N.D. W. Va. Mar. 26, 2009)
`(holding that plaintiff’s attorney is liable to Medicare for unpaid liens because he disbursed
`settlement funds in a liability case to his client without first reimbursing Medicare for its claims).
`Thus, it is to all parties’ benefit to ascertain a plaintiff’s Medicare status as early as possible so as
`to resolve any existing Medicare claims and facilitate payment of settlements.
`In view of the foregoing, we ask that you promptly submit to us the requested information.
`If you know for a fact that your client presently receives Medicare, you should immediately (1)
`notify Medicare of the pending lawsuit;2 (2) provide the Law Department with plaintiff’s Medicare
`identification number and/or social security number; (3) obtain conditional and final payment
`information from Medicare and (4) provide copies of any correspondences to the City. If future
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`2 If you have never notified Medicare about this injury claim before, the first step is to report the injury to the Benefits
`Coordination & Recovery Contractor (BCRC) at P.O. Box 138897, Oklahoma City, OK 73113-8897, or by telephone
`at 1-855-798-2627. A case identifier will be established, and you will then receive a correspondence from the
`BCRC concerning any conditional payments made by Medicare on your client’s behalf for the injuries underlying this
`case. BCRC is the agency that will issue final demand letters on amounts due Medicare. More detailed information
`concerning the foregoing procedures can be found at http://go.cms.gov/cobro by clicking on the links to the left of
`the screen entitled 'Non-Group Health Plan Recovery' and 'Reimbursing Medicare'. There is also a portal on this
`website, the Medicare Secondary Payer Recovery Portal (MSPRP) that allows registered users to access and update
`certain case-specific information online, including an electronic conditional payment letter. Please visit the website
`for information as how to register for this service.
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`FILED: NEW YORK COUNTY CLERK 05/08/2024 06:35 PM
`NYSCEF DOC. NO. 9
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`INDEX NO. 150721/2024
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`RECEIVED NYSCEF: 05/08/2024
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`medical care for plaintiff is anticipated, you may also need to consider a Medicare set-aside
`instrument for payment of future medical costs;3
`If plaintiff was insured under a Medicare Advantage Plan (“MAP”) under Part C of the
`Medicare Act at any time after the incident at issue here, plaintiff should notify the City about the
`MAP coverage, and also inform the MAP(s) of this lawsuit. Recent New York decisions have
`held that a MAP provider can pursue recovery of its reimbursem*nt and/or subrogation claims in
`the same manner as traditional Medicare. See Potts v. Rawlings Co., LLC, 897 F. Supp. 2d 185
`(S.D.N.Y. 2012); Trezza
`v Trezza,
`104 A.D.3d 37, 48
`(2d Dep't 2012)
` (“Based on the express preemption provision set forth in 42 USC § 1395w-26(b)(3), as well as
`the regulations set forth in 42 CFR 422.108(f), we hold that General Obligations Law § 5-335,
`insofar as applied to Medicare Advantage organizations under Part C, is preempted by federal law
`since it would impermissibly constrain contractual reimbursem*nt rights authorized under the
`"Organization as secondary payer" provisions of the Medicare Act.”). Moreover, several federal
`courts have ruled that a MAP provider can also bring a federal action to collect on its liens under
`42 U.S.C. § 1395y(b)(3)(A) - and can seek double damages thereunder. See In re Avandia Mktg.,
`685 F.3d 353, 360 (3d Cir. Pa. 2012); Collins v. Wellcare Healthcare Plans, Inc., 2014 U.S. Dist.
`LEXIS 174420 (E.D. La. Dec. 16, 2014). The City, therefore, will require resolution of any
`Medicare-related claims as a condition to any settlement in this matter, regardless whether the
`claims are asserted by the government under a traditional Medicare plan or by a MAP under a
`Medicare Part C.
`Thank you for your attention to the foregoing. Should you have any questions, feel free to
`contact the City’s Medicare Compliance Unit at medicare@law.nyc.gov.
