January 9, 2009

All Mental Care Medicine, P.C. v State Farm Mut. Ins. Co. (2009 NY Slip Op 50042(U))

https://www.beynensonlaw.com/case-law/all-mental-care-medicine-p-c-v-state-farm-mut-ins-co-2009-ny-slip-op50042u/

Court: Appellate Term, Second Department
Decided: January 9, 2009
Citation: 2009 NY Slip Op 50042(U) · 22 Misc 3d 128(A)
Posture: Trial
Outcome: Insurer prevailed
Issues: Provider's prima facie case
Legal questions: Claimant's prima facie case at trial (see the maps)

Cite as

All Mental Care Medicine, P.C. v State Farm Mut. Ins. Co., 22 Misc 3d 128(A), 2009 NY Slip Op 50042(U) (App Term, 2d Dept, 2d, 11th & 13th 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 provider's trial dismissal for failure to establish a prima facie case was affirmed. The provider relied on a notice to admit and an affirmation from the insurer's attorney, then rested without calling witnesses. The Appellate Term, Second Department, affirmed the judgment in the insurer's favor for the reasons stated in Bajaj v General Assur.

Reported in New York Official Reports at All Mental Care Medicine, P.C. v State Farm Mut. Ins. Co. (2009 NY Slip Op 50042(U))

[*1]

All Mental Care Medicine, P.C. v State Farm Mut. Ins. Co.

2009 NY Slip Op 50042(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As corrected in part through February 24, 2009; it will not be published in the printed Official Reports.

Decided on January 9, 2009

SUPREME COURT OF THE STATE OF NEW YORK

APPELLATE TERM: 2nd, 11th and 13th JUDICIAL DISTRICTS

PRESENT: : WESTON PATTERSON, J.P., RIOS and STEINHARDT, JJ
2007-1803 Q C.

All Mental Care Medicine, P.C. a/a/o AUGUSTIN MARTES, Appellant,
against
State Farm Mutual Insurance Company, Respondent.

Appeal from a decision of the Civil Court of the City of New York, Queens County (Robert D. Kalish, J.), dated January 8, 2007, deemed from a judgment of the same court entered November 9, 2007 (see CPLR 5520 [c]). The judgment, after a nonjury trial, dismissed the complaint.

Judgment affirmed without costs.

In this action by a provider to recover assigned first-party no-fault benefits, plaintiff offered a notice to admit and an affirmation made by defendant’s attorney in order to prove its prima facie case at trial. Plaintiff then rested without calling any witnesses. The court found that plaintiff, having failed to produce a witness, failed to make its prima facie case, and dismissed the complaint. For the reasons set forth in Bajaj v General Assur. (18 Misc 3d 25 [App Term, 2d & 11th Jud Dists 2007]), we affirm the judgment.

Weston Patterson, J.P., Rios and Steinhardt, 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.

Claimant's prima facie case at trial

Open the full map

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

Affirmed dismissal after a nonjury trial because the provider, offering only a notice to admit and the insurer's attorney's affirmation and calling no witness, failed to make out its prima facie case, for the reasons stated in a prior Appellate Term decision.

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

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) FollowedAn insurer's admission that a denial form is genuine does not establish the provider's claim form as an admissible business record.

Similar decisions

All Mental Care Medicine, P.C. v Travelers Indem. Co. (2007 NY Slip Op 50166(U))The provider's officer failed to establish personal knowledge sufficient to admit the supporting documents as business records.
All Is. Med. Care, P.C. v State Farm Mut. Auto. Ins. Co. (2011 NY Slip Op 52227(U))The insurer's doctor's testimony and peer review report established at trial that the services lacked medical necessity.
All Mental Care Medicine, P.C. v Allstate Ins. Co. (2007 NY Slip Op 50612(U))The provider's renewed default-judgment motion failed for lack of a business-records foundation and proof that its claims were submitted.
Psychmetrics Med., P.C. v Travelers Ins. Co. (2008 NY Slip Op 52466(U))The provider failed to establish its prima facie case at trial because it called no witness to authenticate its claim form as a business record.
All Boro Psychological Servs., P.C. v State Farm Mut. Auto. Ins. Co. (2014 NY Slip Op 51787(U))The insurer's affidavits established timely mailing of EUO notices and denials and the provider's failure to appear.