ROBERT LAWRENCE HECHT v. HEALTH & HOSPITAL CORP., 092245/2023, 1 (N.Y. Sup. Ct., Kings County Dec. 27, 2023) (2024)

`

`FILED: KINGS COUNTY CLERK 12/27/2023 02:06 PM
`NYSCEF DOC. NO. 1
`
`INDEX NO. 092245/2023
`
`RECEIVED NYSCEF: 12/21/2023
`
`SUPREME COURT OF THE STATE OF NEW YORK
`COUNTY OF KINGS
`
`In the Matter of the Application of
`ROBERT LAWRENCE HECHT
`
`Petitioner,
`
`JUDGMENT
`
`Index No.:
`
`- Against -
`
`HEALTH & HOSPITAL CORP.,
`Respondent(s),
`
`for judgment pursuant to Workers’ Compensation Law Section 54-b
`
`Petitioner, ROBERT LAWRENCE HECHT, having been awarded payment in the total
`
`amount of $ 175.60 by the New York State Workers’ Compensation Board pursuant to Workers’
`
`Compensation Law Sections 13-g, 13-k, 13-l or 13-m, on 2/25/2022, bearing WCB Dispute
`
`Number: 11382942 11382940 ; and Respondent, HEALTH & HOSPITAL CORP., having
`
`failed to pay said award; and upon Consent of the Designee of the Chair of the Workers’
`
`Compensation Board pursuant to Section 54-b of the Workers’ Compensation Law, it is
`
`ADJUDGED, that Petitioner, ROBERT LAWRENCE HECHT, with an address of 1512
`
`Broadway Hewlett NY 11557 recover of Respondent, HEALTH & HOSPITAL CORP., with an
`
`address of 350 JAY STREET, BROOKLYN NY 11201, the sum of $ 175.60, with interest at the
`
`rate of 1.5 per centum per month pursuant to 12 N.Y.C.R.R. 300.19 from 3/27/2022 in the
`
`amount of $54.61, and attorney’s fees in the amount of $625.00 pursuant to Section 54-b of the
`
`Workers’ Compensation Law, for a total Judgment of $855.21, and Petitioner has execution
`
`therefore.
`
`Dated:
`
`
`
`_________________, _____, 2023
`
`
`
`Clerk
`
`L&B File No.: 1061A-WC-1078
`
`2 of 15
`
`

`

`FILED: KINGS COUNTY CLERK 12/27/2023 02:06 PM
`NYSCEF DOC. NO. 1
`
`INDEX NO. 092245/2023
`
`RECEIVED NYSCEF: 12/21/2023
`
`SUPREME COURT OF THE STATE OF NEW YORK
`COUNTY OF KINGS
`In the Matter of the Application of
`ROBERT LAWRENCE HECHT
`
`- Against -
`
`HEALTH & HOSPITAL CORP.,
`
`for judgment pursuant to Workers’
`Compensation Law Section 54-b
`STATE OF NEW YORK
`)
`COUNTY OF NASSAU
`) ss.:
`
`Respondent(s),
`
`Petitioner,
`
`
`
`ATTORNEY AFFIRMATION
`
`ANDREW SARAGA, ESQ., an attorney duly admitted to practice before the Courts of
`
`the State of New York, under the penalty of perjury, affirms the following:
`
`1)
`
`I am an associate of the law firm of LEWIN & BAGLIO, LLP, attorneys for the
`
`plaintiff, and as such, I am fully familiar with the facts and circ*mstances herein.
`
`2) This Affirmation is made in support of the within application to the Clerk of the
`
`Court to enter judgment on behalf of the Petitioner, ROBERT LAWRENCE HECHT, against
`
`Respondent, HEALTH & HOSPITAL CORP. pursuant to NY Workers Comp. Law § 54-B, the
`
`annexed certified copy of the award, and consent to file judgment rendered by the Workers’
`
`Compensation Board (WCB) directing payment of the medical bills totaling $175.60, including
`
`statutory interest, and statutory attorney’s fees.
`
`3)
`
`ROBERT LAWRENCE HECHT sought reimbursem*nt for medical services
`
`rendered to SHANI BENNETT to assist in their recovery from a work-related accident. ROBERT
`
`LAWRENCE HECHT submitted said claims for reimbursem*nt to HEALTH & HOSPITAL CORP.,
`
`the responsible Insurance Carrier/Self-Insured Employer. Due to HEALTH & HOSPITAL CORP.’s
`
`failure to timely and properly pay such claims, ISLAND MUSCULOSKELETAL CARE, submitted
`
`a request for enforcement to the WCB. On 2/25/2022 the WCB issued an award under Dispute
`
`Number(s) 11382942 11382940 awarding Petitioner the amount of $ 175.60.
`
`4)
`
`To date HEALTH & HOSPITAL CORP. has failed to make any payments towards
`
`the aforementioned balance.
`
`L&B File No.: 1061A-WC-1078
`
`3 of 15
`
`

`

`FILED: KINGS COUNTY CLERK 12/27/2023 02:06 PM
`NYSCEF DOC. NO. 1
`
`INDEX NO. 092245/2023
`
`RECEIVED NYSCEF: 12/21/2023
`
`5)
`
`NY Workers’ Comp. Law §54-B provides that in the event an insurance carrier or
`
`self-insured employer defaults in the payment of an award the medical provider or other interested
`
`party may request consent from the chair of the WCB to file a certified copy of the
`
`Administrative/Arbitration Award decision of the WCB with the county clerk so that judgment may
`
`be entered.
`
`6)
`
`Petitioner has requested such consent, and a copy of the Consent to File together
`
`with supporting documents is annexed hereto.
`
`In Support of Attorney’s Fees
`
`7)
`
`Furthermore, NY Workers’ Comp. Law §54-B provides that the “carrier or self-
`
`insured employer shall be liable for all costs and attorneys fees necessary to enforce the award.”
`
`In order to enforce the annexed award, ROBERT LAWRENCE HECHT retained the services of
`
`Lewin & Baglio, LLP.
`
`8)
`
`Lewin & Baglio, LLP, represents medical providers seeking reimbursem*nt from
`
`insurance companies for services rendered to persons who are injured in motor vehicle or work-
`
`place accidents. The undersigned has practiced primarily in this area of law since 2012.
`
`9)
`
`Your affirmant requests the firm’s usual hourly billing rate for medical collections
`
`services of $250.00 per hour. This rate takes into consideration the firms focused field of practice,
`
`and the years of experience of the attorneys handling this matter.
`
`10)
`
`I am requesting an award of attorney’s fees in the amount of $625.00 for the two
`
`and a half hours worked in enforcing the Workers’ Compensation award in this matter. A detailed
`
`time line is listed below:
`
`Charge
`Time
`Action
`$125.00
`.5
`Review of File and WCB Awards
`$187.50
`.75
`Preparation of Demand for Certified Copy of WCB Awards
`$62.50
`.25
`Filing of Demand for Certified Copy of WCB Awards
`$62.50
`.25
`Receipt and Processing of Certified Copy of WCB Award
`$187.50
`.75
`Preparation and Filing of Application for Judgment
`Total: 2.5hrs at $250/hr $625.00
`
`
`
`L&B File No.: 1061A-WC-1078
`
`4 of 15
`
`