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`PLEASE BE ADVISED THAT WE CANNOT FINALIZE ANY SETTLEMENT
`WITH A CURRENT MEDICARE RECIPIENT WITHOUT FIRST RESOLVING
`MEDICARE’S CLAIM.
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`Very truly yours,
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`Medicare Compliance Officer
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`Encl.
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`3 You should be aware that if CMS determines that Medicare's future interests were not adequately protected, CMS
`may require that plaintiff expend up to the entire amount of the settlement on Medicare-covered expenses related to
`the injury claimed in this lawsuit before Medicare will provide coverage for the further treatment of such injury. See
`Cribb v. Sulzer Metco (US) Inc., 2012 U.S. Dist. LEXIS 134900 (E.D.N.C. Sept. 5, 2012); Sipler v. Trans Am
`Trucking, Inc., 881 F. Supp. 2d 635, 638 (D.N.J. 2012). Accordingly, we suggest that plaintiff evaluate her future
`medical needs with her physicians and consider creating a Medicare set-aside instrument at the appropriate time.
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`FILED: NEW YORK COUNTY CLERK 05/08/2024 06:35 PM
`NYSCEF DOC. NO. 9
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`INDEX NO. 150721/2024
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`RECEIVED NYSCEF: 05/08/2024
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`HON. SYLVIA O. HINDS-RADIX
`Corporation Counsel
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`
`
`The City of New York
`LAW DEPARTMENT
`100 CHURCH STREET
`NEW YORK, NEW YORK 10007
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`GREENBERG & STEIN, PC
`420 Lexington Avenue, Suite 2450
`New York, NY 10170
`
`Re: XAVIER KING v. CITY OF NEW YORK, et al.
`County: New York Ct. Index No.: 150721/2024
`Our File No.: 2024-010771
`
`Dear Counselors:
`This office is unable to evaluate and review your client’s claims against THE CITY OF NEW
`YORK, RYAN COFFARO, ("CITY") without duly executed authorizations permitting the CITY to review
`records pertaining to your client’s arrest, incarceration, and or criminal proceedings. A review of the file
`in the above named action reveals that you have yet to provide said authorizations. In order to facilitate the
`discovery process, please provide this office with the following:
`• Duly executed authorization permitting the Office of the Corporation Counsel to examine
`and copy the records, transcripts and certificates of disposition of any criminal proceedings
`concerning the claims alleged in the complaint;
`• Duly executed authorization permitting the Office of the Corporation Counsel to examine
`and copy all records, created by, or in the possession of, the New York City Police
`Department, relating to the claims alleged in the complaint; and
`• Duly executed authorization permitting the Office of the Corporation Counsel to examine
`and copy all records, created by, or in the possession of, the District Attorney’s Office,
`relating to the claims alleged in the complaint.
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`May 8, 2024
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`Enclosed is a blank authorization for your convenience. Please copy and have your client complete
`a separate original authorization for the New York City Police Department, District Attorney’s Office, and
`the unsealing of related criminal court records and return them to the New York City Law Department, 100
`Church Street, New York, NY 10007 at your earliest convenience. NOTE: - For cases with more than one
`plaintiff please copy the blank authorization supplied herewith and return a separate set of completed
`authorizations for each plaintiff alleging other than only loss of consortium claims. Thank you for your
`anticipated cooperation.
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`Very truly yours,
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`HON. SYLVIA O. HINDS-RADIX
`Corporation Counsel
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`FILED: NEW YORK COUNTY CLERK 05/08/2024 06:35 PM
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`RECEIVED NYSCEF: 05/08/2024
`CONSENT AND AUTHORIZATION FOR RELEASE OF RECORDS SEALED BY
`LAW, INCLUDING RECORDS SEALED PURSUANT TO CRIMINAL PROCEDURE
`LAW § 160.50
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`INDEX NO. 150721/2024
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`Whereas, I, _____________________________________, residing at
`________________________________________________, date of birth: ________________, and
`Social Security # _______________, NYSID # _______________, having caused a notice of claim to be
`filed or commencing an action/lawsuit against THE CITY OF NEW YORK, RYAN COFFARO, ,
`demanding money damages for false arrest, false imprisonment, malicious prosecution, assault and
`battery, and/or other allegations, I hereby waive my statutory rights, for purposes of this
`claim/action/lawsuit, to keep sealed the records of my arrest on or about October 29, 2022 and
`prosecution, including all records maintained by law enforcement agencies, criminal courts, and/or
`district attorney’s office. If my case proceeded in the criminal courts, the docket # was
`_______________.
