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`HYDERALLY & ASSOCIATES,P.C.
`33 PLYMOUTH STREET, SUITE 202
`MONTCLAIR, NEW JERSEY 07042
`TELEPHONE (973) 509-8500
`FACSIMILE (973)509-8501
`Attorneys for Plaintiff, Michelle Ferreira
`
`Exhibit A
`
`Came To Hand: ~ 14ALE
`petivered:
`YU.& jd0ay
`
`
`MICHELLE FERREIRA,
`
`PLAINTIFF,
`
`VS.
`
`
`
`
`
`
`
`SALVASEN HEALTH, BLACKHAWK
`CLAIMS SERVICES, JOHN DOES1-10,
`AND XYZ CORPS.1-10,
`
`DEFENDANTS.
`
`SUPERIOR COURT OF NEW JERSEY
`LAW DIVISION: HUDSON COUNTY
`DOCKET NO.: HUD-L-1103-22
`
`CIVIL ACTION
`
`SUMMONS
`
`BLACKHAWKCLAIMS SERVICES
`
`From The State of New Jersey To The Defendant(s) Named Above:
`
`Theplaintiff, named above, has filed a lawsuit against you in the Superior Court of New Jersey. The
`complaintattachedto this summonsstates the basis for this lawsuit. Ifyou dispute this complaint, you or your
`attorney mustfile a written answeror motion andproofofservice with the deputy clerk ofthe Superior Court
`in the county listed above within 35 days from the date youreceived this summons, not counting the date you
`received it. (The address of each deputy clerk of the Superior Court is provided.) If the complaintis one in
`foreclosure, then you mustfile your written answer or motion and proof of service with the Clerk of the
`Superior Court, HughesJustice Complex, P.O. Box 971, Trenton, NJ 08625-0971. A filing fee payable to the
`Treasurer, State ofNew Jersey and a completed Case Information Statement(available from the deputy clerk
`ofthe Superior Court) must accompany your answer or motion whenit is filed. You mustalso send a copy of
`your answer or motion to plaintiff's attorney whose name and address appear above,orto plaintiff, if no
`attorney is named above. A telephonecall will not protect your rights; you mustfile and serve a written
`answer or motion(with fee of $175.00 and completed Case Information Statement) ifyou wantthe court to
`hear your defense.
`
`Ifyou do notfile and serve a written answer or motion within 35 days, the court may enter ajudgment against
`you for the relief plaintiff demands, plus interest and costs ofsuit. Ifjudgmentis entered against you, the
`Sheriff may seize your money, wages or property to payall or part of the judgment.
`
`If you cannotafford an attorney, you maycall the Legal Services office in the county where you live or the
`Legal Services of New Jersey Statewide Hotline at 1-888-LSNJ-LAW (1-888-576-5529). A list of these
`offices is provided. If you do not have an attorney andare noteligible for free legal assistance, you may
`
`

`

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`obtain a referral to an attorneybycalling one of the Lawyer Referral Services. A list of these numbersis also
`provided.
`
`Michelle M. Smith, Esq.
`Michelle M. Smith, Esq.,
`Clerk of the Superior Court
`
`DATED: April 4, 2022
`
`Nameof Defendant to be served:
`
`BLACKHAWK CLAIMS SERVICES
`
`
`Address of the Defendant to be served:
`
`11111 Richmond Avenue
`Suite 215
`Houston, TX 77082
`
`Phone Number:
`
`T:\Ferreira Michelle and Calisto Pedro\Pleadings\040422.FILED SUMS Blackhawk.doc
`
`