`

`FILED: KINGS COUNTY CLERK 12/27/2023 02:06 PM
`NYSCEF DOC. NO. 1
`
`INDEX NO. 092245/2023
`
`RECEIVED NYSCEF: 12/21/2023
`
`11) As such, the total sum awarded and demanded is $855.21, which encompasses $
`
`175.60 for payment of the outstanding award(s), $54.61 for statutory interest, and $625.00 for
`
`attorney’s fees per statute.
`
`Dated: December 20, 2023
`Westbury, New York
`
`
`
`
`ANDREW SARAGA, ESQ.
`
`L&B File No.: 1061A-WC-1078
`
`5 of 15
`
`

`

`FILED: KINGS COUNTY CLERK 12/27/2023 02:06 PM
`NYSCEF DOC. NO. 1
`
`INDEX NO. 092245/2023
`
`RECEIVED NYSCEF: 12/21/2023
`
`NYS
`
`.
`
`Workers'
`
`Compensation
`Medical
`Bills
`Disputed
`Street
`328 State
`NY
`Schenectady,
`1-800-781-2362
`
`.
`12305
`
`Board
`Unit
`
`SE
`
`THISAGENCYEMPLOYSAND
`STHP
`T DS IM
`
`CARE
`
`October
`
`18, 2023
`
`CLARISSA M. RODRIGUEZ
`CHAIR
`
`HECHT
`LAWRENCE
`ROBERT
`MUSCULOSKELETAL
`ISLAND
`P.0 BOX 360
`NY 11557
`HEWLETT,
`
`Re:
`
`Consent
`
`to File Granted
`
`Dispute
`
`Number(s):
`
`11382940,
`
`11382942
`
`Dear
`
`Dr. HECHT:
`
`Your
`
`request
`
`decision
`
`of
`
`c.onsent
`for
`Workers'
`
`the
`
`to file
`
`a certified
`
`Compensation
`
`copy
`Board
`
`in order
`
`that
`
`judgment
`
`may
`
`be entered
`
`has been
`
`granted.
`
`In this
`
`regard,
`
`I enclose
`
`of
`
`the Administrative
`
`/ Arbitration
`
`Award
`
`in the
`
`above-entitled
`
`dispute
`
`with
`
`the
`
`county
`the following:
`
`clerl(cid:11)
`
`13 Consent
`2) Certified
`Informational
`3)
`
`to File;
`
`copy
`
`of
`
`the
`
`administrative/arbitration
`
`notice
`
`to the
`
`clerk
`
`award
`
`decision;
`the Workers
`
`Law
`Compensation
`('WCL')
`of WCL Section
`4) A copy
`Title
`12 Part
`Regulations
`
`54-b
`
`392
`
`for
`
`simple
`
`interest
`
`from
`
`the
`
`date
`
`of
`
`the
`
`. awards
`
`and
`
`unpaid
`
`medical
`
`bills.
`
`Code,
`
`300.19,
`administrative
`
`and
`
`process;
`Rules
`
`which
`
`together
`
`allow
`
`award
`
`on unpaid
`
`describing
`county
`judgment
`54-b
`Section
`and New York
`and Section
`
`informational
`The
`the WCL Section
`the
`certified
`
`copy
`
`notice
`
`is provided
`
`because
`
`54-b mandate
`
`that
`
`judgment
`
`some
`
`county
`be entered
`
`clerks
`
`are not
`
`aware
`
`of.the
`
`provisions
`
`of
`
`once
`
`consent
`
`is granted
`
`the
`for
`no fee is payable
`to any
`under WCL Section
`54-b.
`
`of
`
`filing
`public
`
`officer
`
`for
`
`filing
`
`or
`
`recording
`
`any
`
`paper
`
`of
`
`the Boards
`
`award
`
`determination,
`instrument
`or
`
`and
`
`that
`
`executed
`
`The New York
`companies.
`
`State
`
`Insurance
`
`Department
`
`also
`
`accepts
`
`complaints
`
`involving
`Department's
`
`licensed
`
`insurance
`
`web
`
`site
`
`at
`
`Providers
`
`may
`
`file
`
`a complaint
`
`via
`
`the Insurance
`
`https://www.dfs.ny.Aov/complaint.
`
`As part
`
`of
`
`your
`
`complaint
`
`with
`
`you were
`New York
`
`granted
`
`State
`
`consent
`Workers'
`
`to enter
`
`judgment
`
`on an administrative
`
`Compensation
`
`Board.
`
`DFS,
`and/or
`
`please
`
`advise
`
`them that
`
`arbitration
`
`award
`
`the
`
`by
`
`If
`
`you
`
`have
`
`any
`
`questions,
`
`please
`
`contact
`
`me at 1-800-781-2362.
`
`Very
`
`truly
`
`yours,
`
`Moss
`Eileen
`Principal WC Examiner
`Disputed
`Medical
`Bills
`
`Unit
`
`6 of 15
`
`