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`Whereas, it is necessary for the above named defendant(s) to have access to the aforementioned records
`of my arrest and any related criminal proceedings and incarceration in order to evaluate and review my
`claims, and prepare its defense thereto, I hereby authorize any and all governmental agencies, bodies and
`employees having custody of such records to release such records to the Office of the Comptroller or the
`Office of the Corporation Counsel of the City of New York, or its authorized agent or employee. I
`specifically authorize the New York City Police Department; New York County District Attorney’s
`Office; New York State Supreme Court, New York County, Criminal Term; and New York City Criminal
`Court to disclose any and all records in their possession relating to the aforementioned arrest/prosecution
`and docket number to the Office of the Corporation Counsel of the City of New York, or its authorized
`agent or employee.
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`____________________________________
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`Plaintiff/Claimant
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`Sworn to before me this ______ day of ____________, 20___
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`______________________________
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`NOTARY PUBLIC
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`FILED: NEW YORK COUNTY CLERK 05/08/2024 06:35 PM
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`INDEX NO. 150721/2024
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`SUPREME COURT OF THE STATE OF NEW YORK
`COUNTY OF NEW YORK
`-----------------------------------------------------------------
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`XAVIER KING,
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`x
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`Plaintiff(s),
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`-against-
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`CITY OF NEW YORK, MUHAMMAD AMIR, RYAN
`COFFARO AND RYAN BARBER,
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`-----------------------------------------------------------------
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`Defendant(s).
`x
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`AMENDED ANSWER
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`Index #: 150721/2024
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`Law Dept. #: 2024-010771
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`Defendants CITY OF NEW YORK, and RYAN COFFARO, by HON. SYLVIA
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`O. HINDS-RADIX, Corporation Counsel, answering the complaint, allege upon information and
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`belief:
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`1.
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`Deny each allegation set forth in paragraph(s) 1-3, 5, 13, 16-48, 50-54, 56,
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`58-63, 66-71, 73, 75, 78, 80, 82-85, 87-88, 90, 92-95, 98-104, 106, 109-115, 117, 119-124, 126,
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`128, 130, 132-134, 137-141, 143-149, inclusive.
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`2.
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`Deny knowledge or information sufficient to form a belief with respect to
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`the truth of the allegations set forth in paragraph(s) 8, 76-77, 97, 108, inclusive.
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`3.
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`Deny each allegation set forth in paragraph(s) 9-12, 14, 15, inclusive, except
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`that the City of New York is a municipal corporation which employed RYAN COFFARO, who
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`was acting within the scope of his employment, and maintains a Police Department pursuant to
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`law.
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`4.
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`Deny each allegation set forth in paragraph(s) 49, 57, 64, 74, 81, 86, 91, 96,
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`107, 118, 127, 131, 135, 142, inclusive, except as otherwise pleaded herein.
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`FILED: NEW YORK COUNTY CLERK 05/08/2024 06:35 PM
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`5.
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`Deny each allegation set forth in paragraph(s) designated 4, 6, 7, 55, 65, 72,
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`79, 89, 105, 116, 125, 129, 136, inclusive, as the same are conclusory and evidentiary and present
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`questions of law and fact which should be reserved for decision at the time of trial.
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`AFFIRMATIVE DEFENSE(S)
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`6.
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`Plaintiff(s)’ culpable conduct caused or contributed, in whole or in part, to
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`his/her/their injuries and or damages.
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`7.
