FILED: NEW YORK COUNTY CLERK 10/18/2024 01:36 PM
`NYSCEF DOC. NO. 8
`
`INDEX NO. 156397/2024
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`RECEIVED NYSCEF: 10/18/2024
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`MURIEL GOODE-TRUFANT
`Acting Corporation Counsel
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`
`
`Dear Counsel:
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`6
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`The City of New York
`LAW DEPARTMENT
`100 CHURCH STREET
`NEW YORK, NEW YORK 10007
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`If you would like to have this case considered for possible early settlement by the
`Early Intervention Unit of the Tort Division, the following items (as applicable) should be
`forwarded to the attention of Janae Bond via email to jbond@law.nyc.gov.
`
`IN ALL CASES COPIES OF THE FOLLOWING ITEMS MUST BE PROVIDED:
`1. Notice of Claim and Filed Summons & Complaint.
`2. Aided Card, if prepared.
`3. UF18 - City Involved Accident Report, if prepared.
`4. All medical and hospital records, including ambulance call report, first treatment, full
`emergency room record, operative and radiology reports, treating physician(s) reports,
`physical therapy records, etc.
`5. Photographs (duplicates, color or laser copies preferred) of the location and of injuries, if
`scarring is claimed.
`6. Proof of any special damages claimed.
`7. Any other item(s) that you believe pertinent to an early resolution of your case.
`8. Social Security number and any other Medicare information – see attached notice
`ALLEGED TRIP AND FALL ON A SIDEWALK OR ROADWAY
`1. Most recently dated Big Apple map.
`2. Any other documents that the plaintiff will rely upon to prove prior written notice.
`MOTOR VEHICLE ACCIDENT CASES
`1. Police Accident Report.
`2. Agency incident/accident report, if prepared.
`3. Repair bills and/or estimates.
`4. If the accident involves traffic light or stop sign, any documentation that the plaintiff will
`rely upon to prove notice.
`ALLEGED PREMISES LIABILITY
`1. Copies of any documents that plaintiff will rely on to establish ownership of the premises.
`2. Prior complaints.
`3. Accident/incident reports.
`DEPARTMENT OF EDUCATION CASES
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`FILED: NEW YORK COUNTY CLERK 10/18/2024 01:36 PM
`NYSCEF DOC. NO. 8
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`INDEX NO. 156397/2024
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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 reimbursement 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,
`
`Nancy A. Goldbach
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`FILED: NEW YORK COUNTY CLERK 10/18/2024 01:36 PM
`NYSCEF DOC. NO. 8
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`INDEX NO. 156397/2024
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`RECEIVED NYSCEF: 10/18/2024
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`MURIEL GOODE-TRUFANT
` Acting Corporation Counsel
`
`
`9
`
`
`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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`
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`medicare@law.nyc.gov
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`October 18, 2024
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`LAW OFFICES OF SEAN H. ROONEY, ESQ.
`26 Court Street, Suite 1816
`Brooklyn, NY 11242
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`Re:
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`Dear Counselor:
`
`BRYCE CLARKE v. THE CITY OF NEW
`YORK, POLICE OFFICER VINCENT
`J.
`FULGIERI and POLICE OFFICER "JOHN
`DOE"(fictitious name, real name unknown)
`Law Dept. File No: 2024-064277
`
`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
`
`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 10/18/2024 01:36 PM
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`INDEX NO. 156397/2024
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`mandatory reporting obligations to the Medicare Secondary Payer Act ("MSPA") requiring . . .
`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 reimbursement 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
`
`
`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 10/18/2024 01:36 PM
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`INDEX NO. 156397/2024
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`RECEIVED NYSCEF: 10/18/2024
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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 reimbursement 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 reimbursement 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.
`
`PLEASE BE ADVISED THAT WE CANNOT FINALIZE ANY SETTLEMENT
`WITH A CURRENT MEDICARE RECIPIENT WITHOUT FIRST RESOLVING
`MEDICARE’S CLAIM.
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`
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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 10/18/2024 01:36 PM
`NYSCEF DOC. NO. 8
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`INDEX NO. 156397/2024
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`RECEIVED NYSCEF: 10/18/2024
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`SUPREME COURT OF THE STATE OF NEW YORK
`COUNTY OF NEW YORK
`-----------------------------------------------------------------
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`BRYCE CLARKE,
`
`x
`
`
`
`Plaintiff(s),
`
`-against-
`
`AMENDED ANSWER
`
`
`Index #: 156397/2024
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`THE CITY OF NEW YORK, POLICE OFFICER
`VINCENT J. FULGIERI AND POLICE OFFICER "JOHN
`DOE"(FICTITIOUS NAME, REAL NAME UNKNOWN),
`
`Law Dept. #: 2024-064277
`
`
`-----------------------------------------------------------------
`
`Defendant(s).