`

`FILED: KINGS COUNTY CLERK 12/27/2023 02:06 PM
`NYSCEF DOC. NO. 1
`
`INDEX NO. 092245/2023
`
`RECEIVED NYSCEF: 12/21/2023
`
`. SUPREME
`COUNTY
`
`COURT,
`OF BRONX
`
`STATE
`
`OF NEW YORK
`
`In the Matter
`
`of
`
`the Application
`
`of
`
`ROBERT
`
`LAWRENCE
`
`HECHT
`
`Petitioner
`
`Health
`
`.
`& Hospital
`
`vs.
`
`Corp.
`
`Respondent(s)
`
`for
`
`judgment
`
`pursuant
`
`to Workers
`
`Compensation
`
`Law
`
`Section
`
`54-b
`
`TO FILE
`CONSENT
`CERTIFIED
`PURSUANT
`COPY OF DECISION
`54-b OF THE
`TO SECTION
`WORKERS'
`COMPENSATION
`
`LAW
`
`INDEX
`
`NO.
`
`Pursuant
`to the
`authority
`Principal WC Examiner,
`Compensation
`Board,
`
`Compensation
`
`clerk
`
`Law,
`certified
`
`Disputed
`do hereby
`to the petitioner
`
`give
`
`copies
`
`of
`
`the
`
`decisions
`
`Sections
`
`granted
`
`to me by Order
`Medical
`Bills
`
`of
`
`the Chair
`
`Unit
`
`of
`
`#973,
`the New·York
`
`I, Eileen
`State
`
`Moss,
`Workers'
`
`Workers'
`
`pursuant
`
`to Section
`
`54-b
`
`of
`
`the
`
`consent,
`in the above
`
`proceeding
`awards
`
`to file with
`
`pursuant
`
`to
`
`appropriate
`the
`Workers'
`
`filed
`
`county
`Compensation
`
`Law
`
`Number(s)
`LAWRENCE
`
`11382940,
`HECHT
`
`13-k,
`13-g,
`payment
`
`awarding
`for medical
`
`Rules,
`judgment
`
`and
`
`Regulations
`
`title
`
`in his/her
`
`name.
`
`making
`or 13-m,
`13-1,
`amount
`in the
`
`Dispute
`on 02/25/2022
`to ROBERT
`to New York
`the petitioner
`
`of $87.80
`
`pursuant
`
`that
`
`Code,
`effectuate
`
`may
`
`services,
`12 Section
`
`plus
`
`interest
`
`3,00.19,'in
`
`order
`
`No appeals
`
`were
`
`taken
`
`in this matter
`
`and
`
`the time
`
`to appeal
`
`has expired.
`
`This
`
`consent
`
`is effective
`
`for
`
`thirty
`
`(30)
`
`days
`
`following
`
`the
`
`execution
`
`of
`
`this
`
`document.
`
`Principal WC Examiner,
`Workers'
`New York
`State
`as the Chair's
`
`Designee
`
`Disputed
`
`Medical
`
`Bills
`
`Unit
`
`Compensation
`
`Board
`
`Sworn
`fl
`
`,
`
`to before
`
`day
`
`of
`
`me this
`ft.
`
`, 20
`
`SHANE S. ROWE
`NOTARY PUBLIC, STATE OF NEW YORK
`Registration No. 02R06111402
`Qualified in Schenectady Coun
`Commission Expires June 7, 20 _
`
`.
`
`Pubhc
`
`Notary
`
`7 of 15
`
`

`

`FILED: KINGS COUNTY CLERK 12/27/2023 02:06 PM
`NYSCEF DOC. NO. 1
`
`INDEX NO. 092245/2023
`
`RECEIVED NYSCEF: 12/21/2023
`
`SUPREME
`COUNTY
`
`COURT,
`OF BRONX
`
`STATE
`
`OF NEW YORK
`
`In the Matter
`
`of
`
`the Application
`
`of
`
`ROBERT
`
`LAWRENCE
`
`HECHT
`
`Petitioner
`
`vs.
`
`Health
`
`& Hospital
`
`Corp.
`
`Respondent(s)
`
`for
`
`judgment
`
`Compensation
`
`to
`pursuant
`Law Section
`
`Workers'
`
`54-b
`
`TO FILE
`CONSENT
`CERTIFIED
`PURSUANT
`COPY OF DECISION
`54-b OF THE
`TO SECTION
`WORKERS'
`COMPENSATION
`
`LAW
`
`INDEX
`
`NO.
`
`granted
`
`to me by Order
`Medical
`Bills
`
`of
`
`Unit
`
`I, Eileen
`the Chair
`#973,
`the New York
`State
`
`of
`
`Pursuant
`to the
`authority
`Principal WC Examiner,
`Compensation
`Board,
`
`Compensation
`
`clerk
`
`county
`Compensation
`
`Law,
`copies
`certified
`Law Sections
`
`Disputed
`do hereby
`to the petitioner
`
`give
`
`consent,
`in the
`
`of
`
`the
`
`decisions
`
`Moss,
`Workers'
`
`Workers'
`
`pursuant
`
`to Section
`
`54-b
`
`of
`
`the
`
`above
`
`proceeding
`awards
`
`to file with
`
`pursuant
`
`to
`
`appropriate
`the
`Workers'
`
`filed
`
`of $87.80
`
`13-k,
`13-g,
`payment
`
`awarding
`for medical
`
`making
`or 13-m,
`13-1,
`amount
`in the
`
`plus
`
`interest
`
`services,
`12 Section
`
`Number(s)
`LAWRENCE
`
`11382942,
`HECHT
`
`Rules,
`judgment
`
`and
`
`Regulations
`
`Title
`
`in his/her
`
`name.
`
`Dispute
`on 02/25/2022
`to ROBERT
`to New York
`
`pursuant
`
`Code,
`effectuate
`
`300.19,
`
`in order
`
`that
`
`the petitioner
`
`may
`
`No appeals
`
`were
`
`taken
`
`in this matter
`
`and
`
`the time
`
`to appeal
`
`has expired.
`
`This
`
`consent
`
`is effective
`
`for
`
`thirty
`
`(30)
`
`days
`
`following
`
`the
`
`execution
`
`of
`
`this
`
`document.
`
`Principal WC Examiner,
`Workers'
`New York
`State
`
`as the Chair's
`
`Designee
`
`Disputed
`
`Medical
`
`Bills
`
`Unit
`
`Compensation
`
`Board
`
`SHANE S. ROWE
`NOTARY PUBLIC, STATE OF NEW YORK
`Registration Non02R06111402
`Qualified in Schenectady Countv
`Commission Expires June 7, 20
`
`- Sworn
`/) kday
`
`to before
`
`of
`
`e this
`fr.
`
`, 20
`
`Notary
`
`Public
`
`8 of 15
`
`