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`At all times mentioned in the complaint, plaintiff(s) knew or should have
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`known in the exercise of due/reasonable care of the risks and dangers incident to engaging in the
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`activity alleged. Plaintiff(s) voluntarily performed and engaged in the alleged activity and
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`assumed the risk of the injuries and/or damages claimed. Plaintiff(s) failed to use all required,
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`proper, appropriate and reasonable safety devices and/or equipment and failed to take all proper,
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`appropriate and reasonable steps to assure his/her/their safety. Plaintiff(s)’ primary assumption of
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`risk solely caused his/her/their injuries and/or damage and defendant(s) owed no duty to the
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`plaintiff(s) with respect to the risk assumed. Plaintiff(s)’ express assumption of risk solely caused
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`his/her/their injuries and/or damage and defendant(s) owed no duty to the plaintiff(s) with respect
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`to the risk assumed. Plaintiff(s)’ implied assumption of risk caused or contributed, in whole or in
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`part to his/her/their injuries. In any action for injuries arising from the use of a vehicle in, or upon
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`which plaintiff(s) were riding; it will be claimed that the injuries and/or damages sustained were
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`caused by the failure of the plaintiff(s) to use available seat-belts and/or other safety devices.
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`8.
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`Defendants are immune from suit for their exercise of discretion in the
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`performance of a governmental function and/or their exercise of professional judgment.
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`9.
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`The amounts recoverable by plaintiff(s) are subject to limitation pursuant to
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`Section 1601 of the Civil Practice Law and Rules, by reason of the culpable conduct of other
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`person(s) who are, or with reasonable diligence could have been made party defendant(s) to this
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`action, or pursuant to Section 15-108 of the General Obligations Law, by reason of a prior
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`settlement between plaintiff(s) and said person(s), or pursuant to Section 4545 of the Civil Practice
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`Law and Rules are subject to reduction by collateral sources received by plaintiff(s), or by reason
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`of the fact that punitive damages are not recoverable against municipal defendant(s).
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`10.
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`If plaintiff demonstrates that the acts complained of were undertaken in the
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`scope of the actor(s) employment, then such acts as may have been committed by law enforcement
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`officers in the employ of the City of New York were justified as being reasonably necessary, and
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`were committed in good faith without malice and with probable cause based on legitimate
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`information and/or circ*mstances that linked plaintiff and unlawful activity, and in the exercise of
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`professional judgment or the performance of discretionary functions for which defendant(s) are
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`qualifiedly privileged under the laws of this State and of the United States, and were pursuant to
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`policies which did not contribute to a disparate impact. Individual defendant(s) represented by the
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`Office of the Corporation Counsel (if any) did not violate any clearly established constitutional or
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`statutory right of which a reasonable person would have known and therefore are/is protected by
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`qualified immunity.
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`11.
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`Such statements as were made concerning the plaintiff(s) were privileged
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`as being true, or fair comment upon matters of opinion, and were made in the good faith belief in
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`their truth without malice to person(s) having a like duty or interest therein.
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`12.
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`Plaintiff(s)’ complaint fails to allege a prima facie case against the
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`defendant answering hereby.
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`WHEREFORE, defendant(s) demand judgment dismissing the complaint and all
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`cross-claims against them, or, in the event that they are adjudged liable, granting judgment over,
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`or apportioning such liability in accordance with their equitable shares of responsibility, and
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`awarding the costs of this action, together with such other and further relief as to the court may
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`seem just.
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`HON. SYLVIA O. HINDS-RADIX
`Corporation Counsel
`100 Church Street
`New York, New York 10007
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`FILED: NEW YORK COUNTY CLERK 05/08/2024 06:35 PM
`NYSCEF DOC. NO. 9
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`INDEX NO. 150721/2024
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`RECEIVED NYSCEF: 05/08/2024
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`Index #: 150721/2024
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`SUPREME COURT OF THE STATE OF NEW YORK
`COUNTY OF NEW YORK
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`XAVIER KING,
`
`- against -
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`Plaintiff(s),
`
`CITY OF NEW YORK, MUHAMMAD AMIR, RYAN COFFARO AND
`RYAN BARBER,
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`Defendant(s).
