Upon the e-filed documents numbered 496 to 770 and due deliberation, it is determined as follows:

ORDERED that plaintiff's motion for summary judgment is granted in its entirety; and it further

ORDERED that plaintiff shall submit a proposed judgment to the Court within twenty (20) days of the posting of this Order on NYSCEF.

This is an action for a declaratory judgment pursuant to CPLR 3001 in which Integon National Insurance Company (Integon or plaintiff) seeks, inter alia, a determination that it is not legally obligated to provide any coverage, reimbursements, or pay any monies, sums, or funds to any of the defendants in relation to eight alleged automobile accidents that Integon contends were staged as a large scale "ring" in order to defraud it.

Integon commenced this action by filing a summons and verified complaint on January 18, 2024. Integon claims that the automobile incidents of March 17, 2023 (Claim No. 9XINY03320), March 24, 2023 (Claim No. 9XINY03316), March 25, 2023 (Claim No. 9XINY03328), April 6, 2023 (Claim No. 9XINY04277), April 22, 2023 (Claim No. 9XINY04296), April 26, 2023 (Claim No. 9XINY04229), May 26, 2023 (Claim No. 9XINY05447) and July 7, 2023 (Claim No. 9XINY07145) (collectively Eight Incidents) were staged and/or intentional events and not the result of a legitimate occurrence, and thus not covered under the respective policies of insurance. Integon alleges that the Insured Claimant Defendants and the Passenger Claimant Defendants (collectively Staged Loss Defendants) staged the Eight Incidents with the intent to obtain insurance benefits to which the Staged Loss Defendants would not otherwise be entitled.

In its complaint, Integon explains that its investigation into the Eight Incidents revealed several red flags, like for example, that each Insured Claimant Defendant who applied for a [*2]policy of insurance from Integon was from Ecuador, each loss involved three occupants in the vehicle, nearly all the losses occurred in the same area, each insured vehicle was allegedly rear-ended by a box truck, or similar commercial vehicle, each loss occurred shortly after the policy of insurance was issued and before any policy premiums were paid (apart from the initial premium paid at the broker's office), nearly every Staged Loss Defendant went to one of two specific medical offices for treatment, each Staged Loss Defendant (except one) retained the same attorney for legal representation, and each policy of insurance was cancelled shortly after each accident for non-payment of insurance premiums.

According to the complaint, each Insured Claimant Defendant was steered and or/directed by Carolina Veronica Rodriguez-Moran and Ruth Stefany Rodriguez-Moran (Facilitator Defendants) to the same insurance broker to obtain a temporary policy of insurance from Integon, and to the same two medical offices for medical treatment. Integon alleges that the Staged Loss Defendants agreed to treat with the Healthcare Provider Defendants because the fraudulent scheme presented an opportunity to realize financial benefits they would not have otherwise realized — by way of either receiving cash kickbacks for treatment or building a bodily injury case to be presented to Integon for a speedy settlement, or both.

Integon alleges that the Healthcare Provider Defendants often subjected the Staged Loss Defendants to various forms of therapy and medically useless and expensive diagnostic tests, and inexplicably prescribed medically unnecessary and expensive "prescription only" medications and durable medical equipment to the Staged Loss Defendants. Integon claims that it has received multiple claims from the Healthcare Provider Defendants stemming from the Eight Incidents, seeking tens of thousands of dollars for medical and other services purportedly rendered to the Staged Loss Defendants by the Healthcare Provider Defendants. Integon seeks a determination that it is not legally obligated to provide any coverage, reimbursements, or pay any monies to the Healthcare Provider Defendants since they each took an assignment of benefits from one or more of the Staged Loss Defendants and are therefore subject to all defenses that Integon asserts against the Staged Loss Defendants.

On January 15, 2025, this Court granted Integon's motion for default judgment against the Insured Claimant Defendants, the Passenger Claimant Defendants, the Defaulting Facilitator Defendants, the Defaulting Adverse Vehicle Defendants, but for defendants Chiropractic Exam Works PC, EDX Medical Supply Inc, First Supply Inc, Gur Medical Supplies Inc, In Trails Med Inc, Manamim MS Inc, Medex Supplies Inc, Provista Med Inc, Therapy Zone Rentals Inc, Viotek Med Supplies Inc., Anthony Manuel Pinela-Rosado, Cesar Andres Tenesaca Fierro, and Tony G. Lien (Excluded Defendants). The Court found that the Excluded Defendants were subject to stipulations/notices accepting their late answer, withdrawing the default motion against them, or discontinuing claims against them. A judgment was thereafter signed and entered by the Suffolk County Clerk against the defaulting defendants in accordance with the January 15, 2025 Order.

Plaintiff now moves for summary judgment against the answering individual defendants and the answering healthcare providers. In support of its motion, plaintiff included numerous exhibits, including certified copies of the subject policies, the affidavit of Renato Pedro, the management adjusting CSL associate manager employed by Assigned Risk Solutions, LTD., a third-party administrator handling and managing claims on behalf of Integon, the affidavit of Edward Block, a claims-field auto NG-Cons II investigator employed by National General Insurance Company, claims administrator for Integon, transcripts from examinations under oath [*3](EUOs), no-fault insurance law denial of claim forms (NF10), affidavits from the adverse drivers involved in the underlying accidents, uncertified police accident reports, ISO claims search results, and different medical records and medical bills.

