January 9, 2009
Vista Surgical Supplies, Inc. v State Farm Mut. Ins. Co. (2009 NY Slip Op 50047(U))
https://www.beynensonlaw.com/case-law/vista-surgical-supplies-inc-v-state-farm-mut-ins-co-2009-ny-slip-op50047u/
- Decided
- January 9, 2009
- Citation
- 2009 NY Slip Op 50047(U) · 22 Misc 3d 128(A)
- Posture
- Trial
- Outcome
- Insurer prevailed
- Legal questions
- Claimant's prima facie case at trial (see the maps)
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.
Reported in New York Official Reports at Vista Surgical Supplies, Inc. v State Farm Mut. Ins. Co. (2009 NY Slip Op 50047(U))
| Vista Surgical Supplies, Inc. v State Farm Mut. Ins. Co. |
| 2009 NY Slip Op 50047(U) [22 Misc 3d 128(A)] |
| Decided on January 9, 2009 |
| Appellate Term, Second Department |
| Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431. |
| As corrected in part through February 24, 2009; it will not be published in the printed Official Reports. |
SUPREME COURT OF THE STATE OF NEW YORK
APPELLATE TERM: 2nd, 11th and 13th JUDICIAL DISTRICTS
PRESENT: : PESCE, P.J., GOLIA and RIOS, JJ
2008-308 Q C.
against
State Farm Mutual Insurance Co., Respondent.
Appeal from a decision of the Civil Court of the City of New York, Queens County (Diccia T. Pineda-Kirwan, J.), dated October 6, 2006, deemed from a judgment of said court entered December 26, 2007 (see CPLR 5520 [c]). The judgment, after a nonjury trial, dismissed the complaint.
Judgment affirmed with $25 costs.
At the trial in this action by a provider to recover assigned first-party no-fault benefits, plaintiff did not call any witnesses. Rather, plaintiff orally moved for the admission into evidence of its notice to admit and defendant’s response thereto, contending that they were sufficient to establish plaintiff’s prima facie case. Defendant objected and cross-moved for a directed verdict dismissing the complaint. The court granted defendant’s cross motion, holding that plaintiff’s notice to admit was improper because it sought information going to the heart of the matter. A judgment was entered dismissing the complaint. This appeal by plaintiff ensued.
An admission that defendant received plaintiff’s claim form is not a concession of the facts set forth in said claim form (Bajaj v General Assur. Co., 18 Misc 3d 25, 28 [App Term, 2d & 11th Jud Dists 2007]; Midborough Acupuncture, P.C. v New York Cent. Mut. Fire Ins. Co., 13 Misc 3d 132[A], 2006 NY Slip Op 51879[U] [App Term, 2d & 11th Jud Dists 2006]). While defendant acknowledged that it received plaintiff’s claim form and that a true copy was annexed to plaintiff’s notice to admit, it remained plaintiff’s burden to lay a sufficient foundation to establish that the claim form is admissible pursuant to the business records exception to the hearsay rule to prove the truth of the matters asserted therein (see Art of Healing Medicine, P.C. v Travelers Home & Mar. Ins. Co., 55 AD3d 644 [2008], affg 15 Misc 3d 144[A], 2007 NY Slip Op 51161[U] [App Term, 2d & 11th Jud Dists 2007]). Since plaintiff failed to proffer such [*2]proof, the court properly held that plaintiff failed to make a prima facie showing (see id.; Dan Med. P.C. v New York Cent. Mut. Fire Ins. Co., 14 Misc 3d 44 [App Term, 2d & 11th Jud Dists 2006]). Accordingly, the judgment is affirmed (see Parochial Bus Sys. v Board of Educ. of City of N.Y., 60 NY2d 539 [1983]).
In light of the foregoing, we reach no other issue.
Pesce, P.J., Golia and Rios, JJ., concur.
Decision Date: January 09, 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.
What must a no-fault claimant prove at trial to make out its prima facie case for overdue benefits?
This decision: Insufficient: claim forms not admitted as business records / insurer's admissions held not to prove the claim
Held at trial that the insurer's admission of receipt of the claim form did not concede its contents, and the provider, calling no witness, failed to lay a business-records foundation, so it made no prima facie showing.
Of the 103 decisions on this question in the Second Department courts and the Court of Appeals, 21 (this one included) are in the same category.
Cited in this decision
A label shows how this decision treated the case it cites.
- Bajaj v General Assur. (2007 NY Slip Op 27487)An insurer's admission that a denial form is genuine does not establish the provider's claim form as an admissible business record.
- Midborough Acupuncture, P.C. v New York Cent. Mut. Fire Ins. Co. (2006 NY Slip Op 51879(U))The provider's attorney affirmation failed to establish the admissibility of its claim forms or a prima facie entitlement to judgment.
- 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.
- Art of Healing Medicine, P.C. v Travelers Home & Mar. Ins. Co. (2007 NY Slip Op 51161(U))The providers' billing manager failed to lay a business-records foundation for their partial summary judgment motion.
- Dan Med., P.C. v New York Cent. Mut. Fire Ins. Co. (2006 NY Slip Op 26483)The provider failed to establish its prima facie case because its corporate officer did not lay a business-records foundation for the claim documents.
Similar decisions
- Vista Surgical Supplies, Inc. v American Tr. Ins. Co. (2006 NY Slip Op 52470(U))The provider failed to prove claim submission in its moving papers and could not supply that essential element through inadmissible reply material.
- Vista Surgical Supplies Inc. v Allstate Ins. Co. (2006 NY Slip Op 52520(U))The provider failed to prove mailing of its claim, while the insurer established that it had never received the claim.
- Vista Surgical Supplies, Inc. v Nationwide Mut. Ins. Co. (2006 NY Slip Op 51556(U))The provider failed to establish claim submission because its mailing proof did not connect the claims to the certified mail receipt.
- Vista Surgical Supplies, Inc. v Statewide Ins. Co. (2006 NY Slip Op 51118(U))The provider failed to establish claim submission because its mailing receipts and the insurer's verification letters were not linked to the claims.
- Vista Surgical Supplies, Inc. v General Assur. Co. (2006 NY Slip Op 51034(U))The provider's action was premature because timely verification requests remained unanswered when the action began.