`

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`HYDERALLY & ASSOCIATES,P.C.
`33 PLYMOUTH STREET,SUITE 202
`MONTCLAIR, NEW JERSEY 07042
`TELEPHONE(973) 509-8500
`FACSIMILE (973)509-8501
`Attorneysfor Plaintiff, Michelle Ferreira
`
`
`MICHELLE FERRE— SUPERIOR COURT OF NEW JERSEY
`PLAINTIEF,
`LAW DIVISION: HUDSON COUNTY
`
`
`VS.
`CIVIL ACTION
`
`SALVASEN HEALTH, BLACKHAWK
`COMPLAINT AND JURY DEMAND
`CLAIMS SERVICES, JOHN DOES1-10,
`AND XYZ CORPS. 1-10,
`
`Plaintiff, Michelle Ferreira (“Ferreira” or “Plaintiff’), who resides at 361 Highland
`Avenue, Kearny, New Jersey, 07032, Hudson County, by way ofthis Complaint against the
`Defendants, Salvasen Health, Blackhawk Claims Services, John Does 1-10, and XYZ Corps.1-10
`
`DEFENDANTS.
`
`(hereinafter collectively “Defendants”) hereby says:
`
`1.
`
`2;
`
`3.
`
`I. Nature of Action, Jurisdiction, and Venue
`This is an action seeking equitable and legal relief for: (1) breach of express contract; (2)
`breach of implied covenantof goodfaith and fair dealing; (3) breach of implied contract;
`(4) fraud; (5) fraudulent inducement; (6) detrimental reliance; and (7) a violation of the
`New Jersey Consumer Fraud Act, N.J.S.A. 56:8 et seq.
`Under Rule 4:4-4, this court has specific jurisdiction due to Defendants’ contacts with New
`Jersey, the nature of the action and the amount in controversy. Additionally, Plaintiff has
`satisfied all prerequisites, and exhausted administrative remedies, prior to bringing these
`
`claims.
`Venueis appropriate in thatthe illegal and improperacts which are the basis for the within
`asserted cause(s) of action occurred within the State ofNew Jersey, and the Defendantsin
`
`1
`
`

`

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`this matter are the entities or organizations located within the State of Texas doing business
`
`in New Jersey undercolor of law.
`
`II. Parties
`
`Ferreira was a memberof Defendants’ health insurance plan.
`
`Defendant, Salvasen Health (“Salvasen”), has its corporate office located at 10713 West
`
`Sam Houston North, Suite 100, Houston, TX 77064.
`
`Defendant, Blackhawk Claims Services (“Blackhawk”), hasits corporate office located at
`
`11111 Richmond Avenue,Suite 215, Houston, TX 77082.
`
`Duringthe relevant time period, JOHN DOES1-10 are currently unknown employees who
`aided and/orabetted in the commission of conduct complained ofherein and/or whoeither
`
`acted within the scope of their employmentat the workplace during working hours,or, to
`the extent they went beyondthe scope of their employment, defendants ratified, embraced
`and addedto this conduct. As the parties engage in discovery,plaintiff retains the right to
`
`amend the Complaint to add these individual employees by name.
`During the relevant time period, XYZ Corps. 1-10 are unknown affiliated corporationsor
`entities or other corporations who haveliability for the claims set forth herein. As the
`parties engage in discovery,plaintiff retains the right to amend the Complaintto add these
`individual entities by name.
`Thus,all defendants are subject to suit underthe statutes alleged above.
`Atall times referred to in this Complaint, employees ofthe corporate defendants, whoare
`referred to herein, were acting within the scope of their employment at the workplace
`during working hours, or,
`to the extent that they were not so acting, the corporate
`defendants ratified, embraced and addedto their conduct.
`
`III. Factual Allegations
`Defendants are in the business of providing healthcare insurance to residents located in
`
`New Jersey.
`Defendants purposefully engage in business in New Jersey to provide health care coverage
`so that New Jerseyresidents can treat with medical providers in New Jersey.
`In or about April, 2020, Ferreira contacted Defendants to inquire about obtaining individual
`health insurance in New Jersey.
`
`10.
`
`11.
`
`12.
`
`13.
`
`

`

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`14.
`
`Defendants advised that they were legally authorized to provide healthcare insurance to
`
`New Jersey residents to cover healthcare services in New Jersey.
`
`15.
`
`Thus, Ferreira went forward with signing paperwork with Defendants to obtain healthcare
`
`insurance in New Jersey.
`
`16.
`
`On or about April 24, 2020, Ferreira received confirmation of coverage via a debit from
`her bank account in New Jersey from Defendants in the amount of $398.45.
`
`17.
`
`Sometimeafter April 24, 2020, Ferreira called Defendants and spoke with a customersales
`
`representative who confirmedthat Ferreira’s New Jersey healthcare coverage waseffective
`
`as of May 1, 2020.
`
`18.
`
`Defendants then sent Ferreira a New Jersey insurance card, with an effective date of May
`
`1, 2020.
`
`19.
`
`Defendants then began debiting Ferreira’s New Jersey account biweekly, for $105.45 and
`
`$168.00 alternately.
`
`20.
`
`21.
`
`22.
`
`23.
`
`24.
`
`25.
`
`26.
`
`27.
`
`28.
`
`29.
`
`30.
`
`31.
`
`This pattern of charges continued until October 27, 2020.
`Beginning in or around October26, 2020, based on Defendants’ representation of coverage
`in New Jersey, Ferreira began seeing medical providers in New Jersey.
`Ferreira treated with ZOV Medical from October, 2020 until May, 2021. (Exhibit “1”).
`
`Ferreira treated with Larry Shemen, MD,PC, in November, 2020. (Exhibit “2”).
`Ferreira treated with Brian Herschorn, MD in November, 2020. (Exhibit “3”).
`On November 30, 2020, Ferreira modified her coverage to include her spouse, Pedro
`
`Calisto (“Calisto”).
`From November 30, 2020 through February 26, 2021, Ferreira was debited $459.00
`
`monthly.
`Ferreira wastreated at Lenox Hill Hospital on November6, 2020. (Exhibit “4”).
`Ferreira treated with The Dermatology Group in February, 2021 and March, 2021. (Exhibit
`
`“5"”),
`Ferreira treated with Barnabas Health Multispecialty in February, 2021. (Exhibit “6”).
`Calisto treated with Summit Medical Group, PA in March, 2021. (Exhibit“7”’).
`
`Calisto underwent surgery in August, 2021.
`
`