Defendants Cesar Tenesaca-Fierro and Anthony Pinela-Rosado, who are Passenger Claimant Defendants (Opposing Passenger Defendants), and were involved in the April 22, 2023 loss, oppose the motion. The Opposing Passenger Defendants provided the ambulance call reports, the bill of particulars and supplemental bill of particulars in connection with the lawsuit they filed in Queens Supreme Court (Index No.: 713051/2023) against the adverse driver involved in the accident, and their own affidavits.

Defendants All City Family Health Care Center Inc., Andrew A Merola, MD, Citimed Complete Medical Care, P.C., Fifth Avenue Surgery Center LLC, Integrated Specialty Asc, LLC, Rockaways ASC Development LLC, SCOB LLC, Surgicore of Jersey City, LLC, Triborough NY Medical Practice, P.C. (collectively Rybak Defendants) also oppose the motion, as do the defendants Global Surgery, LLC, Parkside Medical Care, P.C., Right Choice Supply, Inc., Shop RX Pharmacy, Inc. and Harvey Levitan Medical, P.C. (collectively Tsirelman Defendants), defendant Comprehensive Medical Care at 3rd Avenue, P.C. (Comprehensive), and defendant Advanced Orthopedics, PLLC (Advanced). None of these health care provider defendants provided their own affidavits, but just their attorneys' affirmations and some other documents or cases. The Opposing Passenger Defendants, Rybak Defendants, Tsirelman Defendants, Comprehensive, and Advanced will be referred collectively as Opposing Defendants.

The Court will preface this summary judgment analysis with the statement that insurance fraud is not a victimless crime. Because premium increases partly incorporate fraud costs, insurance fraud hurts all policyholders, not just insurers (Robert W. Emerson, Insurance Claims Fraud Problems and Remedies, 46 U Miami L Rev 907, 913 [1992]). According to the Coalition Against Insurance Fraud, the U.S. loses approximately $308.6 billion in insurance fraud. Compounding the problem is the involvement, in some claims, of unscrupulous professionals, such as medical, legal, or other experts (Robert W. Emerson, Insurance Claims Fraud Problems and Remedies, 46 U Miami L Rev at 913).

The proponent of a summary judgment motion must make a prima facie showing of entitlement to judgment as a matter of law, tendering sufficient evidence to eliminate any material issues of fact from the case. To grant summary judgment it must clearly appear that no material and triable issues of fact are presented (Alvarez v Prospect Hosp., 68 NY2d 320, 324 [1986]; Sillman v Twentieth Century-Fox Film Corp., 3 NY2d 395, 403 [1957]). The movant has the initial burden of proving entitlement to summary judgment (Winegrad v New York Univ. Med. Ctr., 64 NY2d 851, 852 [1985]). Failure to make such a showing requires denial of the motion, regardless of the sufficiency of the opposing papers (id.). Once such proof has been offered, the burden then shifts to the opposing party, which, inorder to defeat the motion for summary judgment, must proffer evidence in admissible form and must "show facts sufficient to require a trial of any issue of fact" (CPLR 3212 [b]; Alvarez v Prospect Hosp., 68 NY2d at 324).

An intentionally caused or staged vehicular collision is not a covered accident under an insurance policy (Adirondack Ins. Exch. v Rodriguez, 215 AD3d 904, 905 [2d Dept 2023]; National Gen. Ins. Online, Inc. v Blasco, 210 AD3d 786, 787 [2d Dept 2022]; see Progressive Advanced Ins. Co. v McAdam, 139 AD3d 691, 692 [2d Dept 2016]). When a collision is intentionally caused, the insurer is not obligated to provide coverage, even to innocent third [*4]parties (Adirondack Ins. Exch. v Rodriguez. 215 AD3d at 905; Nationwide Gen. Ins. Co. v Pontoon, 123 AD3d 1040, 1041 [2d Dept 2014]). Moreover, it does not matter "whether the intentional collision was motivated by fraud or malice" (GEICO v Shaulskaya, 302 AD2d 522, 523 [2d Dept 2003]; see Travelers Indem. Co. v Cruz, 40 AD3d 362, 363 [1st Dept 2007]).

"To interpose a defense of staged-accident fraud , [the insurer] must establish 'the fact or founded belief that the alleged injur[ies] do[ ] not arise out of an insured incident'" (Webster Diagnostic Medicine, P.C. v State Farm Ins. Co., 15 Misc 3d 97, 98 [App Term, 2d Dept, 9th & 10th Jud Dists 2007], quoting Cent. Gen. Hosp. v Chubb Group of Ins. Companies, 90 NY2d 195, 199 [1997]; Ocean Diagnostic Imaging P.C. v Allstate Ins. Co., 6 Misc 3d 134[A] [App Term, 2d Dept, 9th & 10th Jud Dists 2005]). In meeting this burden, an insurer need only establish by a preponderance of the evidence that the collision was not an accident (V.S. Med. Services, P.C. v Allstate Ins. Co., 25 Misc 3d 39, 41 [App Term, 2d Dept, 11th & 13th Jud Dists 2009]). The insurer must demonstrate the facts elicited during an investigation that make up the founded belief (Am. Alternative Ins. Corp. v Washington, 60 Misc 3d 1222[A] [Sup Ct, New York County 2018]). While an insurer may put forth evidence of a fraudulent scheme in order to prove that a collision was not an accident, the insurer need not prove fraud (V.S. Med. Services, P.C. v Allstate Ins. Co., 25 Misc 3d at 40; see Matter of Eagle Ins. Co. v Davis, 22 AD3d 846, 803 [2d Dept 2005]).