`

`FILED: KINGS COUNTY CLERK 12/27/2023 02:06 PM
`NYSCEF DOC. NO. 1
`
`INDEX NO. 092245/2023
`
`RECEIVED NYSCEF: 12/21/2023
`
`NYS
`
`.
`
`.
`
`Workers'
`
`Compensation
`Medical
`Bills
`Disputed
`Street
`328 State
`NY
`Schenectady,
`1-800-781-2362
`
`Board
`Unit
`
`FILE COPY
`
`12305
`
`HECHT ROBERT LAWRENCE
`ISLAND MUSCULOSKELETAL CARE MD
`PO BOX 360
`HEWLETT, NY 11557
`
`Date ofDecision:
`
`02/25/2022
`
`WCBDisputeNumber:
`
`11382940
`
`Health Provider:
`
`Employer
`
`HECHT
`
`ROBERT
`
`LAWRENCE
`
`NYC Health
`
`& Hospital
`
`Corp
`
`WCB·Authorization Number:
`
`WCB CaseNumber:
`
`Carrier Case Number:
`
`Carrier/Self-Insured Employer 1.D. #
`
`205389-0
`
`Claimant:
`
`G2902946
`
`.
`
`08192013893
`Claimant Social Security Number:
`
`W843502
`
`Shani
`
`Bennett,
`Carrier's Name and Address:
`Health & Hospital Corp.
`Attn: Maria Ziccardi
`Deputy Director
`.
`350 Jay Street-9th FI
`Brooklyn, NY 11201
`
`.
`
`Date of Accident or Injury:
`10/16/2020
`
`NOTICE
`
`OF DECISION
`
`AND ADMINISTRATIVE
`
`AWARD
`
`UNDER
`
`SECTION
`
`13-g,
`
`13-k,
`
`13-I
`
`or
`
`13-m
`
`WITH SECTION
`$87.80 WAS NOT PAID IN ACCORDANCE
`CARRIER: MEDICAL
`TOTALING
`13-g,
`TREATMENT(S)
`13-k, 13-I or 13-m OF THE WORKERS'
`THIS AWARD HAS BEEN
`LAW. WHERE APPLICABLE,
`COMPENSATION
`CALCULATED
`BASED UPON THE APPROPRIATE
`FEE SCHEDULE.
`YOU ARE HEREBY NOTIFIED TO
`TO TAE ABOVE INDICATED
`HEALTH PROVIDER
`BY 03126/2022.
`FORWARD
`INCLUDING
`PAYMENT,
`INTEREST*,
`
`THIS FORM, ATTACH
`B ON THE REVERSE.OÚ
`SECTION
`THIS AWARD IS FINAL UNLESS YOU COMPLETE
`YOUR OBJECTION
`TO THIS ORIGINAL
`FORM AND RETURN SAME TO THE
`EVIDENCE
`TO SUPPORT
`ABOVE BY THE SPECIFIED
`DATE. A COPY OF THIS FORM MUST BE SENT TO THE
`ADDRESS
`INDICATED
`THE HEALTH PROVIDER
`CAN SUBMIT COUNTER
`HEALTH PROVIDER.
`IF AN DBJECTION
`IS RAISED,
`EVIDENCE WITHIN 7 DAYS FROM THE RECElPT OF A COPY OF THIS FORM.
`
`IS NOT RAISED TO
`IF AN OBJECTION
`IMPOSED.
`IS ALSO HEREWITH
`IN THE AMOUNT OF $50.00
`A PENA=TY
`WORKERS'
`IN THE AMOUNT OF $50.00 MADE PAYABLE
`TO "CHAIR,
`A CHECK,
`THIS AWARD,
`BOARD",SHOULD
`BE MAILED ALONG WITH THIS ORIGINAL
`FORM TO THE FINANCE
`COMPENSATION
`WORKERS'
`328 STATE STREET,
`N.Y. 12305-2318
`COMPENSATION
`OFFICE,
`BOARD,
`SCHENECTADY,
`ABOVE.
`DATE INDICATED
`
`BY THE
`
`,
`
`IF YOU HAVE ANY QUESTIONS
`1-800-781-2362
`
`PLEASE CONTACT
`
`THE OFFICE OF HEALTH PROVIDER
`
`ADMINISTRATION
`
`AT
`
`to
`1
`
`is directed
`*Employer/Carrier
`rét)ptedrebyrefitþlhMiofíL
`exeict Copy DI
`and
`a true
`ns generaté
`award
`Original
`Workers'
`Côrnpensationpoard.
`the
`
`t
`
`irraccordance
`interest
`This interest
`should
`
`for services
`with 12 NYCRR 300.19, with respect
`to bill(s)
`per annum.
`using a rate of 9.00 percent
`be calculated
`
`b
`
`.
`
`Eileen Moss
`Associate Workers' Compensation
`Disputed Medical Bills Unit
`
`Examiner
`
`9 of 15
`
`