`

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`32.
`
`In or about June, 2021, Ferreira called Defendants, explaining that she wasreceivingbills
`
`from five providers whose claims were denied.
`
`33.
`
`Ferreira explained further that all the providers had verified insurance coverage prior to
`
`34.
`
`35.
`
`36.
`
`37.
`
`38.
`
`39.
`
`40.
`
`4l,
`
`42.
`
`43.
`
`4A,
`
`45.
`
`46.
`
`47.
`
`48.
`
`49.
`
`rendering services and had gotten confirmation that Ferreira and her spouse were covered.
`
`Defendants stated that they dropped Ferreira from their coverage in March, 2021.
`
`Ferreira was shocked and asked why, but Defendants refused to provide an explanation.
`
`Instead, Defendants offered to refund premiumsfor four months.
`
`Ferreira protested that she did not want to be dropped.
`
`Onor about July 23, 2021, Ferreira received a refund totaling $1,128.00.
`
`On September 29, 2021, Ferreira called and emailed Defendants asking for a summary of
`
`plan documents. (Exhibit “8”).
`Defendants responded on September 30, 2021, asking Ferreira to call a phone number
`
`provided.
`
`Ferreira called the provided number but got no answer.
`Ferreira followed up with an email to Defendants on October 13, 2021, explaining her
`difficulty in reaching Defendantdespite using the phone number Defendant provided her
`to contact them. (Exhibit “9”).
`On or about October 15, 2021, Ferreira received information from Defendants that it
`
`processed a claim with an October 26, 2020 dateofservice.
`Shortly after October 15, 2021, Ferreira received information from Defendants that it
`processed a claim with a February 13, 2021 date of service.
`Noother claims were paid by Defendants.
`Ferreira has tens of thousands of dollars in unpaid medical bills for services that were
`
`preapproved by Defendants.
`Ferreira has had to paycertain bills out of pocket.
`Ferreira is still receiving bills for services rendered while she was supposed to have had
`
`coverage through Defendants.
`Further, Ferreira has been requiredto retain an attorneyto assist her in asserting her claims
`
`and protecting herrights.
`
`

`

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`50.
`
`51.
`
`32.
`
`53.
`
`54.
`
`55.
`
`56.
`
`57.
`
`Count I
`(Breach of Express Contract)
`Plaintiff realleges and incorporates herein the paragraphsset forth in this Complaint.
`Defendants had various contractual obligations contained in the plan description,
`
`preauthorizations of services, and related documents.
`
`Defendants violated these and other contracts.
`
`The actions of Defendants giverise to the claim of breach of express contract.
`
`Further, Plaintiff suffered other damages to include but not be limited to a significant
`
`damage to hercredit rating, shame, embarrassment,interruption of medicalservices,etc.
`Plaintiff has lost wages in taking time to try to resolve this matter.
`Asa direct and proximateresult of the actions of defendants, Plaintiff has suffered mental
`anguish, physical discomfort, pain and suffering, shame and embarrassment, emotional
`distress injuries, the physical manifestation of emotional distress injuries and/or physical
`injury. Moreover, Plaintiffhas and/or may have to incur expenses for medical, psychiatric,
`and/or psychological counseling and care. Plaintiff's damages have been experienced in
`the past, and they will continueinto the future.
`Further, Plaintiff has been required to retain an attorney to assist Plaintiff in asserting
`Plaintiff's claims and protecting Plaintiff's rights.
`
`CountIT
`(Breach of the Implied Covenant of Good Faith and Fair Dealing)
`Plaintiff realleges and incorporates herein the paragraphsset forth in this Complaint.
`The actions of Defendantsgiverise to the claim of breach of the implied covenantof good
`
`58.
`
`59.
`
`60.
`
`61.
`
`62.
`
`faith and fair dealing.
`Further, Plaintiff suffered other damages to include but not be limited to a significant
`damageto hercredit rating, shame, embarrassment, interruption of medical services,etc.
`Plaintiff has lost wages in taking time to try to resolve this matter.
`Asa direct and proximate result of the actions of defendants, Plaintiff has suffered mental
`anguish, physical discomfort, pain and suffering, shame and embarrassment, emotional
`distress injuries, the physical manifestation of emotional distress injuries and/or physical
`injury. Moreover, Plaintiffhas and/or may haveto incur expenses for medical, psychiatric,
`
`

