Open MRI of Tarrytown v GEICO Ins. Co. (2009 NY Slip Op 50874(U))

Civil Court of the City of New York, Bronx County

020438-08

Appearance of Counsel-

Plaintiff- Michael J Palumbo, 188 East Post Road, suite 300, White Plains, NY 10601, 914-681-7117

Defendant- Teresa M. Spina, 170 Froehlich Farm Blvd, Woodbury, NY 11797, 516-496-5800

Elizabeth A. Taylor, J.

The issue before the Court is whether the submission of a notice to admit is [*2]sufficient to establish a prima facie case to recover no-fault first party benefits for unpaid medical expenses.

Under CPLR §3123 a notice to admit is a “written request for admission by the latter of the genuineness of any papers or documents…described in and served with the request, or of the truth of any matters of fact set forth in the request, as to which the party requesting the admission reasonably believes there can be no substantial dispute at the trial and which are within the knowledge of such other party or can be ascertained by him upon reasonable inquiry.” (CPLR §3123(a)). If a party fails to respond to a notice to admit within 20 days after service, the matters therein are deemed admitted for the purpose of the pending litigation. (CPLR §3123(a)). A notice to admit is a vehicle for resolving and eliminating matters that may be factually relevant but are not really in dispute, thus a notice to admit is not permissible to seek admissions to material issues. (Villa v. New York City Hous. Auth., 107 AD2d 619, 620 [1984][1st Dep’t]).

In order to establish a prima facie case for first party no-fault benefits a plaintiff must present the claim forms submitted to the insurer in admissible form, then establish that the payment of benefits is overdue, and prove the claim and assignment forms were served upon insurer. (Mary Immaculate Hosp. v. Allstate Ins. Co., 5 AD3d 742, 742-743 [2004][2nd Dep’t]). Laying the proper evidentiary foundation is commonly done by a witness who can testify that the claim form is a business record pursuant to CPLR §4518. However, it has become increasingly popular for plaintiffs to attempt to forgo the necessity of a witness through the use of interrogatory responses and responses or lack of responses to notices to admit to establish their prima facie case.

The Appellate Term, First Department has allowed the use of interrogatory responses to establish a prima facie case, stating “having admitted receipt of plaintiff’s claims for no-fault first party benefits, defendants may not now be heard to argue that plaintiff failed to establish that the claims had been mailed and received. (P.L.P. Acupuncture, P.C., v. Travelers Indem. Co., 19 Misc 3d 126(A) [2008][N.Y.App. Term 1st Dept.], quoting Fair Price Med. Supply, Inc. v. St. Paul Travelers Ins. Co., 16 Misc 3d 8,9 [2007][N.Y.App. Term 1st Dept.]). However, there are notable differences between the use of interrogatories and a notice to admit. As previously mentioned, a notice to admit may not be used to seek answers to material issues, whereas, an interrogatory is given under oath and may be used to address any relevant question. (Villa at 620). Furthermore, the use of a defendant’s response to interrogatory questions in which it is stated that the claims were mailed and received followed by a subsequent denial is much different than the scenario in which a defendant fails to respond to a notice to admit and it is therefore deemed admitted that they received the claim.

Courts differ drastically on the treatment of the notice to admit to establish a prima facie claim. A number of courts find that the use of a notice to admit seeking admissions as to the receipt of relevant claim forms, bills and defendant’s denial of the same goes to the “heart of the matter” or is a “material issue” and therefore, inadmissible to establish plaintiff’s prima facie case. (see RJ Med. P.C. v. All-State Ins. Co., 15 Misc 3d 1140(A) [2007][NY City Civ. Ct. Bronx County]; PDG Psychological, [*3]P.C. v. State Farm Ins. Co., 12 Misc 3d 1183(A) [2006][N.Y.City Civ. Ct. Kings County]). Meanwhile, other courts have held that the information requested in the notice to admit does not individually go to the “heart of the matter” even though collectively they may be dispositive. (see Seaside Med., P.C. v. General Assur. Co., 16 Misc 3d 758 [2007][NY Dist. Ct. Suffolk]). Further, other courts have held that the admissions of the receipt of relevant claim forms, bills and denials by notice to admit does not go to the “heart of the matter” and is therefore permissible; however, it does not establish a prima facie case because the formalities of the business record exception to the hearsay rule have not been observed. (Bajaj v. General Assur. Co., 18 Misc 3d 25, 28 [2007][NY App. Term 2nd Dept.]).

This Court is cognizant that the Second Department and First Department often differ on matters concerning no-fault litigation. However, since the First Department has yet to speak on the matter, this Court is bound by the Bajaj decision of the Appellate Term, Second Department. “The doctrine of stare decisis requires trial courts…in this department to follow precedents set by the Appellate Division of another department until the Court of Appeals or [the Appellate Division of this department] pronounces a contrary rule.” (Striver 140 v. Cruz, 1 Misc 3d 29, 31 [2003][NY App. Term 2nd Dept.]), quoting Mountain View Coach Lines v. Storms, 102 AD2d 663, 664 [1984][2nd Dept.]).

The Second Department has held that a plaintiff must lay a proper foundation for the admissibility under the business records exception to establish a prima facie case. (Bajaj at 28). According to Bajaj,the use of a notice to admit to ask the defendants if they have received the claim form is a proper use of the notice to admit. (id.). If defendant fails to respond to this notice to admit, it is then admissible that the defendant in fact received plaintiff’s claim form. (id.). However, an acknowledgment by defendant that they received the claim form is not a concession of the facts set forth in the claim. (id.). It remains the plaintiff’s burden to lay the sufficient foundation establishing that the claim form is a business record, and as such, is admissible to prove the truth of the matters asserted therein. (id.). This holding continues to be upheld by the Second Department. (see Vista Surgical Supplies, Inc. v. State Farm Mutual Ins. Co., 22 Misc 3d 128(A) [2009][N.Y.App. Term 2nd Dept.]).

Accordingly, the Court finds that an admission by notice to admit that defendant received plaintiff’s claim form is not a concession of the facts set forth in the claim form. The plaintiff still has the burden to establish the claim form is admissible as a business record exception to the hearsay rule to prove the truth of the matters asserted therein. Due to their failure to establish that the claim forms are business records, plaintiffs have not established a prima facie case. It is noted that the plaintiffs called no witnesses to testify.

Accordingly, plaintiff’s actions are dismissed.

The foregoing shall constitute the decision and order of this Court.

Dated: __April 30, 2009_______________

J.C.C.