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AMERICAN TRANSIT INSURANCE COMPANY v. ALEXANDRE DEMOURA MD PC d...

Docket 156684/2024, New York State, New York County, Supreme Court (July 23, 2024)
Case TypeTorts - Motor Vehicle
TagsTort, Civil, Vehicle
Plaintiff AMERICAN TRANSIT INSURANCE COMPANY
Defendant ALEXANDRE DEMOURA MD PC d/b/a NEW YORK SPINE INSTITUTE A/A/O KENNETH WILLIAMS
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ANSWER WITH COUNTER-CLAIM(S)

Document AMERICAN TRANSIT INSURANCE COMPANY v. ALEXANDRE DEMOURA MD PC d/b/a NEW YORK SPINE INSTITUTE A/A/O KENNETH WILLIAMS, 156684/2024, 5 (N.Y. Sup. Ct., New York Cou...
Plaintiff cannot establish that it complied with the time frames as set forth in the No Fault Regulations and thereby cannot meet its burden of filing “proof of the facts constituting the claim.” See: American Tr. Ins. Co. v Small 2020 NY Slip Op 33138(U) [Sup.
That at the time of the accident there was an existing insurance policy issued by the Plaintiff containing Person Injury Protection benefits under the New York State No-Fault Law.
That the Defendant Alexandre DeMoura M.D., P.C. d/b/a New York Spine Institute submitted bills and claim for payment to Plaintiff in the amount of $31,340.05 for medical services provided on November 28, 2022.
That Defendants-Assignees are entitled to payment of the bill, statutory interest at a rate of 2% per motion (pursuant to 11 NYCRR §65-3.9(a)) until the amount due is paid in full, computed from thirty days after the date the claim was submitted to the Plaintiff.
Pursuant to 22 NYCRR 130-1.1, the undersigned, an attorney duly admitted to practice in the courts of the State of New York, certifies that, upon information and belief and reasonable inquiry, the contention contained in the annexed documents are not frivolous Dated: August 21, 2024
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SUMMONS + COMPLAINT Verified

Document AMERICAN TRANSIT INSURANCE COMPANY v. ALEXANDRE DEMOURA MD PC d/b/a NEW YORK SPINE INSTITUTE A/A/O KENNETH WILLIAMS, 156684/2024, 1 (N.Y. Sup. Ct., New York Cou...
The Defendant Alexandre DeMoura MD PC d/b/a New YorkSpineInstitute allegedly provided services to the assignor Kenneth Williams on November28, 2022, including and relating to spinal surgery.
The Defendants submitted claimsto the Plaintiff for services allegedly provided to the assignor Kenneth Williams on November28, 2022, including andrelating to spinal surgery.
The patient was not informedofthe financial relation between the referring provider and the Defendant as required by both New York and New Jersey law and no payment is due as a result.
The alleged injuries treated and supplies provided by the Defendants were not causally related to the accident at issue and therefore not covered underthe no-fault statutes.
As such, the Defendants did not submit a proper proof of loss under the No-Fault Regulations to the Insurance Law andare not entitled to any legal fees if they did prevail on their claims.
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NOTICE OF CHANGE OF FIRM NAME OR ADDRESS (PRE RJI)

Document AMERICAN TRANSIT INSURANCE COMPANY v. ALEXANDRE DEMOURA MD PC d/b/a NEW YORK SPINE INSTITUTE A/A/O KENNETH WILLIAMS, 156684/2024, 8 (N.Y. Sup. Ct., New York Cou...
To all adverse parties and the Clerk of the Court: PLEASE TAKE NOTICE that the undersigned has a new address and demands that all papers and notices in this matter be served at the address stated below.
December 12, 2024 Date of Notice
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REPLY TO COUNTERCLAIM(S)

Document AMERICAN TRANSIT INSURANCE COMPANY v. ALEXANDRE DEMOURA MD PC d/b/a NEW YORK SPINE INSTITUTE A/A/O KENNETH WILLIAMS, 156684/2024, 7 (N.Y. Sup. Ct., New York Cou...
The Plaintiff, by its attorneys SHORT & BILLY, P.C., for its Reply to the Counterclaims of Defendant Alexandre DeMoura M.D., P.C. d/b/a New York Spine Institute a/a/o Kenneth Williams, respectfully alleges:
Denies knowledge or information sufficient to form a belief as to the truthfulness of the allegations of paragraph 52 contained in Defendant’s Fourth Counterclaim.
The patient was not informed of the financial relationship between the referring provider and the Defendant as required by both New York and New Jersey Law and no payment is due as a result.
The alleged injuries treated and services provided by the Defendant were not causally related to the accident at issue and therefore not covered under the no-fault statute.
As such, the Defendant did not submit a proper proof of loss under the No-Fault Regulations to the Insurance Law and are not entitled to any legal fees if they did prevail on their claims.
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EXHIBIT(S) - 1 Prior Arbitration Award