`

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`and/or psychological counseling and care. Plaintiff's damages have been experienced in
`the past, and they will continue into the future.
`Further, Plaintiff has been required to retain an attorney to assist Plaintiff in asserting
`
`63.
`
`Plaintiff's claims and protecting plaintiff's rights.
`
`CountIll
`(Breach of Implied Contract)
`Plaintiff realleges and incorporates herein the paragraphsset forth in this Complaint.
`
`64.
`
`65.
`
`66.
`
`67.
`
`68.
`
`69.
`
`70.
`
`71.
`
`72.
`
`73.
`
`74.
`
`75.
`
`Defendants made various oral agreements and representations to Plaintiff.
`
`Defendants violated these and other oral representations.
`
`The actions of Defendants giverise to the claim of breach of implied contract.
`Further, Plaintiff suffered other damages to include but not be limited to a significant
`damageto her credit rating, shame, embarrassment, interruption of medical services,etc.
`
`Plaintiffhas lost wages in taking timeto try to resolve this matter.
`As a direct and proximate result of the actions of defendants, Plaintiff has suffered mental
`anguish, physical discomfort, pain and suffering, shame and embarrassment, emotional
`distress injuries, the physical manifestation of emotional distress injuries and/or physical
`injury. Furthermore, Plaintiffhas suffered lost wages, a diminished ability to earn a living,
`and a diminished capacity to enjoyplaintiff's life. Moreover, Plaintiffhas and/or may have
`to incur expenses for medical, psychiatric, and/or psychological counseling and care.
`Plaintiff's damages have been experienced in the past, and they will continue into the
`
`future.
`Further, Plaintiff has been required to retain an attorney to assist Plaintiff in asserting
`
`Plaintiff's claims and protecting Plaintiffs rights.
`
`Count IV
`(Fraudulent Inducement)
`Plaintiff realleges and incorporates herein the paragraphsset forth in this Complaint.
`Defendants fraudulently advised Plaintiff that they were an authorized health care provider
`properly licensed to provide health care coverage in New Jersey.
`At the time Defendants made such fraudulent representations, Defendants were well aware
`
`they werefalse.
`Defendants made such fraudulentrepresentations to induce Plaintiff to pay them money.
`
`6
`
`

