September 21, 2006
Empire State Psychological Servs., P.C. v Travelers Ins. Co. (2006 NY Slip Op 51869(U))
https://www.beynensonlaw.com/case-law/empire-state-psychological-servs-p-c-v-travelers-ins-co-2006-ny-slip-op-51869u/
- Decided
- September 21, 2006
- Citation
- 2006 NY Slip Op 51869(U) · 13 Misc 3d 131(A)
- Posture
- Trial
- Outcome
- Insurer prevailed
- Later treatment
- Declined to follow in 1 and followed in 1 later decisions (see Cited by)
- 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 Empire State Psychological Servs., P.C. v Travelers Ins. Co. (2006 NY Slip Op 51869(U))
| Empire State Psychological Servs., P.C. v Travelers Ins. Co. |
| 2006 NY Slip Op 51869(U) [13 Misc 3d 131(A)] |
| Decided on September 21, 2006 |
| 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| This opinion is uncorrected and will not be published in the printed Official Reports. |
SUPREME COURT OF THE STATE OF NEW YORK
APPELLATE TERM: 2nd and 11th JUDICIAL DISTRICTS
PRESENT: : PESCE, P.J., WESTON PATTERSON and BELEN, JJ
2005-1064 Q C.
against
Travelers Insurance Company, Appellant.
Appeal from a judgment of the Civil Court of the City of New York, Queens County (Howard G. Lane, J.), entered August 10, 2004. The judgment, after a nonjury trial, and upon the denial of defendant’s motion for judgment as a matter of law pursuant to CPLR 4401, awarded plaintiff the principal sum of $1,061.63.
Judgment reversed without costs, defendant’s motion which was for judgment as a matter of law granted, and complaint dismissed.
In this action to recover first-party no-fault benefits for health care services rendered to plaintiff’s assignor, at the close of plaintiff’s case defendant moved pursuant to CPLR 4401 for judgment as a matter of law. The court reserved decision until after defendant presented its case, and then denied the motion, which defendant had renewed, and awarded judgment to plaintiff in the principal amount sought.
Whether considered solely on plaintiff’s proof or upon all the evidence presented, defendant’s motions should have been granted. Plaintiff rested its case without calling any witnesses. As its only proof, plaintiff offered into evidence, without objection, defendant’s [*2]response to a written interrogatory which established only that defendant received from plaintiff several bills on a given date, and that defendant timely denied these bills on the ground of the absence of medical necessity for the health care services provided. As a matter of law, plaintiff failed to establish the fact and the amount of the loss sustained and that payment of no-fault benefits was overdue by proof that it submitted to defendant “prescribed statutory billing forms” (Mary Immaculate Hosp. v Allstate Ins. Co., 5 AD3d 742, 742 [2004]; see Amaze Med. Supply v Eagle Ins. Co., 2
Misc 3d 128[A], 2003 NY Slip Op 51701[U] [App Term, 2d & 11th Jud Dists]) or its substantial equivalent (11 NYCRR 65-3.5 [f]). Accordingly, plaintiff failed to make out a prima facie case.
Pesce, P.J., Weston Patterson and Belen, JJ., concur.
Decision Date: September 21, 2006
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 interrogatory answer showing only receipt of bills and their timely denial did not prove the fact and amount of loss or overdue payment through statutory billing forms.
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. One decision in other departments that cites or is cited by this one is on the full map.
Cited in this decision
A label shows how this decision treated the case it cites.
- Mary Immaculate Hosp. v Allstate Ins. Co. (2004 NY Slip Op 02359) FollowedThe hospitals established entitlement to summary judgment by proving that statutory billing forms were mailed and received and payment was overdue.
- Amaze Med. Supply v Eagle Ins. Co. (2003 NY Slip Op 51701(U)) FollowedA provider's completed claim forms establish its prima facie case without additional medical proof when the insurer is precluded.
Cited by
A label shows how the later decision treated this one.
- Fair Price Med. Supply, Inc. v St. Paul Travelers Ins. Co. (2007 NY Slip Op 27173) Declined to followThe insurer's verified interrogatory answers established receipt and partial payment of the claims and defeated its proof-of-billing objection.
- 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
- PDG Psychological, P.C. v Travelers Ins. Co. (2009 NY Slip Op 50437(U))The provider failed to prove its prima facie case at trial because its witness could not establish a business-record foundation for the claim forms.
- 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.
- PDG Psychological, P.C. v Progressive Cas. Ins. Co. (2009 NY Slip Op 50436(U))The provider's trial witnesses failed to establish a business-record foundation for its bill under CPLR 4518.
- P.L.P. Acupuncture, P.C. v Travelers Indem. Co. (2008 NY Slip Op 50484(U))The insurers' admission of receipt defeated their challenge to the provider's proof that its no-fault claims were mailed and received.
- Psychology YM, P.C. v Nationwide Mut. Ins. Co. (2009 NY Slip Op 51634(U))The provider failed to establish entitlement to summary judgment because its billing company's affidavit did not comply with CPLR 4518.