Here, Integon established its prima facie entitlement to judgment as a matter of law by demonstrating, through admissible evidence, that the Eight Incidents were deliberately caused to fraudulently obtain insurance benefits (Natl. Gen. Ins. Online, Inc. v Blasco, 210 AD3d 786, 787 [2d Dept 2022]; State Farm Mut. Auto. Ins. Co. v Laguerre, 305 AD2d 490, 491 [2d Dept 2003]).

The affirmation of plaintiff's investigator, Mr. Block, the EUOs of the individual defendants, and the numerous attached exhibits substantiated the investigator's allegations of the insureds' participation in a "ring" that stages traffic incidents to defraud insurers (Webster Diagnostic Medicine, P.C. v State Farm Ins. Co., 15 Misc 3d at 98). The affirmations from Mr. Block and Mr. Pedro, the verified complaint, the EUOs, the ISO reports, the affidavits from the adverse drivers, and the medical records contained sufficient non-conclusory factual allegations to support Integon "founded belief" that the Eight Incidents were intentional and staged to defraud the insurer (see Unitrin Safeguard Ins. Co. v Manuel, 236 AD3d 558, 559 [1st Dept 2025] ["plaintiff demonstrated a founded belief that claimants' injuries did not arise out of the accident"]). Integon established that the Eight Incidents were not covered accidents by the preponderance of admissible evidence.

Plaintiff's investigator, Mr. Block, affirmed that upon receiving notice of various accidents that occurred somewhat contemporaneous with each other, and which had common characteristics, Integon identified various "red flags" that necessitated further investigation into whether the subject losses were legitimate accidents or whether they were intentional acts designed to defraud Integon. According to Mr. Block, these factors included, but were not limited to, the following: (i) each loss involved an insured driver (Insured Claimant Defendants) and two passengers (Passenger Claimant Defendants) — all from Ecuador; (ii) each Insured Claimant Defendant applied for insurance through the same insurance broker, Mansi International, LLC (Mansi); (iii) although having no apparent relationship, one or more of the Insured Claimant Defendants utilized the same address on their respective policy applications; (iv) many of the Insured Claimant Defendants applied using an address that did not correspond [*5]to the address listed on the police reports or otherwise communicated to Integon after the alleged incident(s); (v) nearly all occupants lived in the same geographic area; (vi) nearly all the losses occurred in the same area and occurred under identical circumstances — a rear-ended collision with a commercial vehicle; (vii) each loss occurred within 45 days after Integon issued each policy of insurance, before any policy premiums were made (apart from the initial premium paid at the broker's office); (viii) nearly every individual went to one of two specific medical offices for treatment, and each (except one) retained the same attorney for legal representation; and (ix) each policy of insurance was cancelled shortly after each incident for non-payment of insurance premiums and not a single cancellation was contested (NYSCEF Doc No. 564).

Mr. Block further affirmed that based on Integon's investigation and the EUOs conducted, Integon concluded that not a single loss was a covered event, but rather was staged and/or intentional, each being a mere component of a larger scheme to defraud Integon. According to Mr. Block, nearly every Insured Claimant Defendant that appeared for an EUO purchased a vehicle with cash — some did not know from whom he/she purchased the vehicle or could not recall the details regarding the purchase, (ii) each vehicle was first purchased at auction (some on the same date) and subsequently sold to the Insured Claimant Defendant, (iii) each Insured Claimant Defendant was steered to the same insurance broker - Mansi (iv) each Insured Claimant Defendant was brought, in person, to the same broker's office by the same individual(s), i.e., one or more of the Facilitator Defendants, (v) one or more of the Facilitator Defendants were, in the past, involved in independent motor vehicle incidents and treated at one of the medical offices where most of the Individual Defendants purportedly received medical treatment (NYSCEF Doc No. 564).

Mr. Block's affirmation relies on the transcripts from the EUOs of the Insured Claimant Defendants and the Passenger Claimant Defendants. The EUOs submitted by Integon in support of its motion were mostly unsigned by the respective individual defendants. Integon provided affidavits and affirmations about the generation and mailing of the letters requesting signed copies of the respective transcripts and that most of the EUO transcripts were not returned (see NYSCEF Doc Nos. 728-729). Specifically, Integon presented the affirmation of Arthur DiMartini, which set forth the standard office practices and procedures related to the generation and mailing of letters (accompanied by the EUO transcripts), requesting that the transcripts be signed, executed and returned to the law office within 60 days. Integon also provided copies of the letters sent to each of the individual defendants who appeared at the EUOs.