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`COMBINED DEMAND FOR
`BILL OF PARTICULARS & DISCOVERY
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`HON. SYLVIA O. HINDS-RADIX
`Corporation Counsel
`Attorney for Defendants THE CITY OF NEW YORK, RYAN COFFARO, 100
`Church Street
`New York, New York 10007
`Telephone Numbers:
`
`Early Intervention Unit (settlements – all Boroughs)
`(212) 356-1665
`Pleadings Unit (212) 356-3235 (pleadings matters only)
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`All Other Matters (Inquire by county of venue)
`Bronx Office: (718) 503-5030 (EBT’s - 5045)
`Brooklyn Office: (718) 834-4600 (EBT’s - 4475)
`Manhattan Office: (212) 356-2725 (EBT's-2791)
`Queens Office: (718) 558-2100 (EBT's - 2105)
`Staten Island Office: (718) 876-3600 (EBT's-3603)
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`Please refer to the following Law Dept. #: 2024-010771
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`and indicate the County in which the action is pending in all papers,
`correspondence and other communications with respect thereto.
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`SUPREME COURT OF THE STATE OF NEW YORK
`COUNTY OF NEW YORK
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`x
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`INDEX NO. 150721/2024
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`RECEIVED NYSCEF: 05/08/2024
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`XAVIER KING,
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`-against-
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`
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`Plaintiff(s),
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`COMBINED DEMAND FOR
`VERIFIED BILL OF
`PARTICULARS & DISCOVERY
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`CITY OF NEW YORK, MUHAMMAD AMIR, RYAN
`COFFARO AND RYAN BARBER,
`
`------------------------------------------------------------------------
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`x
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`Defendant(s).
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`DEMAND FOR VERIFIED BILL OF PARTICULARS
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`PLEASE TAKE NOTICE that pursuant to CPLR 3041, plaintiff(s) is required within 30
`days following service of this demand to serve upon HON. SYLVIA O. HINDS-RADIX, Corporation Counsel,
`a verified bill of particulars setting forth in reasonable detail a statement of the following:
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`1. The exact date and time of the act or occurrence.
`2. The specific location of the act or occurrence with reference to addresses, landmarks, or
`other identifying points of reference, including the direction and distance therefrom. If the occurrence took
`place inside a premise, state specifically the location within the premise and also include the block and lot of
`the premises.
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`3. State the injuries claimed, if any.
`4. State those injuries claimed to be permanent.
`5. If applicable, set forth the length of time it is alleged the plaintiff(s) was confined to:
`(a) Hospital(s);
`(b) Bed;
`(c) House.
`6. If applicable, set forth the amount claimed as special damages for:
`(a) Physician(s) services;
`(b) Nurses services;
`(c) Hospital expenses;
`(d) Drugs and medical supplies;
`(e) X-rays and diagnostic tests.
`For each of the foregoing elements of damages please state the name and address(es) of the
`provider(s) and the dates of treatment. If any of the foregoing elements of damages have been repaid to the
`plaintiff(s) or otherwise paid for by other sources, identify each type of service recompensed, the source or
`sources of such recompense, the amount so paid and the net amount of out of pocket expenses sustained by the
`plaintiff(s).
`
`7. If applicable, state the total amount of all other special damages not specified in items
`above; and please state the
`(a) name and address of each service provider;
`(b) each date of the service;
`(c) amount of the expense for each provider;
`(d) amount of any expense paid by a third-party (including any payment made to
`reimburse plaintiff);
`(e) name and address of the third-party paying any expense; and
`(f) amount of any unreimbursed expense paid by plaintiff(s) personally to each
`provider.
