June 2, 2009

Inwood Hill Med., P.C. v Utica Mut. Ins. Co. (2009 NY Slip Op 51129(U))

https://www.beynensonlaw.com/case-law/inwood-hill-med-p-c-v-utica-mut-ins-co-2009-ny-slip-op-51129u/

Court: Appellate Term, Second Department
Decided: June 2, 2009
Citation: 2009 NY Slip Op 51129(U) · 23 Misc 3d 145(A)
Posture: Summary judgment
Outcome: Insurer prevailed
Issues: Provider's prima facie case
Legal questions: Claimant's prima facie case on motions (see the maps)

Cite as

Inwood Hill Med., P.C. v Utica Mut. Ins. Co., 23 Misc 3d 145(A), 2009 NY Slip Op 51129(U) (App Term, 2d Dept, 9th & 10th Jud Dists 2009)

Posture, outcome, issues and treatment by other decisions are Beynenson Law’s classification. Treatment labels are assigned by a language model reading the citing decision; negative and appeal-history labels are checked by a second reader.

Summary

Editorial summary by Beynenson Law, not part of the court’s decision.

The providers' medical biller failed to establish admissibility of the supporting documents, defeating their motion for summary judgment. In the action for assigned no-fault benefits, the District Court denied the providers' motion because the supporting affidavit was legally insufficient. The Appellate Term, Second Department, found that the affidavit did not establish admissibility of the attached documents under CPLR 4518 and affirmed the order, insofar as appealed from.

Reported in New York Official Reports at Inwood Hill Med., P.C. v Utica Mut. Ins. Co. (2009 NY Slip Op 51129(U))

[*1]

Inwood Hill Med., P.C. v Utica Mut. Ins. Co.

2009 NY Slip Op 51129(U) [23 Misc 3d 145(A)]

Decided on June 2, 2009

Appellate Term, Second Department

Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431.

This opinion is uncorrected and will not be published in the printed Official Reports.

Decided on June 2, 2009

SUPREME COURT OF THE STATE OF NEW YORK

APPELLATE TERM: 9th and 10th JUDICIAL DISTRICTS

PRESENT: : RUDOLPH, P.J., TANENBAUM and MOLIA, JJ
2008-1439 N C.

Inwood Hill Medical, P.C. and WESTCHESTER NEURODIAGNOSTIC, P.C. a/a/o LENNY MUNOZ, Appellants,
against
Utica Mutual Insurance Company, Respondent.

Appeal from an order of the District Court of Nassau County, Third District (Rhonda E. Fischer, J.), entered May 19, 2008. The order, insofar as appealed from, denied plaintiffs’ motion for summary judgment.

Order, insofar as appealed from, affirmed without costs.

In this action by providers to recover assigned first-party no-fault benefits, plaintiffs moved for summary judgment and defendant cross-moved for summary judgment. Insofar as is relevant to this appeal, the court denied plaintiffs’ motion on the ground that the affidavit submitted by plaintiffs’ medical biller was legally insufficient. This appeal by plaintiffs ensued.

Plaintiffs failed to make a prima facie showing of their entitlement to summary judgment since the affidavit submitted by plaintiffs’ medical biller failed to establish that the documents annexed to plaintiffs’ moving papers were admissible pursuant to CPLR 4518 (see Alvarez v Prospect Hosp., 68 NY2d 320 [1986]; Art of Healing Medicine, P.C. v Travelers Home & Mar. Ins. Co., 55 AD3d 644 [2008]; Fortune Med., P.C. v Allstate Ins. Co., 14 Misc 3d 136[A], 2007 NY Slip Op 50243[U] [App Term, 9th & 10th Jud Dists 2007]). Consequently, plaintiffs’ motion for summary judgment was properly denied.

Rudolph, P.J., Tanenbaum and Molia, JJ., concur. [*2]
Decision Date: June 02, 2009

Legal questions

A question of no-fault law this decision rules on, from our Legal Questions pages. Bars count the decisions on the question by year and court, coloured by category; circles are this decision and the decisions on the question it cites or that cite it. Point at a bar or circle for details. The categories and summaries are Beynenson Law’s classification, made by a language model and checked by a second reading.

Claimant's prima facie case on motions

Open the full map

On summary judgment or another pretrial motion, what must a no-fault claimant show to establish its prima facie case?

This decision: Insufficient: claim forms not shown admissible as business records / merits of claim not proved

Held the providers failed their prima facie showing because their medical biller's affidavit did not establish that the annexed documents were admissible under CPLR 4518.

Proof sufficientMailing/receipt not shownOverdue not shownBusiness-record foundation lackingOther element missingThis decisionCites it or cited by itCited or followed

Of the 1,065 decisions on this question in the Second Department courts and the Court of Appeals, 208 (this one included) are in the same category.

Cited in this decision

A label shows how this decision treated the case it cites.

Art of Healing Medicine, P.C. v Travelers Home & Mar. Ins. Co. (2008 NY Slip Op 07846) FollowedThe providers failed to establish a prima facie case because they did not demonstrate the admissibility of their billing records.
Fortune Med., P.C. v Allstate Ins. Co. (2007 NY Slip Op 50243(U)) FollowedAn insurer's acknowledgment of claim receipt does not concede the admissibility of the claim forms or the facts they contain.

Similar decisions

Inwood Hill Med., P.C. v Progressive Cas. Ins. Co. (2009 NY Slip Op 51397(U))The insurer failed to prove the assignor's EUO and IME nonappearances, while the providers failed to authenticate their billing records.
Inwood Hill Med. P.C. v Utica Mut. Ins. Co. (2007 NY Slip Op 51309(U))The insurer's late denials precluded its statutory, policy-condition, exclusion, and fraudulent-billing defenses.
Careplus Med. Supply, Inc. v Utica Mut. Ins. Co. (2009 NY Slip Op 51132(U))The provider failed to establish its prima facie case because its affidavit did not establish admissibility of the supporting documents.
A.B. Med. Servs., PLLC v Country-Wide Ins. Co. (2009 NY Slip Op 51130(U))The providers' medical biller failed to establish admissibility of the supporting documents, defeating their motion for summary judgment.
Inwood Hill Med., P.C. v Metropolitan Prop. & Cas. Ins. Co. (2009 NY Slip Op 51264(U))The insurer was precluded from asserting a workers' compensation defense because it failed to establish timely mailing of its denial.