`

`FILED: KINGS COUNTY CLERK 12/27/2023 02:06 PM
`NYSCEF DOC. NO. 1
`
`SECT1ON A - BILLING INFORMAT1ON
`1. Diagnosis or nature of disease or injury (Rate items 1,2,3or 4 to column E by kne.) Enter code and desenbe nature of injury.
`1. I
`1 I
`
`INDEX NO. 092245/2023
`
`RECEIVED NYSCEF: 12/21/2023
`
`2,
`
`MM DD YY
`06
`24
`21
`
`1
`
`B
`
`C
`
`4.
`A
`D
`(USEVWCBCODE)
`Datesofservice
`Procedures,servicesofSupplies
`E lainUnusualCirc*mstances
`To
`P
`MM DD YY Service Blank OPT/HCPCS
`MODIFIER
`11
`992'13
`
`E
`
`F
`
`G
`
`H
`
`I
`
`DiagnosisCode
`
`$Charges
`
`Daysor
`Units
`
`COB ZipCodeWhereSeruceswas
`Rendered
`
`87. 80
`
`1
`
`N
`
`10469
`
`USN lil
`(
`
`2.FederalTaxI.D.Number
`113292487
`NameandMailingAddressofHealthProvider
`HECHT ROBERT LAWRENCE
`ISLAND MUSCULOSKELETAL CARE MD
`2475EASTCHESTER
`ROAD
`BONX, NY 10469
`
`PatienesAccountNo.
`
`4.7otalCharge
`$
`87.80
`
`5.Ant.Pd.(Car,erUseOnly)G.Bal.Due(carrierUseOnly)
`$
`87.80
`
`NameandBillingAddressofHealthProvider
`HECHT ROBERT LAWRENCE
`ISLAND MUSCULOSKELETAL
`PO BOX360
`HEWLETT, NY 11557
`
`CARE MD
`
`INDICATE THE BASIS FOR THIS OBJECTION BELOW AND RETURN THIS ORIGINAL FORM WITH
`IF YOU OBJECT TO THIS AWARD,
`DEVIDENCE TO THE NYS WORKERS' COMPENSATION BOARD, DISPUTED MEDICAL BILLS UNIT,PO BOX 5205,
`BINGHAMTON, NY 13902-5205 BY THE DATE SPECIFIED ON THE FRONT OF THIS FORM. THE CARRIER MUST SEND A COPY OF THIS
`FORM TO THE HEALTH PROVIDER WHEN OBJECTING.
`
`I
`M M
`
`I
`D D
`
`Y Y
`
`Amount paid
`
`n
`
`.
`
`Bill (or bills) was not received.
`
`D4rse-e_saFILED:
`
`No medical reportsfiled.
`Issues not yet adjudicated.
`ATTACHCOPVOFC-8-1BFORM
`Workers' Compensation Board disallowed Claim.
`ATTACHCOPYOFDECISIONNOTICE.
`
`I
`M M
`
`COPYOFCHECK(S)OR
`ATTAC‰ˆ
`' FORMULTIPLEBILLSAND "
`PAYMENTDATES,ATTACH
`ALIST.
`
`Written explanation was sent to Provider on:.
`COPYOFEXPLANATIONMUSTBEATTACHED
`
`Decision appealed. Issues not yet adjudicated.
`ATTACHACOPYOFRB-89FORM
`
`M M
`
`D D
`
`y y
`
`Bill (or bills) was not timely.
`
`
`ATTACHACOPYOFCMS-1500SHOWINGACKNOWLEDGEMENTDATE
`
`D D
`
`Y
`
`¡
`
`Claim Controverted.
`ATTACHACOPYOF
`FROf/ SROl-04FORM.
`
`DATEFROItsROl-04
`FILED:
`
`M M
`
`D D
`
`Y Y
`
`30 days have not lapsed since Claimwas determined.
`
`Other (Attachevidence if any.)
`
`Carrier Contact
`
`Contacts Telephone Number
`10 of 15
`
`M M
`
`D D
`Date
`
`Y Y
`
`

`

`FILED: KINGS COUNTY CLERK 12/27/2023 02:06 PM
`NYSCEF DOC. NO. 1
`
`INDEX NO. 092245/2023
`
`RECEIVED NYSCEF: 12/21/2023
`
`NYS
`
`Workers'
`
`Compensation
`Medical
`Bills
`Disputed
`328 State
`Street
`NY
`Schenectady,
`1-800-781-2362
`
`12305
`
`Board
`Unit
`
`FILE COPY
`
`.
`
`HECHT ROBERT LAWRENCE
`ISLAND MUSCULOSKELETAL CARE MD
`PO BOX 360
`HEWLETT, NY 11557
`
`.
`
`Date of Decision:
`
`02/25/2022
`
`WCBDisputeNumber:
`
`Health Provider:
`
`Employer
`
`HECHT
`
`ROBERT
`
`LAWRENCE
`
`NYC Health
`
`& Hospital
`
`Corp
`
`WCB Authorization Number:
`
`WCB CaseNumber:
`
`G2902946
`
`.
`
`205389-0
`
`Claimant:
`
`Shani
`
`Bennett,
`Carrier's Name and Address:
`Health & Hospital Corp.
`Attn: Maria 21ccardi
`Deputy Director
`350 Jay Street-9th FI
`Brooklyn, NY 11201
`
`Carrier CaseNumber:
`
`08192013893
`
`Insured Employer I.D. #
`
`Carrier/Self
`W843502
`
`Claimant Social Security Number:
`
`Date of Accident or Injury:
`10/16/2020
`
`NOTICE
`
`OF DECISION
`
`AND ADMINISTRATIVE
`
`AWARD
`
`UNDER
`
`SECTION
`
`13-g,
`
`13-8-,
`
`13-I
`
`or
`
`13-m
`
`WITH SECTION
`$§L80 WAS NOT PAID IN ACCORDANCE
`CARRIER: MEDICAL
`TOTALING
`13-g,
`TREATMENT(S)
`13-k, 13-1or 13-m OF THE WORKERS'
`COMPENSATION
`THIS AWARD HAS BEEN
`LAW. WHÈRE APPLICABLE,
`YOU ARE HEREBY NOTIFIED TO
`CALCULATED
`BASED UPON THE APPROPRIATE
`FEE SCHEDULE.
`HEALTH PROVIDER
`BY 03/26/2022.
`FORWARD
`TO THE ABOVE INDiCATED
`INCLUDING
`PAYMENT,
`INTEREST*,
`
`B .ON THE REVERSE OF THIS FORM, ATTACH
`SECTION
`THIS AWARD IS FINAL UNLESS YOU COMPLETE
`YOUR OBJECTION
`EVIDENCE
`TO SUPPORT
`TO THIS ORIGINAL
`FORM AND RETURN SAME TO THE
`ABOVE BY THE SPECIFIED
`DATE. A COPY OF THIS FORM MUST BE SENT TOTHE
`ADDRESS
`INDICATED
`IF AN OBJECTION
`THE HEALTH PROVIDER
`HEALTH PROVIDER.
`IS RAISED,
`CAN SUBMIT COUNTER
`EVIDENCE WITHIN 7 DAYS FROM THE RECElPT OF A COPY OF THIS FORM.
`
`IF AN OBJECTION
`IMPOSED.
`IN THE AMOUNT OF $50.00
`A PENALTY
`IS ALSO HEREWITH
`IS NOT RÁlSED TO
`WORKERS'
`IN THE AMOUNT OF $50.00 MADE PAYABLE
`THIS AWARD, A CHECK,
`TO "CHAIR,
`COMPENSATION
`BE MAILED ALONG WITH THIS ORIGINAL
`FORM TO THE FINANCE
`BOARD",SHOULD
`WORKERS'
`328 STATE STREET,
`COMPENSATION
`N.Y. 12305-2318
`OFFICE,
`SCHENECTADY,
`BOARD,
`DATE INDICATED
`ABOVE.
`
`BY THE
`
`IF YOU HAVE ANY QUESTIOES
`1-800-781-2362
`
`PLEASE CÒNTACT
`
`THE OFFICE OF HEALTH PROVIDER
`
`ADMINISTRATION
`
`AT
`
`iÃx iNIPea
`*Employer/Ca
`on of dffi#0
`rendered
`original
`the WOrk
`
`s
`39
`S6&× at Q(cid:5)
`el,i
`asÆegezáted
`award
`rs'
`CO
`
`ri
`
`.
`
`o dance with 12 NYCRR 300.19, with respect
`for services
`to bill(s)
`per annum.
`using a rate of 9.00 percent
`tWest shoúId be calculated
`by
`
`Eileen Moss
`Associate Workers' Compensation
`Disputed Medical Bills Unit
`
`Examiner
`
`Certified
`
`On
`
`11 of 15
`
`