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`8. State the occupation of plaintiff(s) at the time of the incident; and please state the:
`(a) name and address of any employer for 5 years prior to alleged incident and up to
`the time of trial;
`length of time totally disabled from work;
`(b)
`length of time partially disabled from work;
`(c)
`(d) amount claimed for lost earnings, if any;
`i. if a loss of earnings claim is alleged, please state the yearly gross earnings for
`each year during 5 years prior to alleged incident and up to the time of trial;
`and
`(e) number of days absent from work as a result of injuries sustained from the
`incident.
`9. State the (a) name and address of any school attended by plaintiff(s) for 5 years prior to
`alleged incident and up to the time of trial; and (b) the number of days lost from school as a result of injuries
`sustained from incident.
`10. State the home address of plaintiff(s) for a period of 5 years prior to the alleged incident
`
`to the present.
`
`11. State any other name used by plaintiff(s) and the time period when the name was used.
`12. State the date of birth and social security number of plaintiff(s) (this request is made
`pursuant to Section 111 of the Medicare, Medicaid and SCHIP Extension Act of 2007, 42 U.S.C. §1395
`(B)(8)).
`
`13. State whether plaintiff(s) is (are) or ever was (were) a Medicare recipient(s). If plaintiff
`is (are) or ever was (were) a Medicare recipient, provide their Medicare Beneficiary Identifier (MBI)
`number and respond to the following:.
`a. State whether plaintiff(s) is (are) or ever was (were) enrolled in any Medicare
`Advantage Plan (MAP) also known as Medicare Part C. If Plaintiff is or was
`enrolled in a MAP, please provide the policy/plan number and effective date(s)
`of coverage along with copies of any insurance cards since the date of
`accident/incident and all Explanation of Benefits (EOB) statements related to the
`subject accident/incident;
`b. State whether plaintiff (s) is (are) or was (were) enrolled in a Prescription Drug
`Plan (PDP) also known as Medicare Part D. If Plaintiff is or was enrolled in a
`PDP, please provide the policy/plan number and effective date(s) of coverage
`along with copies of any insurance cards since the date of accident/incident and
`all Explanation of Benefits (EOB) statements related to the subject
`accident/incident;
`14. State whether plaintiff(s) is (are) or ever was (were) a Medicaid recipient(s). If plaintiff
`is or was a Medicaid recipient please provide the following:.
`a. Plaintiff’s Client Identification Number (CIN);
`b. A copy of any and all Medicaid Identification cards;
` A copy of the Notice that was provided to HRA pursuant to CPLR§306-c and
`c.
`filed with the Court.
`15. Please state whether plaintiff(s) is (are) or ever was (were) receiving Social Disability
`Income (SSDI) and to/from dates that benefits were received and amount of said benefits.
`16. If plaintiff(s) has (have) ever been convicted of a crime (including any guilty plea),
`please state (a) the NYSID number of plaintiff; (b) the dates of every conviction; (c) whether the conviction
`was state or federal; and (d) the county where each conviction occurred.
`17. If the complaint alleges loss of services, set forth the pecuniary loss, if any, alleged in the
`complaint. Enumerate the damages for:
`(a) Loss of services;
`(b) Consortium;
`(c) Other expenses.
`18. State those injuries arising from the use or operation of a motor vehicle which are
`claimed to be serious, as defined in Insurance Law § 5102 (d), if any.
`19. If property damage is claimed, please state (a) all property damaged; (b) the fair market
`value of each item at the time it was damaged; (c) the cost of repairing each item; (d) the cost of replacing
`each item; (e) the date each item was acquired; (f) the purchase cost of each item; (g) the amount(s) provided
`
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`by a third-party to reimburse damage; (h) the name and address of any third-party which reimbursed damage;
`and (i) amount of any unreimbursed payment made by plaintiff(s) to replace or repair a damaged item.
`20. State the manner in which it is claimed the accident occurred.
`21. State separately the acts or omissions constituting the alleged negligence of each of the
`answering defendant(s), if any.
`22. State separately the acts of each of the answering defendant(s) constituting the
`intentional wrongs claimed, if any.
`23. State the names of the employee(s) or agents of the answering defendant(s) who are
`alleged to ha