While the Opposing Defendants challenge the admissibly of the EUO transcripts, the EUO transcripts are admissible as Integon demonstrated that the transcripts were sent to the witnesses to be reviewed for any corrections, and that sufficient time to do so has passed (see CPLR 3116 [a] ["The deposition shall be submitted to the witness for examination and shall be read to or by him or her, and any changes in form or substance which the witness desires to make shall be entered at the end of the deposition with a statement of the reasons given by the witness for making them. The deposition shall then be signed by the witness before any officer authorized to administer an oath. If the witness fails to sign and return the deposition within sixty days, it may be used as fully as though signed"]; see also LM Gen. Ins. Co. v Bunting, 2024 NY Misc LEXIS 60645, at *11 [Sup Ct, Nassau County, Apr. 15, 2024, No. 602116/2023] ["in the absence of any indication that the [EUO] transcript was mailed to [the witness] and not returned within 60 days, the Court will not consider the transcript in deciding plaintiff's motion"]; Suarez Med., PLLC v Nationwide Ins., 2025 NY Slip Op 51996[U] [Civ Ct, Kings County, Dec. 16, [*6]2025] [applying CLR 3116 (a) to EUO transcripts]; State Farm Fire & Cas. Co. v Quinones, 2025 NY Mis. LEXIS 1293, at *10 [Sup Ct, New York County Mar. 7, 2025, No. 152505/2021] [same]; Jiang Acupuncture PC v State Farm Ins. Co., 80 Misc 3d 1211[A] [Civ Ct, Queens County 2023] [same]). The Opposing Defendants cited to no authority stating that CPLR 3116 (a) is not applicable to EUO transcripts.

Furthermore, the unsigned EUO transcripts of the individual defendants are admissible, since they were certified by the court reporter (Am. States Ins. Co. v Huff, 119 AD3d 478, 479 [1st Dept 2014] ["EUO transcript of Huff was admissible evidence on the motion for summary judgment as it was certified by the court reporter and is considered a party admission"]; Jamaica Dedicated Med. Care, P.C. v Praetorian Ins. Co., 47 Misc 3d 147[A] [App Term, 2d Dept, 11th & 13th Jud Dists 2015]; Lifex Med. Care, P.C. v Safeco Nat. Ins. Co., 32 Misc 3d 126[A] [App Term, 2d Dept, 11th & 13th Jud Dists 2011]; see also MML Med. Care, P.C. v Praetorian Ins. Co., 46 Misc 3d 12 [A] [App Term, 2d Dept, 11th & 13th Jud Dists 2014]).

Based on the review of the admissible EUOs transcripts, Mr. Block revealed significant discrepancies in the accounts of the Insured Claimant Defendants and the Passenger Claimant Defendants regarding their activities before and after the accident, and irregularities with respect to the individuals' various identities and addresses. Many Passenger Claimant Defendants were randomly called on the date of the respective loss, got into a vehicle not knowing one of the other passengers, were on the phone while the alleged incident occurred, and did not know exactly where they were going or why. Several of the Staged Loss Defendants were in some way contacted by "Carolina" or "Estefania" — either related to the purchase of the respective vehicle or referral to the respective medical office for treatment. The Court agrees with Integon that the transcripts of the EUOs reveal clear inconsistencies among the testimonies provided by the occupants of the vehicles involved in the eight losses as to how they each knew each other, who was in the vehicle and when, where they were going and why. Such "red flags" in the EUOs undermined the credibility of the accounts of the Insured Claimant Defendants and the Passenger Claimant Defendants (see Unitrin Safeguard Ins. Co. v Manuel, 236 AD3d at 559).

For example, regarding the March 17, 2023 loss, the insured driver Stefania Baculima testified that on the day of the alleged accident she and her passenger friend Dennys Albuja picked up Yuleidy Mendoza at a McDonalds somewhere in Queens and were driving to eat at another McDonalds off the Whitestone Expressway. Ms. Mendoza testified that she did not know where they were going, and that Mr. Albuja is Ms. Baculima's cousin. Mr. Albuja testified that he is not Ms. Baculima's cousin, and that Ms. Mendoza and Ms. Baculima were in the vehicle together when they picked him up.

Regarding the April 22, 2023 loss, the insured driver Alfredo Salazar-Ochoa testified that a week after the incident he began treatment at a therapy clinic in Queens, even though he lived in East Hampton because he apparently did not know of any other places to treat. Mr. Salazar-Ochoa also testified that both the passengers were sitting in the back of his vehicle. Passenger Anthony Pinela-Rosado testified that on the contrary he was sitting in the front passenger seat, and that the incident was the first time he met Mr. Fierro.

In another example, the May 26, 2023 loss, the insured Ernesto Fajardo-Moran testified that he purchased the subject vehicle in the Bronx with $5,000 in cash, without inspecting the vehicle and with no documents reflecting the purchase of the vehicle. Mr. Fajardo-Moran had no explanation as to why he sold his 2012 Nissan for $5,000 to a family member just prior to buying the Nissan that was involved in the loss for the same price. Although he had two friends [*7]in his vehicle when the loss occurred, Mr. Fajardo-Moran testified that he did not know either of their last names.

Significantly, Mr. Block's affirmation does not only rely on the inconsistencies in the EUOs to demonstrate that the Eight Incidents were staged collisions. Integon also included affidavits from the drivers of the adverse vehicles attesting to the facts of the losses including the fact that the incidents were intentionally caused by the insured drivers. For example, Tony G. Lien who was involved in the April 22, 2023 loss with the insured driver Alfredo Salazar-Ochoa and the passengers Cesar Andres Tenesaca Fierro and Anthony Pinela-Rosado affirmed as to the following details:

I was headed eastbound in the right lane of the Brooklyn Queens Expressway, when a Ford vehicle from the middle lane suddenly cut over directly in front of my truck.