`

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`76.
`
`Plaintiff detrimentally relied upon Defendants’ false representations and paid Defendants
`
`moneyfor the purpose of obtaining health care coverage.
`Plaintiff then further detrimentally relied upon Defendants’
`
`77.
`
`false and fraudulent
`
`representations when she subsequently sought medical treatment and provided Defendants’
`healthcare card to represent that she had healthcare insurance.
`
`78.
`
`Dueto the fact that Defendants’ representations were false, Plaintiff has been harmed by
`
`healthcare providers sending her collections notices and damaginghercredit rating score.
`
`79.
`
`80.
`
`81.
`
`82.
`
`83.
`
`84.
`
`85.
`
`86.
`
`87.
`
`88.
`
`Such damagehas occurred in the past and continuesinto the future.
`
`The actions of Defendantsgive rise to the claim of fraudulent inducement.
`
`Further, Plaintiff suffered other damages to include but not be limited to a significant
`
`damageto hercredit rating, shame, embarrassment, interruption of medical services,etc.
`Plaintiff has lost wages in taking timetotry to resolve this matter.
`As a direct and proximate result of the actions of defendants, Plaintiff has suffered mental
`anguish, physical discomfort, pain and suffering, shame and embarrassment, emotional
`distress injuries, the physical manifestation of emotionaldistress injuries and/or physical
`injury. Furthermore, Plaintiff has suffered lost wages, a diminishedability to earn a living,
`and a diminished capacity to enjoyplaintiff's life. Moreover, Plaintiffhas and/or may have
`to incur expenses for medical, psychiatric, and/or psychological counseling and care.
`Plaintiff's damages have been experienced in the past, and they will continue into the
`
`future.
`
`Further, Plaintiff has been required to retain an attorney to assist Plaintiff in asserting
`Plaintiff's claims and protecting Plaintiff's rights.
`
`Count V
`(Fraud)
`Plaintiff realleges and incorporates herein the paragraphsset forth in this Complaint.
`Defendants fraudulently advised Plaintiff that they were an authorized health care provider
`
`properly licensed to provide health care coverage in New Jersey.
`At the time Defendants made such fraudulent representations, Defendants were well aware
`
`they werefalse.
`Defendants made such fraudulent representations to induce Plaintiff to pay them money.
`
`

`

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`89.
`
`Plaintiff detrimentally relied upon Defendants’ false representations and paid Defendants
`
`90.
`
`moneyfor the purpose of obtaining health care coverage.
`Plaintiff then further detrimentally relied upon Defendants’
`false and fraudulent
`representations whenshe subsequently sought medical treatment and provided Defendants’
`healthcare card to represent that she had healthcare insurance.
`
`91.
`
`Due to the fact that Defendants’ representations were false, Plaintiff has been harmed by
`healthcare providers sending her collections notices and damaginghercredit rating score.
`Such damagehas occurred in the past and continues into the future.
`Further, Plaintiff suffered other damages to include but not be limited to a significant
`damageto her credit rating, shame, embarrassment, interruption of medical services,etc.
`Plaintiff has lost wages in taking timeto try to resolve this matter.
`As a direct and proximate result of the actions of defendants, Plaintiff has suffered mental
`anguish, physical discomfort, pain and suffering, shame and embarrassment, emotional
`distress injuries, the physical manifestation of emotional distress injuries and/or physical
`injury. Furthermore,Plaintiff has suffered lost wages, a diminished ability to earnaliving,
`and a diminished capacity to enjoy plaintiff's life. Moreover, Plaintiffhas and/or may have
`to incur expenses for medical, psychiatric, and/or psychological counseling and care.
`Plaintiff's damages have been experienced in the past, and they will continue into the
`
`92.
`
`93.
`
`94.
`
`95.
`
`96.
`
`future.
`Further, Plaintiff has been required to retain an attorney to assist Plaintiff in asserting
`Plaintiff's claims and protecting Plaintiffs rights.
`
`CountVI
`(Detrimental Reliance)
`Plaintiff realleges and incorporates herein the paragraphsset forth in this Complaint.
`Defendants fraudulently advised Plaintiff that they were an authorized health care provider
`properly licensed to provide health care coverage in New Jersey.
`At the time Defendants made such fraudulent representations, Defendants were well aware
`
`97.
`
`98.
`
`99.
`
`they were false.
`Defendants made such fraudulentrepresentations to induce Plaintiff to pay them money.
`
`100.
`
`

`

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`101.
`
`Plaintiff detrimentally relied upon Defendants’ false representations and paid Defendants
`
`moneyfor the purpose of obtaining health care coverage.
`Plaintiff then further detrimentally relied upon Defendants’
`
`102.
`
`false and fraudulent
`
`representations when she subsequently sought medical treatment and provided Defendants’
`
`healthcare card to represent that she had healthcare insurance.
`
`103.
`
`Dueto the fact that Defendants’ representations were false, Plaintiff has been harmed by
`
`healthcare providers sending her collections notices and damaginghercredit rating score.
`
`104.
`
`105.
`
`106.
`
`107.
`
`108.
`
`109.
`
`110.
`
`111.
`
`112.
`
`Such damage has occurredin the past and continuesinto the future.
`
`Further, Plaintiff suffered other damages to include but not be limited to a significant
`damageto her credit rating, shame, embarrassment, interruption of medicalservices,etc.
`Plaintiff has lost wages in taking time to try to resolve this matter.
`As a direct and proximateresult of the actions of defendants, Plaintiff has suffered mental
`anguish, physical discomfort, pain and suffering, shame and embarrassment, emotional
`distress injuries, the physical manifestation of emotionaldistress injuries and/or physical
`injury. Furthermore,Plaintiff has suffered lost wages, a diminishedability to earn a living,
`and a diminished capacity to enjoy plaintiff's life. Moreover, Plaintiffhas and/or may have
`to incur expenses for medical, psychiatric, and/or psychological counseling and care.
`Plaintiff's damages have been experienced in the past, and they will continueinto the
`
`future.
`Further, Plaintiff has been required to retain an attorney to assist Plaintiff in asserting
`Plaintiff's claims and protecting Plaintiffs rights.
`
`Count VII
`(ConsumerFraudAct, N.J.S.A. 56:8 ef seq.)
`Plaintiff realleges and incorporates herein the paragraphsset forth in this Complaint.
`Defendants fraudulently advised Plaintiffthat they were an authorized health care provider
`properly licensed to provide health care coverage in New Jersey.
`At the time Defendants made such fraudulent representations, Defendants were well aware
`
`they werefalse.
`Defendants made such fraudulentrepresentations to induce Plaintiff to pay them money.
`
`

