July 7, 2011
Allstate Social Work & Psychological Servs., PLLC v GEICO Gen. Ins. Co. (2011 NY Slip Op 21234)
https://www.beynensonlaw.com/case-law/allstate-social-work-psychological-servs-pllc-v-geico-gen-ins-co-2011-ny-slip-op-21234/
- Judge
- Edwards, J.
- Decided
- July 7, 2011
- Citation
- 2011 NY Slip Op 21234 · 32 Misc 3d 721
- Posture
- Trial
- Outcome
- Insurer prevailed
- Legal questions
- Claimant's prima facie case at trial · Proof of mailing (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 Allstate Social Work & Psychological Servs., PLLC v GEICO Gen. Ins. Co. (2011 NY Slip Op 21234)
| Allstate Social Work & Psychological Servs., PLLC v GEICO Gen. Ins. Co. |
| 2011 NY Slip Op 21234 [32 Misc 3d 721] |
| July 7, 2011 |
| Edwards, J. |
| Civil Court of the City Of New York, Kings County |
| Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431. |
| As corrected through Wednesday, September 21, 2011 |
[*1]
| Allstate Social Work and Psychological Services, PLLC, as Assignee of Lee Howell and Others, Plaintiff, v GEICO General Insurance Company, Defendant. |
| Allstate Social Work and Psychological Services, PLLC, as Assignee of Latarsha Brown and Others, Plaintiff, v GEICO General Insurance Company, Defendant. |
| Allstate Social Work and Psychological Services, PLLC, as Assignee of Amedeo Rodriguez and Others, Plaintiff, v GEICO General Insurance Company, Defendant. |
Civil Court of the City of New York, Kings County, July 7, 2011
APPEARANCES OF COUNSEL
Law Office of Teresa M. Spina, Woodbury (Dominick Dale of counsel), for defendant. Gary Tsirelman, P.C., Brooklyn (Wesley Mead of counsel), for plaintiff.
{**32 Misc 3d at 716} OPINION OF THE COURT
Genine D. Edwards, J.
In the instant actions for no-fault benefits, bench trials were held on April 13, 2011 and April 14, 2011. After establishing how the bills were created and given to Israel & Israel for [*2]mailing, plaintiff’s witness, Vladmir Grinsberg, could not set forth how the bills were mailed. Mr. Grinsberg instead offered that the denial of claims indicated defendant received the bills. Plaintiff’s counsel contended that the defendant’s denial of claim forms were admissible as party admissions for the limited purpose of proving the bills were mailed and received. Defendant objected and argued that plaintiff has to lay a foundation for the admission of the denial of claim forms. Hence, a directed verdict should be rendered in defendant’s favor in all three actions.
This court requested post-trial memoranda regarding the admissibility of the defendant’s denial of claim forms as party admissions for the limited purpose of establishing that plaintiff mailed its bills to the defendant.
After due deliberation of the evidence adduced at trial, as opposed to documents annexed to a summary judgment motion, this court adheres to the Appellate Term’s ruling that denial of claim forms shall be admitted into evidence only upon the laying of a business record foundation. (Bath Med. Supply, Inc. v Utica Mut. Ins. Co., 23 Misc 3d 141[A], 2009 NY Slip Op 51030[U] [App Term, 2d, 11th & 13th Jud Dists 2009]; Bajaj v General Assur., 18 Misc 3d 25 [App Term, 2d Dept 2007].) Besides testifying that he received the denial of claim forms, Mr. Grinsberg failed to proffer any evidence to authenticate the denial of claim forms.
Accordingly, defendant’s motions for directed verdict in each of the three actions are granted because plaintiff failed to shoulder its prima facie burden.
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.
What must a no-fault claimant prove at trial to make out its prima facie case for overdue benefits?
This decision: Insufficient: claimant did not prove at trial that the claim was submitted (mailed to and received by the insurer)
Held at trial the provider failed its prima facie burden because its witness could not explain how the bills were mailed and the insurer's denial forms, offered to prove receipt, lacked a business-record foundation.
Of the 103 decisions on this question in the Second Department courts and the Court of Appeals, 4 (this one included) are in the same category.
Did a party’s evidence establish that it mailed a no-fault claim, denial, verification request or examination notice?
This decision: The provider's or claimant's proof did not establish mailing of its claim form, NF-2 or verification response
Held the provider did not prove its bills were mailed and received: its witness could not say how they were mailed, and the insurer's denial forms offered to show receipt were inadmissible without a business-record foundation.
Of the 1,400 decisions on this question in the Second Department courts and the Court of Appeals, 67 (this one included) are in the same category.
Cited in this decision
A label shows how this decision treated the case it cites.
- Bath Med. Supply, Inc. v Utica Mut. Ins. Co. (2009 NY Slip Op 51030(U)) FollowedThe provider failed to prove its trial prima facie case because it did not establish admissibility of its claim forms as business records.
- 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
- Allstate Social Work & Psychological Svcs PLLC v GEICO Gen. Ins. Co. (2005 NY Slip Op 50024(U))The insurer failed to prove timely mailing of its denials because its employee's affidavit did not detail the office mailing procedures.
- City Wide Social Work & Psychological Servs., PLLC v GEICO Gen. Ins. Co. (2007 NY Slip Op 50603(U))The provider's employee affidavits failed to establish a business-records foundation for the claim at issue on appeal.
- Allstate Social Work & Psychological Servs., P.L.L.C. v Utica Mut. Ins. Co. (2007 NY Slip Op 52042(U))The provider lacked a business-record foundation, while the insurer failed to prove verification mailing or lack of coverage.
- Five Boro Psychological Servs., P.C. v Progressive Northeastern Ins. Co. (2011 NY Slip Op 51528(U))A denial form offered to show that a claim was denied, rather than to prove its contents, needs no CPLR 4518 business-record foundation.
- New York Diagnostic Med. Care, P.C. v GEICO Gen. Ins. Co. (2013 NY Slip Op 23360)The provider established claim submission through the insurer's denials and proved the loss through admissible claim forms.