`x
`
`Defendants THE CITY OF NEW YORK, and POLICE OFFICER VINCENT J.
`
`FULGIERI, by MURIEL GOODE-TRUFANT, Acting Corporation Counsel, answering the
`
`complaint, allege upon information and belief:
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`1.
`
`2.
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`Deny each allegation set forth in paragraph(s) 15-24, 26-27, inclusive.
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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) 1, 3-4, 6(1ST), 14, inclusive.
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`3.
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`Deny each allegation set forth in paragraph(s) 13, inclusive, except that with
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`respect to those portions of the street(s), sidewalks and appurtenances referred to in the complaint
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`which were or may have been owned by the City of New York, defendant(s) had such duties as
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`were imposed by law.
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`4.
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`Deny each allegation set forth in paragraph(s) 7-12, inclusive, except that
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`THE CITY OF NEW YORK owned, and VINCENT J. FULGIERI operated the vehicle identified
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`in the complaint.
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`5.
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`Deny each allegation set forth in paragraph(s) 2, 5, 6(2ND), inclusive,
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`except that the City of New York is a municipal corporation which employed POLICE OFFICER
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`VINCENT J. FULGIERI, in scope of employment which maintains a Police Department pursuant
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`to law.
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`6.
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`Deny each allegation set forth in paragraph(s) 25, inclusive, except as
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`otherwise pleaded herein.
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`AFFIRMATIVE DEFENSE(S)
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`7.
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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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`8.
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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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`9.
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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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`10.
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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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`11.
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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, 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. Individual defendant(s)
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`represented by the Office of the Acting Corporation Counsel of the City of New York(if any) did
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`not violate any clearly established constitutional or statutory right of which a reasonable person
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`would have known and therefore are/is protected by qualified immunity.
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`12.
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`Plaintiff(s)’ complaint fails to consecutively number allegations as required
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`by section 3014 of the CPLR.
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`13.
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`In cases involving authorized emergency vehicle(s) engaged in an
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`emergency operation, or persons, teams, motor vehicles, and other equipment, while actually
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`engaged in work on a highway, or hazard vehicles while actually engaged in hazardous operations
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`on or adjacent to a highway, defendant(s) were not reckless in the manner in which they acted, and
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`are entitled to the benefits of VTL sec. 1103 and/or VTL sec. 1104.
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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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`
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`MURIEL GOODE-TRUFANT
`Acting Corporation Counsel
`100 Church Street
`New York, New York 10007
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`INDEX NO. 156397/2024
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`RECEIVED NYSCEF: 10/18/2024
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`Index #: 156397/2024
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`SUPREME COURT OF THE STATE OF NEW YORK
`COUNTY OF NEW YORK
`
`BRYCE CLARKE,
`
`- against -
`
`Plaintiff(s),
`
`THE CITY OF NEW YORK, POLICE OFFICER VINCENT J. FULGIERI
`AND POLICE OFFICER "JOHN DOE"(FICTITIOUS NAME, REAL NAME
`UNKNOWN),
`
`Defendant(s).
`
`COMBINED DEMAND FOR
`BILL OF PARTICULARS & DISCOVERY
`
`MURIEL GOODE-TRUFANT
`Acting Corporation Counsel
`Attorney for Defendants THE CITY OF NEW YORK, and POLICE OFFICER
`VINCENT J. FULGIERI, 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)
`
`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)
`
`Please refer to the following Law Dept. #: 2024-064277
`
`and indicate the County in which the action is pending in all papers,
`correspondence and other communications with respect thereto.
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`FILED: NEW YORK COUNTY CLERK 10/18/2024 01:36 PM
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`SUPREME COURT OF THE STATE OF NEW YORK
`COUNTY OF NEW YORK
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`------------------------------------------------------------------------ x
`
`INDEX NO. 156397/2024
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`RECEIVED NYSCEF: 10/18/2024
`
`BRYCE CLARKE,
`
`-against-
`
`
`
`Plaintiff(s),
`
`COMBINED DEMAND FOR
`VERIFIED BILL OF
`PARTICULARS & DISCOVERY
`
`THE CITY OF NEW YORK, POLICE OFFICER VINCENT J.