Prior to cutting over, I observed the occupants of that Ford staring into the cab of my truck.

After making eye contact with me, the Ford and its occupants swung in front of my truck from the middle lane and cut me off.

Once they cut over from the middle lane, the Ford immediately came to a dead stop directly in front of me for no rational reason.

I applied my brakes but the Ford left no room or time for me to avoid striking it in the rear.

Additionally, shortly before each alleged loss, each Insured Claimant Defendant procured from Integon a policy sold by the same broker. Each certified policy of insurance contained the Mandatory Personal Injury Protection (PIP) Endorsement, as well as an exclusion for personal injuries sustained by any person who intentionally causes his or her own personal injury.

Mr. Block also affirmed that Integon's investigation determined that each individual loss was coordinated and directed by the Defaulting Defendants Carolina Veronica Rodriguez-Moran and Ruth Stefany Rodriguez-Moran (Morans). According to Mr. Block, Integon's investigation revealed that the Morans are allegedly in the "business" of selling motor vehicles, however neither owns any legitimate business authorized to do business in New York, let alone sell motor vehicles. Each insured vehicle was purchased at auction, with considerably high mileage — some purchased on the same day and most of them purchased shortly before they were insured with Integon. ISO Claims Search results attached to Mr. Block's affidavit show that the Morans were previously involved in similar incidents and used various social security numbers, some invalid. Carolina Veronica Rodriguez-Moran has submitted 8 separate and distinct motor vehicle accident claims — rear end "accidents" that occurred on the Long Island Expressway and the Van Wyck Expressway, the very same roads where many of the injured parties had their incidents. Based on Mr. Block's investigation, the Morans sought and received medical treatment from various healthcare providers from which most injured parties received treatment.

According to Mr. Block, the Morans steered the insured injured parties to Mansi, an insurance brokerage firm, for vehicle insurance and registration. An affidavit from Ibrahim Mansi shows that despite the testimony provided by them at their respective EUOs, each Insured Claimant Defendant was personally escorted to Mansi by Carolina Veronica Rodriguez-Moran to purchase a policy of insurance.

Mr. Block also affirmed that based on his investigation predetermined medical treatment [*8]and referral patterns were indicative of the large scale fraudulent scheme. After the losses, each injured party went to one of two medical offices for physical therapy and other treatment and testing — one office located at 87-10 Northern Boulevard, Jackson Heights, New York 11372 (Jackson Heights Clinic) and one office located at 82-17 Woodhaven Boulevard, Glendale, New York 11385 (Glendale Clinic). Nearly each Individual Defendant was initially evaluated by defaulting defendant, Jean Marie Gaetan (Gaetan) or some other practitioner at the location, then systematically referred for physical therapy performed by the answering defendant Future Rehab Physical Therapy, P.C. at the Jackson Heights Clinic or the answering defendant New Arena, P.T., P.C. at the Glendale Clinic. Patients were also referred by Gaetan and other practitioners at each location to ancillary medical providers for durable medical equipment (DME), prescription medications, and diagnostic testing provided by one or more of the Healthcare Provider Defendants. Mr. Block submitted numerous delivery receipts for DME accompanied by pre-signed prescriptions with Gaetan's signature, which he argues show that fraudulent prescriptions for DME were issued.

Regarding the involvement of the Healthcare Providers, Mr. Block also affirmed that whether evaluated by at the Jackson Heights Clinic or the Glendale Clinic — nearly every single Individual Defendant was referred to Medical MRI for imaging studies of multiple body parts. The MRI referrals provided by Integon confirm that. Mr. Block claims that like the referrals for DME, the referrals for this diagnostic testing were pre-determined, fraudulent prescriptions that were used by various Healthcare Provider Defendants to support their claims. For example, 5 individual referrals that were used by one or more Healthcare Provider Defendants to submit claims for transcranial doppler studies, videonystamography tests, musculoskeletal ultrasounds, carotid ultrasounds, were issued by the Glendale Clinic, bear the same purported signature of Gaetan, and 4 of them are exact photocopies of each other (with the exception patient information and date) designating the same body parts injured, same body parts to be tested, and same tests to be performed.

Lastly, Mr. Block added that nearly every loss was initially reported to Integon by the law firm of Goldin & Rivin.

Mr. Block concluded that Integon maintains a founded belief that any injuries allegedly sustained were not as a result of a covered event as defined in the applicable policies of insurance, and that each loss was a component of a larger scheme by the Staged Loss Defendants, the Facilitator Defendants, and the Healthcare Provider Defendants, to defraud Integon. Therefore, Integon demonstrated a "founded belief" that the Eight Incidents were not covered by no-fault insurance based on, among other things, the investigation undertaken by its investigator, the EUO testimony of the insureds and passengers, the affidavits/affirmations of the drivers in the opposing vehicles, the certified policies, the policy applications, and various medical records (see Nationwide Gen. Ins. Co. v South, 223 AD3d 411, 411 [1st Dept 2024]).