`

`FILED: KINGS COUNTY CLERK 12/27/2023 02:06 PM
`NYSCEF DOC. NO. 1
`
`INDEX NO. 092245/2023
`
`RECEIVED NYSCEF: 12/21/2023
`
`A - Bf(NG
`SECT.N
`INFORMADON
`1. Diagnosis or nature of disease or injury (Rate items 1,2,3or 4 to column E by IIne.)Enter code and desenbe nature of injury.
`1, l
`3.
`2. I
`
`"
`
`4.
`D
`(USEWCBCODE)
`Procedures,senticesofSupplies
`ExplainUnusualCirc*mstances
`Placeof Leave
`ce Blank OPT/HCPCS.
`MODIFIER
`11
`99213
`
`A
`Datesofservice
`
`To
`MM DD YY
`
`From
`MM DD YY
`08
`05
`21
`
`1
`
`B
`
`C
`
`E
`
`F
`
`G
`
`H
`
`I
`
`DiagnosisCode
`
`SCharges
`
`Daysor
`Units
`
`COB ZipCodewhereServiceswas
`Rendered
`
`87.80
`
`1
`
`N
`
`10469
`
`2.FederalTaxI.D.Number
`113292487
`
`.ng.N gif
`(
`
`3.Patient'sAccountNo.
`
`4.'!otalCharge
`$
`87.80
`
`5.Ant.Pd.(CanerUseOr.y) 6.Bal.Due(carrierUseOnly)
`$
`$
`87.80
`
`NameandMailingAddressofHealthProvider
`HECHT ROBERT LAWRENCE
`ISLAND MUSCULOSKELETAL CARE MD
`2475EASTCHESTER
`ROAD
`BONX, NY 10469
`
`NameandBillingAddressofHealthProvider
`HECHT ROBERT LAWRENCE
`ISLAND MUSCULOSKELETAL
`PO BOX360
`HEWLETT, NY 11557
`
`CARE MD
`
`INDICATE THE BASIS FOR THIS OBJECTION BELOW AND RETURN THIS ORIGINAL FORM WITH
`IF YOU OBJECT TO THIS AWARD,
`EVIDENCE TO THE NYS WORKERS' COMPENSATION BOARD, DISPUTED MEDICAL BILLS UNIT,PO BOX 5205,
`OBINGHAMTON, NY 13902-5205 BY THE DATE SPECIFIED ON THE FRONT OF THIS FORM. THE CARRIER MUST SEND A COPY OF THIS
`FORM TO THE HEALTH PROVIDER WHEN OBJECTING.
`
`Bill was paid on
`
`M M
`
`D D
`
`Y Y
`
`Amount paid
`
`$
`
`s
`
`-
`
`Bill (or bills) was not received.
`
`DATEC-8.1BFILED:
`
`No medical reportsfiled.
`Issues not yet adjudicated.
`ATTACHCOPYOFC-8.1BFORM
`Workers' CompensationBoard disallowed Claim.
`ATTACHCOPYOFDECISIONNOTICE.
`
`I
`M M
`
`COPYOFCHECK(S)OR
`vOUCHER(S)MUSTBE
`ATTACHED.
`*FORMULTTPLEBILLSAND
`PAYMENTDATES,ATTACH
`4 L'ST.
`
`Written explanation was sent to Provider on:.
`COPYOFEXPLANATTONMUSTBEATTACHED
`
`Decision appealed. Issues not yet adjudicated.
`ATTACHACOPVOFRB¬99FORM
`
`M M
`
`D D
`
`Y Y
`
`Bill (or bills) was not timely.
`DATE-
`ATTACHACOPYOFCMS-1ti00SHOWINGACKNOWLEDGEMENT
`
`D D
`
`I
`Y Y
`
`¡
`
`Claim Controverted.
`ATTACHACOPYOF
`FROI/ SRŒI-04FORM.
`
`DATEFROI/ SROl-04
`FILED
`
`y y
`
`30 days have not lapsed since claim was determined.
`
`Other (AttaChevidence if any.)
`
`Carrier Contact
`
`ContaCt'sTelephone Number
`12 of 15
`
`M M
`
`D D
`Date
`
`Y Y
`
`