`

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`113.
`
`Plaintiff detrimentally relied upon Defendants’ false representations and paid Defendants
`
`moneyfor the purposeof obtaining health care coverage.
`
`114.
`
`Plaintiff then further detrimentally relied upon Defendants’
`
`false and fraudulent
`
`representations when she subsequently sought medical treatment and provided Defendants’
`
`healthcare card to represent that she had healthcare insurance.
`
`115.
`
`Dueto the fact that Defendants’ representations were false, Plaintiff has been harmed by
`
`healthcare providers sending her collections notices and damaging hercredit rating score.
`
`116.
`
`117.
`
`Such damage has occurredin the past and continuesinto the future.
`
`Thus, Defendants engaged in consumer fraud in that they engaged in an unconscionable
`
`commercial practice, deception, fraud, false pretense, false promise or misrepresentation
`
`in connection with the sale of goodsor services.
`
`118.
`
`Defendants sold such services, offered to sell such services, and attempted to sell such
`
`services.
`
`119.
`
`Defendants
`
`engaged in consumer
`
`fraud when they made
`
`an (1)
`
`affirmative
`
`misrepresentation;
`
`(2) a knowing omission; or (3) a violation of specific consumer
`
`120.
`
`protection.
`Defendants made an affirmative misrepresentation of fraud when they made an untrue
`statement, regardless of whether the person or business making the statement knew thatit
`
`was untrueat the time it is made.
`
`121.
`
`Further, Defendants engaged in a knowing omission consumer fraud when they knowingly
`
`concealed, suppressed or omitted a materialfact.
`The material fact Defendant omitted was the fact that they were not properly licensed to
`
`122.
`
`conduct business in New Jersey and that they were not actually providing bonafide health
`
`coverageto Plaintiff.
`
`123.
`
`124.
`
`125.
`
`126.
`
`Plaintiff suffered an ascertainable loss as noted abovethatis calculated above.
`
`Further, Plaintiff suffered other damages to include but not be limited to a significant
`damageto hercredit rating, shame, embarrassment, interruption of medical services, etc.
`Plaintiff has lost wages in taking time to try to resolve this matter.
`As a direct and proximateresult of the actions of defendants, Plaintiff has suffered mental
`anguish, physical discomfort, pain and suffering, shame and embarrassment, emotional
`10
`
`