In opposition, the Opposing Defendants failed to raise a triable issue of fact as to whether the collisions were intentionally caused or staged. Although the Opposing Defendants make very similar arguments, mainly that Integon has failed to meet its burden of proof and that the motion is premature, the Court will address each of their oppositions separately.

The Opposing Passenger Defendants argue that Integon has failed to meet its burden of proof, that whether an accident was staged is a triable issue of fact, that the motion is premature [*9]because discovery remains outstanding, and that they are eligible injured persons under the mandatory PIP endorsement.

The Opposing Passenger Defendants provided their own affidavits stating that the driver of their vehicle did not suddenly switch lanes, did not stop abruptly, slam on the brakes, or swerve the car in any fashion, but simply slowed the vehicle for obvious traffic conditions ahead on the expressway (NYSCEF Doc No. 735). The Opposing Passenger Defendants affirmed that the accident was genuine, unanticipated, and caused the actual injury, and that at no time did they conspire with any individual, nor did they participate in or consent to any intentional or staged event.

However, as it pertains to Opposing Passenger Defendants, this Court granted Integon's default motion as to the insured/driver Alfredo Salazar Ochoa, and therefore the allegations that the insured purchased the policy of insurance and intentionally caused the accident, have been deemed admitted. Pursuant to the judgment issued by this Court on February 4, 2025, Integon established that the April 22, 2023 loss was staged as to the insured driver Alfredo Salazar Ochoa. Tellingly, the Opposing Passenger Defendants did not provide an affidavit from the insured driver Alfredo Salazar Ochoa with their opposition papers.

Additionally, the Opposing Passenger Defendants' own affidavits are insufficient to raise a triable issue of fact as to whether Integon established a funded belief that the injuries sustained by them were not the products of a covered event. Just because the Opposing Passenger Defendants were injured in the incident and even had surgery, is not related to the fact the Alfredo Salazar Ochoa intentionally caused the incident as established by the default judgment. When a collision is intentionally caused, the insurer is not obligated to provide coverage, even to innocent third parties, which the Opposing Passenger Defendants might be (Adirondack Ins. Exch. v Rodriguez, 215 AD3d 904, 905 [2d Dept 2023]; see Nationwide Gen. Ins. Co. v Pontoon, 123 AD3d 1040,1040 [2d Dept 2014]; see also Matter of Govt. Employees Ins. Co. v Shaulskaya, 302 AD2d 522, 523 [2d Dept 2003] [passenger was not entitled to uninsured motorist coverage for injury sustained in deliberate crash]).

Furthermore, contrary to the position taken by the Opposing Passenger Defendants, Integon is not required to establish that the subject collision was a product of fraud or demonstrate a staged accident by clear and convincing evidence (V.S. Med. Services, P.C. v Allstate Ins. Co., 25 Misc 3d at 40; see Matter of Eagle Ins. Co. v Davis, 22 AD3d at 803). Rather, as fully discussed above, the insurer must demonstrate the facts elicited during an investigation that make up the founded belief that the incident was staged (see Webster Diagnostic Medicine, P.C. v State Farm Ins. Co., 15 Misc 3d at 98). And, here, as described in detail above, Integon has demonstrated a founded belief that the injuries sustained by the Opposing Passenger Defendants were not the products of a covered event and that no coverage can be afforded.

Also, the Opposing Passenger Defendants' characterization that Mr. Block's affirmation is based solely on the EUOs is inaccurate, in light of the numerous other documents that are referenced to and attached to such affirmation as discussed above.

Lastly, the Court rejects Opposing Passenger Defendants' argument that summary judgment should not be granted as it is premature. "A party contending that a motion for summary judgment is premature is required to demonstrate that additional discovery might lead to relevant evidence or that the facts essential to oppose the motion are exclusively within the knowledge and control of the movant" (Everhome Mortg. Co. v Aber, 195 AD3d 682, 688 [2d [*10]Dept 2022], quoting Haidhaqi v Metro. Transp. Auth., 153 AD3d 1328, 1329 [2d Dept 2017]). "The mere hope or speculation that evidence sufficient to defeat a motion for summary judgment may be uncovered during the discovery process is insufficient to deny the motion" (Mahmud v Ouyang, 208 AD3d 861, 862 [2d Dept 2022]; Haidhaqi v Metro. Transp. Auth., 153 AD3d at 1329).

Here, Opposing Passenger Defendants failed to make the requisite showing. While they pointed to the outstanding discovery demands that they made, such discovery demands were only made after Integon filed its motion for summary judgment and they did not demonstrate that such additional discovery might lead to relevant evidence. "To speculate that something might be caught on a fishing expedition provides no basis pursuant to CPLR 3212(f) to postpone decision on [a] summary judgment motion" (Orange County-Poughkeepsie Ltd. Partnership v Bonte, 37 AD3d 684, 687 [2d Dept 2007]). The Opposing Passenger Defendants offered nothing beyond mere speculation and bald conjecture concerning what relevant evidence they hoped to uncover during discovery, which would bear on whether the incidents were staged (see Shah v MTA Bus Co., 201 AD3d 833, 834 [2d Dept 2022]).

The Rybak Defendants argue that Integon's motion should be denied in its entirety because Integon failed to establish a prima facie entitlement to summary judgment as a matter of law, that substantial and necessary discovery remains outstanding making the motion premature, and that there are material triable issues of fact that are facially apparent in the record. For the reasons described above, these arguments are rejected.