`

`FILED: KINGS COUNTY CLERK 12/27/2023 02:06 PM
`NYSCEF DOC. NO. 1
`
`INDEX NO. 092245/2023
`
`RECEIVED NYSCEF: 12/21/2023
`
`OF NEW YORK
`STATE
`WORKERS'
`COMPENSATION
`328 STATE
`STREET
`NY 12305-2318
`SCHENECTADY,
`
`BOARD
`
`- SE
`
`THISAGENCYEMPLOYSAND
`
`STH DS`IM
`
`RODRIGUEZ
`
`cuRISSAC
`
`(518)
`
`486-9564
`
`INFORMATION
`
`FOR COUNTY
`
`CLERK
`
`has been
`you
`is acting
`said
`of
`
`Board
`
`default
`Workers'
`
`or
`
`("Board"),
`in the payment
`
`on behalf
`
`award,
`
`Compensation
`
`Law
`
`The
`
`person
`
`before
`
`awarded
`
`payment
`
`the New York
`
`Workers'
`
`State
`
`Compensation
`
`by
`of an individual
`a filing
`is being
`to secure
`a judgment.
`
`who
`
`made
`
`has been
`
`awarded
`
`payment.
`
`Due
`
`to a
`
`pursuant
`
`to Section
`
`54-b
`
`of
`
`the
`
`you
`
`should
`
`have
`
`been
`
`signed
`
`consent
`
`to file
`
`of
`
`presented
`
`with
`
`a certified
`
`from
`
`the Chair
`
`of
`
`copy
`the Board,
`
`("WCL")
`of
`the decision
`
`or
`
`the Chair's
`
`the Board,
`designee.
`
`Accordingly,
`an original
`and
`
`Attached
`
`please
`
`find
`
`the text
`
`of Section
`
`54-b
`
`of
`
`the
`
`Workers'
`
`Compensation
`
`Law.
`
`This
`
`section
`
`of
`
`law provides
`
`that
`
`in the event
`
`an insurance
`
`Fund
`
`defaults
`
`in the payment
`
`of an award
`
`consent
`
`of
`
`the Chair
`
`the Chair's
`
`carrier,
`made
`
`by
`file with
`
`self-insured
`
`employer
`
`or
`
`the State
`
`Insurance
`
`the Board,
`the
`
`party
`any
`clerk
`
`for
`
`employer
`
`with
`
`may,
`in which
`
`the
`
`the
`
`or
`the county
`a certified
`copy
`be entered
`(WCL
`
`designee,
`in which
`the carrier
`
`county
`or self-insured
`
`to an award
`the county
`has
`its principal
`
`place
`
`of
`
`the
`
`decision
`
`that
`
`awarded
`
`coinpensation.
`
`in the Supreme
`
`Court
`
`by
`
`the
`
`clerk
`
`Immediately
`of
`such
`
`upon
`
`such
`
`county
`
`in
`
`Section
`
`54-b).
`
`filing,
`
`conformity
`
`occurred
`
`or
`
`injury
`of business,
`must
`"judgment
`therewith."
`
`Please
`
`be advised
`
`provides
`
`that
`
`of
`
`the Board
`
`it
`
`the Board
`that
`is the county
`upon
`consent
`
`has no authority
`is to enter
`who
`
`to enter
`
`judgment
`
`a judgment.
`Section
`the filing
`
`upon
`
`of
`
`54-b
`
`the
`
`specifically
`certified
`decision
`
`clerk
`
`of
`
`the Chair
`
`(or
`
`the Chair's
`
`designee).
`
`find
`
`Rules
`
`on the
`
`attachment
`
`please
`
`also
`
`the text
`
`of
`
`the New York
`
`Code,
`intereston
`
`and
`
`awards;
`centum
`
`and Civil
`
`per
`
`annum.
`
`12 Part
`Title
`Law & Rules
`
`300.19,
`Section
`
`which
`
`provides
`
`for
`
`computation
`
`of
`
`5004,
`
`which
`
`sets
`
`the rate
`
`of
`
`interest
`
`at nine
`
`per
`
`Additionally,
`Regulations
`
`Practice
`
`If
`
`there
`
`Office
`
`number
`
`are any
`of General
`
`questions,
`
`Counsel,
`
`(518)
`
`486-9564,
`
`facsimile
`
`328 State
`
`Street,
`number
`
`please
`
`contact
`
`the New York
`
`Workers'
`
`State
`New York
`
`Compensation
`
`12305-2318,
`
`Board,
`telephone
`
`Schenectady,
`402-0113.
`
`(518)
`
`13 of 15
`
`