`

`Case 2:22-cv-02648 Document 1-1 Filed 05/05/22 Page 13 of 35 PageID: 19
`Case 2:22-cv-02648 “Document 1-1~ Filed 65/05/22 Page 13of35 PagélD:19
`
`distress injuries, the physical manifestation of emotional distress injuries and/or physical
`injury. Furthermore, Plaintiffhas suffered lost wages, a diminishedability to earn a living,
`and a diminished capacity to enjoyplaintiff's life. Moreover, Plaintiffhas and/or may have
`to incur expenses for medical, psychiatric, and/or psychological counseling and care.
`Plaintiff's damages have been experienced in the past, and they will continue into the
`
`future.
`
`127.
`
`Further, Plaintiff has been required to retain an attorney to assist Plaintiff in asserting
`
`Plaintiff's claims and protecting Plaintiffs rights.
`
`128.
`
`Plaintiff is entitled to treble damages and attorneys’ fees and costs due to Defendants’
`
`violation of the New Jersey ConsumerFraud Act
`
`WHEREFORE,asto each and every count, Plaintiff demands judgment on each andall
`
`of these Counts against the Defendants jointly and severally, as follows:
`
`A.
`
`w
`
`OnBOO
`
`Compensatory damagesof notless than $200,000;
`Paymentofall outstanding medicalbills and claims, as well as those Plaintiff may
`receive in the future that were incurred during the relevant time period;
`
`Damages for humiliation, mental and emotionaldistress;
`
`Statutory damages,if applicable;
`Punitive damages andor liquidated damages where permitted by law;
`
`Attorneys’ fees and costs of suit; and
`Such other, further anddifferent relief as the Court deemsfitting, just and proper.
`
`Plaintiff hereby reserves the right to amend this Complaint to supplement or modify the factual
`obligations and claims contained herein, based upon information received from the Defendants,
`witnesses, experts, and others in the course of discovery in this matter.
`
`DEMAND FOR TRIAL BY JURY
`
`Plaintiff respectfully demandsa trial by jury onall issues in the within action sotriable.
`
`11
`
`

`

`Case 2:22-cv-02648 Document 1-1 Filed 05/05/22 Page 14 of 35 PageID: 20
`Case 2°22-cv-02648 “Docurient1-1- Filed 65/05/22 Pagé 14of35 PagelD:20
`
`DESIGNATION OF TRIAL COUNSEL
`
`TY HYDERALLYis hereby designatedastrial counsel on behalfof Plaintiff.
`
`CERTIFICATION OF NO OTHER ACTIONS OR PARTIES
`
`[hereby certify that the matter in controversyis not the subject of any other action pending
`in any court or of a pending arbitration proceeding,that no other action orarbitration proceeding
`is contemplated, and that there are no other parties known to meat this time who should bejoined
`
`as parties to this action.
`
`DEMAND FOR PRODUCTION OF INSURANCE AGREEMENTS
`
`Demand is hereby made that you disclose to the undersigned whether there are any
`insurance agreements or policies under which anyperson orfirm carrying on an insurance business
`maybeliable to satisfy all or part of a judgment which maybeenteredin the action or to indemnify
`or reimburse for payment madeto satisfy the judgment.
`
`If so, please attach a copyofeach,orin the alternative state, under oath and certification:
`(a) policy number; (b) name and addressofinsurer; (c) inception and expiration date; (d) names
`and addressesofall persons insured thereunder; and (¢) medical paymentlimits.
`
`HYDERALLY & ASSOCIATES,P.C.
`Attorneysfor Plaintiff
`
`BY:
`
`
`
`TY HYDERALLY
`for the Firm
`
`DATED:
`
`April 1, 2022
`
`T:\Ferreira.Michelle|\Pleadings\032822.COM
`
`12
`
`

`

`Case 2:22-cv-02648-Document4-4.- Filed.05/05/22_Page 15 of 35 PagelD: 21
`Case 2:22-cv-02648 Document 1-1 Filed 05/05/22 Page 15 of 35 PageID: 21
`
`Exhibit “1”
`
`

`

`Case 2:22-cv-02648 Document 1-1 Filed 05/05/22 Page 16 of 35 PageID: 22
`Case2:22-¢v-02648 ~Document-1=1° ° Filed 05/05/22--Page +6-0f-35- PagelD: 22 .
`
`eee
`
`ZOV Medical, PLLC
`Oksana Zbarksy M.D,
`;
`VadimZbarskyM.D,
`
`116 East 63rd Street, Sulte 1
`New York, NY 10065
`
`Michelle Ferreira
`361 Highland Ave
`Kearny, NJ 07032
`
`tate i
`
`}
`
`i ent
`
`Date: 07/22/2021
`
` aayOOFee
`$190.00
`NoPayment
`
`aeesiHe
`
`EOF Worseas
`No Payment
`
`
`%ag seeaerae
`
`i
`aN
`ste ee,aey
`
`
`
`
`
`
`
`
`
`
`Card Number:
`Expiration Date
`Security Code:
`
`en
`
`
`
`
`
`
`
`Make all checks payable to
`Z20V Medical
`
`

`

`Case 2:22-cv-02648 Document 1-1 Filed 05/05/22 Page 17 of 35 PageID: 23
`Case 2:22-cv-02648 Document-1=1: ‘Filed 05/05/22 --Page-£7.0f 35-RagelD: 23 .
`
`Exhibit “2”
`
`