Document AMERICAN TRANSIT INSURANCE COMPANY v. ALEXANDRE DEMOURA MD PC d/b/a NEW YORK SPINE INSTITUTE A/A/O KENNETH WILLIAMS, 156684/2024, 6 (N.Y. Sup. Ct., New York Cou...
The 64 year old EIP reported involvement accident on in a motor vehicle October 7, 2021; claimed related and underwent intraoperative injury monitoring (IONM) provided by the applicant on November neurophysiological 28, 2022 the date on which lumbar fusion surgery was performed.
Page 1/7 The applicant payment of which these medical services, a claim for submitted was timely denied by the respondent based upon a peer review by Howard Levy, M.D.
Dr. Levy considered possible injuries arguments and justification the need for neurophysiological the intraoperative for they were not warranted under the issue and determined that monitoring at circumstances presented.
the medical that to the subject of the previous of exacerbation However, Dr. Levy did not address the possibility accident on to the EIP's lumbar spine as a result of the motor vehicle injury October 7, 2021.
the Appellate Term has held that judgment is a conclusive final "[t]he declaratory it was entered on default...." Ava that determination, notwithstanding Acupuncture, P.C. v NYCentral Mut.
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AFFIRMATION/AFFIDAVIT OF SERVICE Service of S/C via personal service

Document AMERICAN TRANSIT INSURANCE COMPANY v. ALEXANDRE DEMOURA MD PC d/b/a NEW YORK SPINE INSTITUTE A/A/O KENNETH WILLIAMS, 156684/2024, 4 (N.Y. Sup. Ct., New York Cou...
is not a party to this action and is over the age of eighteen
I, ALANFELDMAN,affirms and says deponent in the State of NewYork.
years and resides That on 8/5/2024 at 1:19 PMat 761 MERRICKAVENUE,WESTBURY,NY11590, deponent served the within SUMMONS& VERIFIED COMPLAINT, EXHIBIT AWITHNOTICEOFELECTRONICFILING to and leaving with DAWN"DOE" for ALEXANDREDEMOURAMDPCDBA by personally delivering NEWYORKSPINE INSTITUTE, a true copy thereof, and that deponent knew the person so served to be the AUTHORIZEDPARTY/Managing Agent and stated (s)he was authorized to accept legal papers for the corporation.
Said documents were conformed with index number and date of filing A description of the person served on behalf of the defendant is as follows: Approx Age: 51 - 65 Yrs., Approx Weight: 161-200 Lbs., Approx Height: Approx Skin: White, Approx Hair: Blonde Other: REFUSEDTOGIVE LASTNAME.
5' 4" - 5' 8", Sex: Female, I affirm this August 6, 2024, under the penalties under the laws of NewYork, which may perjury include a fine or imprisonment,that the foregoing is this document maybe true, and I understand that in an action or proceeding in a court of law.
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AFFIRMATION/AFFIDAVIT OF SERVICE Service of S/C via Sec of State

Document AMERICAN TRANSIT INSURANCE COMPANY v. ALEXANDRE DEMOURA MD PC d/b/a NEW YORK SPINE INSTITUTE A/A/O KENNETH WILLIAMS, 156684/2024, 3 (N.Y. Sup. Ct., New York Cou...
being duly sworn, deposes and says that deponent is over the age of eighteen years, Jeffrey Teitel, service, TEITEL SERVICEBUREAUINC., and is not a party to this is employed by the attorney action.
the office of the Secretary of State of NewYork in the City That on the 31st day of July, 2024 at of Albany he served the annexed Summons,Verified Complaint and Notice of Electronic Filing on ALEXANDREB.
of that he knewthe person so served as foresaid Deponent further to be a clerk in the Office of the Secretary of State of NewYork, duly authorized to accept such service on behalf of said defendant.
states Sue Zouky is a white female, approximately 130 pounds with grey hair.
approximately 62 years of age, stands 5 feet 3 inches tall, weight of perjury under the laws of New I affirm this 31st day of July, 2024, under the penalties York, which may include a fine or imprisonment, is true, and I the foregoing that this document maybe filed in an action or proceeding in a court of law.
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