`

`FILED: KINGS COUNTY CLERK 12/27/2023 02:06 PM
`NYSCEF DOC. NO. 1
`
`INDEX NO. 092245/2023
`
`RECEIVED NYSCEF: 12/21/2023
`
`New York
`
`State
`
`Workers'
`
`Compensation
`
`Law
`
`Section
`
`54-b.
`
`Enforcement
`
`on failure
`
`to pay
`
`award
`
`or
`
`judgment.
`
`due under an award for the period of thirty days
`in the payment of any compensatipn
`In case of default by a carrier or self-insured employer
`to make full payment of an award for medical
`is due and payable, or in the case of failure by a carrier or self-insured employer
`after payment
`the chair in any such case or on the chair's consent any
`to section thirteen-g of this chapter,
`care issued by the board or the chair pursuant
`party to an award may file with the county clerk for the county in which the injury occurred or the county in which the carrier or self-insured
`or ending,
`(1) a certified copy of the decision of the board awarding compensation
`employer has his or her principal place of business,
`from which no appeal has been taken within the time allowed therefor, or if an
`diminishing or increasing compensation
`previously awarded,
`appeal has been taken by a carrier or self-insured employer who has not complied with the provisions of section fifty of this article, where he
`or she fails to deposit with.the chair the amount of the award as security for its payment within ten days after the same is due and payable,
`to section thirteen-g of this chapter, and thereupon judgment must be
`or (2) a certified copy of the award for medical care issued pursuant
`in default be
`entered in the supreme court by the clerk of such county in conformity therewith immediately upon such filing.
`If the payment
`the board may declare the entire award due and judgment may be entered in accordance with the provisions of this section.
`an installment,
`to the same proceedings as though rendered in a
`Such judgment shall be entered in the same manner, have the same effect and be subject
`that no appeal may be taken therefrom. The court shall vacate or modify such
`suit duly heard and determined by the supreme court, except
`to conform to any later award or decision of the board upon presentation of a certified copy of such award or decision. The award
`judgment
`may be so compromised by the board as in the discretion of the board may best serve the interest of the persons entitled to receive the
`in accordance with the provisions of
`compensation or benefits. Where an award has been made against a carrier or self-insured employer
`subdivision nine of section fifteen; or of section twenty-five-a of this chapter, such an award may be similarly compromised
`by the board,
`of any such fund, notice shall be
`of the fund to which the award is payable, but if there be no representative
`upon notice to a representative
`any other provision of law, such
`given to such representative as may be designated by the chair of the board; and notwithstanding
`the chair nor any party in interest shall
`the necessity of any approval by the state comptroller. Neither
`compromise shall be effective without
`be required to pay any fee to any public officer for filing or recording any paper or instrument or for issuingp transcript of any judgment
`executed in pursuance of this section. The carrier or self-insured employer shall be liable for all costs and attorneys fees necessary to
`the term "carrier" shall
`enforce the award. For the purposes of this section,
`include the state insurance fund and any stock corporation,
`the business of workers' compensation
`insurer authorized to transact
`insurance in this state.
`mutual corporation or reciprocal
`
`Title
`
`12 New York Code,
`Interest
`on Unpaid
`
`Rules
`Awards
`
`and Regulations
`and Unpaid
`
`Section
`Medical
`
`Bills
`
`300.19
`
`Section
`
`300.19(o).
`
`Computation
`
`and
`
`date
`
`of accrual
`
`of
`
`interest.
`
`Interest shall be computed on the entire amount of the award. For the purpose of computing interest,
`
`the date of accrual
`
`is:
`
`(a) the 45th day after the bill was submitted to the insurance carrier or self-insured employer and no payment
`was made nor objection to payment was timely raised;
`(b) the 30th day after the date of filing of the final decision of award
`establishing the employer's liability for the payment of a medical bill by the Workers' Compensation Board; or
`(c) the 30th day after the date of decision by an appellate court establishing the employer's liability for payment of a medical bill.
`Payment of interest
`in all cases shall accrue until the date of payment of the award.
`
`Section
`
`300.19(o).
`
`Interest
`
`Rate
`
`the actuary shali use simple interest at the rate provided in section 5004 of the Civil Practice
`In computing the interest due on an award,
`Law and Rules, which shall not exceed 1 and 1/2 percent per month.
`
`New York
`
`State
`
`Civil
`
`Practice
`
`Law and Rules
`
`Section
`
`5004.
`
`Rate
`
`of
`
`interest.
`
`Interest shall be at the rate of nine per centum per annum, except where otherwise provided by statute.
`
`14 of 15
`
`

`

`FILED: KINGS COUNTY CLERK 12/27/2023 02:06 PM
`NYSCEF DOC. NO. 1
`
`INDEX NO. 092245/2023
`
`RECEIVED NYSCEF: 12/21/2023
`
`SUPREME
`COUNTY
`
`COURT
`OF KINGS
`
`OF THE
`
`STATE
`
`OF NEW YORK
`
`In the Matter
`
`of
`
`the Application
`
`of
`
`ROBERT
`
`LAWRENCE
`
`HECHT
`
`HEALTH
`
`- Against
`& HOSPITAL
`
`-
`
`CORP.,
`
`to
`pursuant
`judgment
`for
`Law Section
`Compensation
`OF NEW YORK
`OF NASSAU
`
`STATE
`COUNTY
`
`Workers'
`
`54-b
`
`)
`) ss.:
`
`Petitioner,
`
`Respondent(s),
`
`I, ELIZABETH
`
`SCHNEIDER,
`
`sworn
`
`say:
`
`the
`
`age
`
`I am over
`Proposed
`Chair
`of
`provided
`
`securely
`United
`
`of 18 years.
`Attorney's
`Judgment,
`Workers'
`Compensation
`the
`on behalf
`by the WCB,
`wrapped
`postpaid
`Postal
`States
`Service
`
`being
`duly
`On D
`, I personally
`to File
`, and Consent
`Affirmatio
`together
`with
`Board
`(WCB)
`MUSCULOSKELETAL
`ISLAND
`into the
`placed
`I personally
`as follows:
`
`of
`
`envelope,
`addressed
`
`mailed
`Issued
`
`a copy
`of petitioner's
`by the Designee
`documents
`supporting
`CARE to the
`respondent
`control"
`"exclusive
`of
`the
`
`of
`
`the
`
`in a
`
`Respondenes
`Address:
`& HOSPITAL
`HEALTH
`STREET
`JAY
`350
`BROOKLYN
`NY 11201
`
`CORP.
`
`Such
`
`being
`preceding
`communication
`
`the
`papers
`
`address
`in this
`by mail.
`
`within
`action,
`
`the State
`between
`
`previously
`which
`
`designated
`places
`there
`
`by him for
`then was
`and
`
`upon
`that
`purpose,
`is now a regular
`
`the
`
`Dated: December
`
`20, 2023
`
`or Me on
`
`U
`
`B(cid:20)
`
`CHNEIDER
`
`Suz ne olzman
`of New York
`Public, St
`No
`No:01R
`97
`Qualifieclin NassauCounty
`CommissionExpires:July D1,2025
`
`/
`Andrew L Saraga
`Notary Public,State of NewYork
`No:02SA6313879
`Qualifiedin Suffolk County
`CommissionExpires:January 4, 2027
`
`L&B
`
`File No.:
`
`1061A-WC-1078
`
`15 of 15
`
`