The Rybak Defendants, which are medical provider defendants, failed to raise a triable issue of fact as to whether the collisions were intentionally caused or staged (Natl. Gen. Ins. Online, Inc. v Blasco, 210 AD3d at 788). In support of their opposition, the Rybak Defendants are relying solely on an affirmation of counsel who does not allege to have any personal knowledge of the facts. An attorney affirmation is insufficient to raise a triable issue of fact in opposition to Integon's prima facie showing (Bank of New York Mellon v Aiello, 164 AD3d 632, 633 [2d Dept 2018]).

The Rybak Defendants argue that to disclaim coverage on the basis that the underlying collision ^[FN1] was not an "accident," and that therefore Integon was not required to provide coverage to the Rybak Defendants, Integon would have to demonstrate that the Rybak Defendants submitted claims as assignors of someone that was a party to the collision. The Rybak Defendants contend that Integon's failure to provide an assignment of benefits form for any of the individual defendants such that it could be determined whether the Rybak Defendants submitted claims on behalf of any individual who purportedly intentionally caused the incidents in question, is damning to Integon's position. The Court disagrees.

In its verified complaint, Integon alleged that the Healthcare Provider Defendants purportedly received assignments of benefits (AOB) which transferred the rights, duties, obligations and liabilities of the individual patient to the respective healthcare providers. In their [*11]answer, the Rybak Defendants raised as an affirmative defense that they "have filed actions in the Civil Court of New York, Kings County prior to the present declaratory judgment action being filed" and that Integon "was and is still obligated to provide first-party no-fault benefits to the Answering Defendants" (NYSCEF Doc No. 40). Such defenses lead to the conclusion that the Rybak Defendants have admitted that they were assignees of individuals who were parties to the alleged incidents. The Rybak Defendants did not submit their own affidavits stating otherwise.

An assignee "stands in the shoes" of an assignor and thus acquires no greater rights than its assignor (Long Is. Radiology v Allstate Ins. Co., 36 AD3d 763, 765 [2d Dept 2007] [internal citations omitted]). As the Healthcare Provider Defendants "stand in the shoes" of their assignors, any claims and defenses that can be asserted by Integon against the Staged Loss Defendants can in turn be asserted against the Healthcare Provider Defendants, including, of course, the Rybak Defendants. While it is unclear which of the eight accident or parties the Rybak Defendants refer to in their papers, each insured has defaulted in this action and the allegations that they staged the losses are deemed admitted.

Furthermore, Rybak Defendants failed to demonstrate that Integon's motion was premature since they "were merely hopeful that further discovery would lead to evidence which would support their opposition to the motion" (Adirondack Ins. Exch. v Rodriguez, 215 AD3d 904, 905 [2d Dept 2023]).

The Tsirelman Defendants incorporate by reference the arguments of the Opposing Passenger Defendants and the Rybak Defendants. The Tsirelman Defendants also "failed to raise an issue of fact, as they did not submit an affidavit of someone with personal knowledge of the legitimacy and circumstances of the accident or any other admissible evidence to rebut plaintiff's showing" (Unitrin Safeguard Ins. Co. v Manuel, 236 AD3d at 559-560).

Contrary to the Tsirelman Defendants' contention, Mr. Block's affirmation is admissible given his personal knowledge and expertise in conducting investigations for more than ten years (see Ameriprise Ins. Co. v Hampton, 60 Misc 3d 1222[A] [Sup Ct, New York County 2018]. Mr. Block's affidavit relies on admissible evidence — the signed policy applications, the certified policies, the signed EUO transcripts, the certified EUO transcripts, and the sworn affidavits/affirmations from the drivers of the adverse vehicles.

In focusing their opposition on arguing that the motion is premature, the Tsirelman Defendants cite to a number of cases, all distinguishable from this action. In State Farm Mut. Auto. Ins. Co. v Lifeline Med. Imaging, P.C., 237 AD3d 451, 451-452 (1st Dept 2025), one of the cases cited to by the Tsirelman Defendants, the Appellate Division, First Department denied the motion as premature, as the insurer failed to offer the defendant medical provider "an objective justification for requesting the EUOs, as required by the governing no-fault regulation." In that case, State Farm sought a declaration that it was not obligated to provide no-fault coverage for various claims submitted by Lifeline, a medical provider, based on Lifeline's failure to meet a condition precedent to coverage by failing to appear for duly scheduled EUOs. Such is clearly not the case here. In Liberty Mut. Ins. Co. v Valera, 208 AD3d 1104 (1st Dept 2022), another case cited to by the Tsirelman Defendants, the Appellate Division, First Department denied the insurers' motion for summary judgment without prejudice since the insurer failed to prove that [*12]the alleged misrepresentation as to the correct address when procuring the insurance was a material misrepresentation and the affidavit of the insurers' underwriter was conclusory and not supported by relevant documentary evidence. Here, Mr. Block's affirmation is not conclusory and was supported by admissible evidence. In another example used by the Tisrelman Defendants, Lima v Ancona, 192 AD3d 1093 (2d Dept 2021), the Appellate Division, Second Department dealt with a claim involving coercion and mistake surrounding the validity of a release and permitted the plaintiff to obtain via a subpoena certain training materials and employee handbooks utilized by the insurance company to conclude the release was invalid. Here, Integon's motion is not about quashing a subpoena as in Lima v Ancona.