`

`Case 2:22-cv-02648 Document 1-1 Filed 05/05/22 Page 18 of 35 PageID: 24
`Case 2:22-cv-02648 ‘Document1-1 Filed 65/05/22 Page18 of35 PagelD:24
`
`-BILL-
`
`Larry Shemen, MD, PC
`Phone: 212-472-6660
`
`Tax ID: 133825985
`
`Staternent Date: 08/04/2021
`
`Account Number: 18152979
`
`Account Name: Michelle Ferreira
`
`Patient Acct #s: 18152979... Bill #s: 49576
`
`_ Addressee;
`Michelle Ferreira
`
`| 361 Highland Ave
`| Kearny, NJ 07032
`
`
`
`
`[
`]American Express
`{ ] Credit Card
`
`[
`) Debit
`
`{
`) Discover
`{
`] Master Card
`
`{
`] Visa
`
`
`Amountve
`[
`$ 7925.00 |
`
`_RemitTo:
`Larry Shemen, MD, PC
`233 East 69th Street Suite 1D
`
`New York, NY 10021-5449
`
`Please Detach and Return the top portion ofthe bill with your paymentto insure proper credit. Retain the bottom portion for your records.
`
`Page: 1
`Next Appt:
`
`
`1850.00
`
`Account Name: Michelle Ferreira
`Statement Date: 08/04/2021
`
`" Procedure / Payment Description
`Credit
`CPT
`Patient Owes Diagnosis
`| Date
`Insurance
`Charge
`
`Patient: Ferreira, Michelle / Prov: Shemen, Larry
`-~--> Balanca Forward
`Patient: Ferreira, Michelle / Prov: Shemen, Larry / Total Charges: 7000.00, Patient Pald: -925.00
`5000.00
`30118 Exc Intranasal Les; Ext Approach
`Payment: Charged to Visa
`15733 Musc Myoq/Fscq Flp H&N Pedcl
`
`11/06/2020
`07/27/2021
`11/06/2020
`
`Self-Pay
`
`2000.00
`
`c44.301
`
`-925.00
`
`4075.00
`2000.00 M95.3
`
`
`| Statement Balance
`. Current Balance Due Upon Receipt:
`
`7925.00
`
`’ Balance Aging:
`0-30
`7925 .00
`
`31-60
`0,00
`
`61-90
`0.00
`
`91-120
`0.00
`
`121+
`0.00
`
`Unapplied Payments:
`
`QO.
`
`pee ————
`Messages
`
`se —
`
`
`
`Total:
`
`7925.00
`
`|
`
`linens Ohaman RADY BA A900 Paak ONIbh Bien ak Onin A Bn oo BIN AANA OER AA BIN RARR THR. BRR RR AR
`
`

`

`Case 2:22-cv-02648 Document 1-1 Filed 05/05/22 Page 19 of 35 PageID: 25
`Case 2:22-cv-02648 ~ Docimént’1-1'~ Filed 03/05/22- Page 19 of 35-PagetB: 25:
`
`Exhibit “3”
`
`

`

`Case 2:22-cv-02648 Document 1-1 Filed 05/05/22 Page 20 of 35 PageID: 26
`Case 2:22-cv-02648 -Bocument-1:1- ‘Filed 65/05/22 Page 20 of35 PagélD: 26
`
`Activity Listing for FERAEIRA, MICHELLE (24021485)
`
`
`
`Y View Optians=Close t + Gexpandal
`
`vClalms(Count: 3, Amount: $501.00, Balance: $401.00}
`vv Claim lafsistad
`BOS; 11/23/2020
`Rendering Providert HERSCHORN, BRIAN M.D.
`1cD Codes: 110.509 °
`
`Amount $165.00
`
`Balance: $165.00
`
`Status: Clalm at CAROINAL SELECT
`
`
`
`
`
`Pracadyro Adjusunent=BalaneaDOSReceived Nesctipion Units Charge Paymans
`
`
`
`Qala
`442362020
`COMP EVE EXAMINATION, ESTAB PATIENT.
`1
`3:65.00
`
`Clolm at CARDINAL SELECT as of 22/20/2020
`$0.00
`$0.00
`$165.00
`Clalmn Totals.
`$165.00
`$9,09
`$0.00
`$165.00
`vaNting Activity
`ttn
`Bale
`BISNAVAL)
`11/25;2020
`> Statarmenc Actlulty (Nono}
`DOS; 11/10/2020
`© Clalin & 146903746,
`Rendaring Providan H