`FULGIERI AND POLICE OFFICER "JOHN
`DOE"(FICTITIOUS NAME, REAL NAME UNKNOWN),
`
`Defendant(s).
`
`------------------------------------------------------------------------ x
`
`DEMAND FOR VERIFIED BILL OF PARTICULARS
`
`PLEASE TAKE NOTICE that pursuant to CPLR 3041, plaintiff(s) is required within 30
`days following service of this demand to serve upon MURIEL GOODE-TRUFANT, Acting Corporation
`Counsel, a verified bill of particulars setting forth in reasonable detail a statement of the following:
`
`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.
`
`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;
`if a loss of earnings claim is alleged, please state the yearly gross earnings for
`i.
`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 have committed the acts set forth in the items above.
`24. Describe any alleged dangerous and defective condition and or the object or
`instrumentality complained of, as well as the nature of the condition alleged.
`25. State whether any repairs were made prior to the happening of the alleged accident.
`26. If it is alleged that repairs were made prior to the happening of the accident, state when,
`where, and by whom, the repairs were made.
`27. State whether actual or constructive notice is claimed or whether it is alleged that
`defendant created the condition complained of.
`28. If actual notice is claimed, then set forth the following:
`(a) The names of the employees, agents and/or servants of the defendant(s) to
`whom it will be alleged said actual notice was given;
`(b) By whom will it be claimed that said actual notice was given on each occasion
`
`aforesaid;
`
`(c) The date or dates of each said notice;
`(d) The place said actual notice was given.
`29. If constructive notice is claimed, state the length of time said condition is alleged to have
`existed prior to the happening of the alleged occurrence.
`30. If prior written notice is claimed, specify the nature of such notice.
`31. If prior written notice is claimed, then set forth the following:
`(a) The name(s) of the entity, agency, employees, agents and/or servants of the
`defendant(s) to whom it will be alleged said prior written notice was given;
`(b) By whom will it be claimed that said prior written notice was given on each
`
`occasion aforesaid;
`
`(c) The date or dates of each said notice;
`(d) The place said notice was given.
`32. In any action where plaintiff(s) claim the violation of any statute, ordinance, rule, order,
`requirement or regulation, state separately and specifically all such statutes, ordinances, rules or regulations
`alleged to have been violated by the answering defendant(s).
`33. If applicable, describe in what respects defendant(s) failed to provide plaintiff(s) with a
`safe place to work.
`34. If applicable, state whether plaintiff(s) will allege that this defendant(s) was a party to a
`contract. If yes;
`
`(a) State the parties to the contract;
`(b) State the contract number.
`35. If applicable, set forth each and every item of construction, excavation or demolition work
`which the plaintiff(s) will allege was not so constructed, shored, equipped, guarded, arranged, operated and
`conducted as to provide reasonable and adequate safety; setting forth the manner in which the construction,
`shoring, equipping, guarding, arranging, operating and/or conducting of the construction, excavating, or
`demolition work is alleged to have caused the plaintiff(s) alleged injury.
`36. If applicable, state whether the plaintiff(s) will allege that this defendant(s) exercised
`control over the work being performed at the job site. If yes, state the nature and extent of the control allegedly
`exercised and the exact manner in which said control was exercised.
`37. If applicable, state those injuries claimed to be “grave”, as defined in the Workers’
`Compensation Law § 11.
`
`
`ALLEGED DEFAMATION
`Where applicable, in addition to the foregoing, if plaintiff(s) alleges defamation, the
`following items are additionally demanded:
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`38. Whether the alleged defamatory statement was communicated orally or in a writing.
`39. With respect to each of the answering defendant(s), the particular words complained of
`and allegedly communicated.
`40. The name(s) and address(es) of any person(s) it is alleged heard or received the defamatory
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`statement(s).
`
`41. If it is alleged that the defamatory statement(s) were communicated in a writing, set forth
`the date(s), nature, and content of the writing.
`42. If it is alleged that any defamatory statement was published, set forth the date(s), nature
`and name of the media or publication and each republication of the alleged defamatory statement.
`43. The circumstances, acts, and/or omissions which evince defendant(s) knowledge of the
`falsity, or reckless disregard of the truth, or malice, with respect to the statement(s) allegedly made.
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