Although the Tisrelman Defendants argue that Integon's summary judgment motion was premature, they failed to demonstrate that any proof necessary for their opposition was exclusively within Integon's possession or that they made further attempts to obtain that information (Unitrin Safeguard Ins. Co. v Manuel, 236 AD3d 558, 560 [1st Dept 2025]; see Voluto Ventures, LLC v Jenkens & Gilchrist Parker Chapin LLP, 44 AD3d 557, 557 [1st Dept 2007]; see also CPLR 3212 [f]). Their attorney's affirmation was insufficient in that regard (Unitrin Safeguard Ins. Co. v Manuel, 236 AD3d at 560; see 354 Chauncey Realty, LLC v Brownstone Agency, Inc., 213 AD3d 544, 545 [1st Dept 2023] ["plaintiff did not submit an affidavit to demonstrate that essential facts exist but cannot yet be stated, relying instead upon a nonprobative affirmation of counsel which asserts speculative arguments"]).

Comprehensive advances the same arguments as the other Opposing Defendants, that is that Integon failed to proffer sufficient admissible evidence to establish that the Eight Incidents were staged. Comprehensive also failed to raise an issue of fact and did not include any affidavits from someone with personal knowledge.

Comprehensive focuses on the alleged inadmissibility of various documents, primarily the EUO transcripts (which has been discussed at length above), the affidavits of the adverse drivers, and the police reports, and the ISO reports. The affidavits/affirmations of the adverse drivers are admissible, since they are properly notarized and/or affirmed by the adverse drivers and contain those individuals' description of the facts leading up to the similar rear-end impacts and are based on those individuals' personal knowledge. As to the uncertified police records, the Court agrees with Comprehensive that they are inadmissible and not to be considered (see Yassin v Blackman, 188 AD3d 62, 65 [2d Dept 2020] [internal citation omitted] ["A properly certified police accident report is admissible where 'the report is made based upon the officer's personal observations and while carrying out police duties'"]).

Additionally, Comprehensive's contention that an award of summary judgment is premature because Integon has not yet provided discovery responses is without merit, because Comprehensive failed to demonstrate that "discovery might lead to relevant evidence or that the facts essential to justify opposition to the motion were exclusively within the knowledge and control of the movant" (Queens Syndicate Co. v Daniarov, 240 AD3d 723, 724 [2d Dept 2025], quoting Leak v Hybrid Cars, Ltd., 132 AD3d 958, 959 [2d Dept 2015] [internal quotation marks omitted]).

Advanced relies on and incorporates by reference, the arguments made by the other answering defendants. Similarly to the other opposing defendants, Advanced failed to raise any issues of fact.

Advanced claims that Integon has not submitted evidence of a person with knowledge as to whether all eight accidents were staged because neither Mr. Block nor Mr. Pedro witnessed the accidents themselves. However, Integon submitted affidavits from the adverse drivers involved in the incidents, albeit not from all Eight Incidents. Furthermore, since every single Staged Loss Defendant (other than the two Opposing Passenger Defendants) has defaulted, the statements he or she made at the EUOs as to how he or she allegedly operated their respective vehicles are to be construed as false and their injuries not the result of the incidents (see Unitrin Safeguard Ins. Co. v Manuel, 236 AD3d at 560 ["Insofar as claimants asserted in their EUOs that they were passengers in the vehicle at the time of the accident, the court properly construed claimants' default as an admission that their EUO statements were false and their injuries were not the result of the accident, as alleged by plaintiff in the complaint"]).

In conclusion, the Opposing Defendants failed to raise an issue of fact as to whether the collisions were intentionally caused or staged. They did not submit any admissible evidence to rebut Integon's prima facia showing, they failed to show that Integon did not establish a prima facie entitlement to summary judgment as a matter of law, and they also failed to demonstrate that this motion premature.

As it is well settled that an intentional and staged collision caused in the furtherance of an insurance fraud scheme is not a covered accident under a policy of insurance (Matter of Liberty Mut. Ins. Co. v Goddard, 29 AD3d 698, 699 [2d Dept 2006]) and Integon established that the eight collisions were staged and intentional, the eight collisions were not covered events under the respective policies and the Healthcare Provider Defendants equally are not afforded coverage under the applicable policies of insurance.

Consequently, the motion for summary judgment is granted in its entirety, including summary judgment on all declarations requested by Integon in its complaint. Integon has established as a matter of law that it is entitled to all the declarations it seeks in the complaint, including, but not limited to, declarations that the eight alleged automobile incidents were not products of covered events, that Integon is not obligated to provide first-party coverage, reimbursement, or pay any monies, sums, or funds, including but not limited to present and/or future claims for no-fault benefits, and/or uninsured/underinsured (SUM) benefits, to any of the defendants, or any other individual or entity, in connection with the alleged automobile incidents, and that Integon is not obligated to provide any coverage, reimbursement, or to pay any monies, sums or funds to any of the defendants, or any other individual or entity, for first-party no-fault benefits for any healthcare services rendered to any of the Staged Loss Defendants in connection with the alleged automobile incidents. Plaintiff is to submit a proposed judgment to the Court.

The foregoing constitutes the decision and Order of the Court.