April 27, 2012

Jamhil Med., P.C. v Allstate Ins. Co. (2012 NY Slip Op 50775(U))

https://www.beynensonlaw.com/case-law/jamhil-med-p-c-v-allstate-ins-co-2012-ny-slip-op-50775u/

Court: Appellate Term, Second Department
Decided: April 27, 2012
Citation: 2012 NY Slip Op 50775(U) · 35 Misc 3d 135(A)
Posture: Summary judgment
Outcome: Insurer prevailed
Issues: Provider's prima facie case
Legal questions: Claimant's prima facie case on motions (see the maps)

Cite as

Jamhil Med., P.C. v Allstate Ins. Co., 35 Misc 3d 135(A), 2012 NY Slip Op 50775(U) (App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2012)

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 failed to establish its prima facie case because it did not show that its claim forms were admissible business records. The Appellate Term, Second Department, reversed the judgment awarding assigned no-fault benefits, vacated the portion of the order granting the provider summary judgment and denied the motion. The provider relied on the annexed claim forms to establish the fact and amount of its loss. It did not demonstrate their admissibility under CPLR 4518 (a), which permits business records to prove the act, transaction, occurrence or event recorded. Without admissible proof of the loss, the provider was not entitled to summary judgment; the appellate court reached no other issue.

Reported in New York Official Reports at Jamhil Med., P.C. v Allstate Ins. Co. (2012 NY Slip Op 50775(U))

[*1]

Jamhil Med., P.C. v Allstate Ins. Co.

2012 NY Slip Op 50775(U) [35 Misc 3d 135(A)]

Decided on April 27, 2012

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This opinion is uncorrected and will not be published in the printed Official Reports.

Decided on April 27, 2012

SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS

PRESENT: : PESCE, P.J., RIOS and ALIOTTA, JJ
.

Jamhil Medical, P.C. as Assignee of ALBERT CHRISTIE and CHEDDI HOLNESS, Respondent, —
against
Allstate Ins. Co., Appellant.

Appeal from an order of the Civil Court of the City of New York, Kings County (Jacqueline D. Williams, J.), entered May 3, 2010. The order, insofar as appealed from as limited by the brief, granted plaintiff’s motion for summary judgment. The appeal is deemed to be from a judgment of the same court entered June 28, 2010, pursuant to the May 3, 2010 order, awarding plaintiff the principal sum of $11,957.93 (see CPLR 5501 [c]).

ORDERED that the judgment is reversed, without costs, so much of the order as granted plaintiff’s motion for summary judgment is vacated, and plaintiff’s motion is denied.

In this action by a provider to recover assigned first-party no-fault benefits, defendant appeals, as limited by its brief, from so much of an order of the Civil Court as granted plaintiff’s motion for summary judgment. A judgment was subsequently entered, from which the appeal is deemed to have been taken (see CPLR 5501 [c]).

Contrary to the finding of the Civil Court, plaintiff failed to establish its prima facie entitlement to summary judgment. Plaintiff relied upon its claim forms to establish the fact and the amount of the loss sustained; however, plaintiff failed to demonstrate that the claim forms annexed to its motion papers were admissible under the business records exception to the hearsay rule, which allows a document to be used as proof of the “act, transaction, occurrence or event” recorded in the document (CPLR 4518 [a]; see Art of Healing Medicine, P.C. v Travelers Home & Mar. Ins. Co., 55 AD3d 644 [2008]; Dan Med., P.C. v New York Cent. Mut. Fire Ins. Co., 14 Misc 3d 44 [App Term, 2d & 11th Jud Dists 2006]). As plaintiff failed to make out its prima facie case, its motion should have been denied. In light of the foregoing, we reach no other issue.

Accordingly, the judgment is reversed, so much of the order entered May 3, 2010 as granted plaintiff’s motion for summary judgment is vacated, and plaintiff’s motion is denied.

Pesce, P.J., Rios and Aliotta, JJ., concur.
Decision Date: April 27, 2012

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 on motions

Open the full map

On summary judgment or another pretrial motion, what must a no-fault claimant show to establish its prima facie case?

This decision: Insufficient: claim forms not shown admissible as business records / merits of claim not proved

Held the provider failed its prima facie burden because it did not show the claim forms it relied on for the fact and amount of the loss were admissible business records under CPLR 4518 (a).

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

Of the 1,065 decisions on this question in the Second Department courts and the Court of Appeals, 208 (this one included) are in the same category.

Cited in this decision

A label shows how this decision treated the case it cites.

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.
Dan Med., P.C. v New York Cent. Mut. Fire Ins. Co. (2006 NY Slip Op 26483) FollowedThe 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

Jamhil Med., P.C. v Tri-State Consumer Ins. Co. (2012 NY Slip Op 52049(U))The insurer's motion to vacate an unopposed summary judgment order was denied for failure to show a reasonable excuse.
RLC Med., P.C. v Allstate Ins. Co. (2009 NY Slip Op 51131(U))The provider's billing manager failed to establish admissible business records, defeating the provider's motion for summary judgment.
Capri Med., P.C. v Allstate Ins. Co. (2007 NY Slip Op 50611(U))The provider failed to make a prima facie showing because its officer's affidavit did not establish a business-records foundation.
Jamhil Med., P.C. v Clarendon Natl. Ins. Co. (2012 NY Slip Op 51644(U))The insurer established timely mailing of IME notices and a denial based on the assignor's failure to appear for the scheduled IMEs. The president of the independent medical review service retained to schedule the examinations established timely mailing of the scheduling letters.
Careplus Med. Supply, Inc. v Allstate Ins. Co. (2016 NY Slip Op 50196(U))A provider need not establish claim forms' admissibility under CPLR 4518 as part of its prima facie entitlement to summary judgment.