July 7, 2005
A.B. Med. Servs. PLLC v GMAC Ins. (2005 NYSlipOp 51079(U))
https://www.beynensonlaw.com/case-law/a-b-med-servs-pllc-v-gmac-ins-2005-nyslipop-51079u/
- Decided
- July 7, 2005
- Citation
- 2005 NY Slip Op 51079(U)
- Posture
- Summary judgment
- Outcome
- Insurer prevailed
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 A.B. Med. Servs. PLLC v GMAC Ins. (2005 NYSlipOp 51079(U))
| A.B. Med. Servs. PLLC v GMAC Ins. |
| 2005 NYSlipOp 51079(U) |
| Decided on July 7, 2005 |
| 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| This opinion is uncorrected and will not be published in the printed Official Reports.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., PATTERSON and BELEN, JJ.
2004-911 K C
against
GMAC Insurance, Respondent.
Appeal by plaintiffs from so much of an order of the Civil Court, Kings County (R. Garson, J.), entered on May 20, 2004, as denied their motion for summary judgment.
Order unanimously affirmed without costs.
In this action to recover first-party no-fault benefits for medical services rendered to their assignor, plaintiffs established a prima facie entitlement to summary judgment by proof that they submitted claims, setting forth the fact and the amount of the loss sustained, and that payment of no-fault benefits was overdue (see Insurance Law § 5106 [a]; Mary Immaculate Hosp. v Allstate Ins. Co., 5 AD3d 742 [2004]; Amaze Med.
Supply v Eagle Ins. Co., 2 Misc 3d 128[A], 2003 NY Slip Op 51701[U] [App Term, 2d & 11th Jud Dists]).
In opposition to plaintiffs’ motion, defendant asserted the defense that the alleged injuries were not causally related to the accident (see Central Gen. Hosp. v Chubb Group of Ins. Cos., 90 NY2d 195, 199 [1997]; Mount Sinai Hosp. v Triboro Coach, 263 AD2d 11, 18-19 [1999]). Unlike the affidavit in the case of A.B. Medical Servs. PLLC v GMAC Ins., 7 Misc 3d 132[A], 2005 NY Slip Op 50602[U] [App Term, 2d & 11th Jud Dists]), the affidavit of the defendant’s claims representative herein set forth additional facts sufficient to demonstrate that the defense was based upon a “founded belief that the alleged injur[ies] do[] not arise out of an insured incident” (Central Gen. Hosp, 90 NY2d at 199 [1997]; Mount Sinai Hosp., 263 AD2d at 18-19). [*2]Therefore, since defendant demonstrated the existence of a triable issue of fact as to whether there was a lack of coverage (see Zuckerman v City of New York, 49 NY2d 557 [1980]), plaintiffs’ motion for summary judgment was properly denied.
Decision Date: July 07, 2005
Legal questions (2)
Questions 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.
Did the insurer show the claimed injuries did not arise from a covered accident (staged, intentional, or unrelated)?
This decision: Founded belief shown; the question must be tried
Held the claims representative's affidavit set forth additional facts sufficient to show a founded belief that the injuries were not causally related to the accident, raising a triable issue that defeated the providers' motion.
Of the 234 decisions on this question in the Second Department courts and the Court of Appeals, 102 (this one included) are in the same category.
On summary judgment or another pretrial motion, what must a no-fault claimant show to establish its prima facie case?
This decision: Claimant's proof held to make out its prima facie case (rules on the question, but another ground decided the case)
Held the providers established prima facie entitlement by proof that they submitted claims stating the fact and amount of loss and that payment was overdue.
Of the 1,065 decisions on this question in the Second Department courts and the Court of Appeals, 513 (this one included) are in the same category.
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)The 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))A provider's completed claim forms establish its prima facie case without additional medical proof when the insurer is precluded.
- A.B. Med. Servs. PLLC v GMAC Ins. (2005 NYSlipOp 50602(U)) DistinguishedTransportation benefits claimed under the revised no-fault regulations are reimbursable but cannot be assigned to a transportation provider.
Similar decisions
- A.B. Med. Servs. PLLC v State Farm Mut. Auto. Ins. Co. (2004 NY Slip Op 51627(U))The insurer's special-investigator affidavit raised a triable coverage issue concerning whether the collision furthered an insurance fraud scheme.
- A.B. Med. Servs. PLLC v New York Cent. Mut. Fire Ins. Co. (2006 NY Slip Op 51347(U))The insurer's low-impact study and supporting affidavit raised a triable issue whether the claimed injuries arose from the accident.
- A.B. Med. Servs., PLLC v Utica Mut. Ins. Co. (2008 NY Slip Op 51859(U))The insurer's investigators established a founded belief that the assignor's injuries did not arise from an insured incident.
- A.B. Med. Servs., PLLC v New York Cent. Mut. Fire Ins. Co. (2009 NY Slip Op 50331(U))The insurer's evidence established a founded belief that the assignors' injuries did not arise from an insured incident.
- A.B. Med. Servs. Pllc v Lumbermens Mut. Cas. Co. (2004 NY Slip Op 50692(U))The providers failed to establish entitlement to summary judgment because their billing manager did not identify the provider represented.