November 4, 2011
Raz Acupuncture, P.C. v GEICO Gen. Ins. Co. (2011 NY Slip Op 52064(U))
https://www.beynensonlaw.com/case-law/raz-acupuncture-p-c-v-geico-gen-ins-co-2011-ny-slip-op-52064u/
- Decided
- November 4, 2011
- Citation
- 2011 NY Slip Op 52064(U) · 33 Misc 3d 137(A)
- Posture
- Summary judgment
- Outcome
- Insurer prevailed
- Later treatment
- Declined to follow in 1 later decision (see Cited by)
- Legal questions
- Claimant's prima facie case on motions (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 Raz Acupuncture, P.C. v GEICO Gen. Ins. Co. (2011 NY Slip Op 52064(U))
| Raz Acupuncture, P.C. v GEICO Gen. Ins. Co. |
| 2011 NY Slip Op 52064(U) [33 Misc 3d 137(A)] |
| Decided on November 4, 2011 |
| 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| This opinion is uncorrected and will not be published in the printed Official Reports.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, 11th and 13th JUDICIAL DISTRICTS
PRESENT: : PESCE, P.J., WESTON and RIOS, JJ
2010-735 K C.
against
Geico General Ins. Co., Appellant.
Appeal from an order of the Civil Court of the City of New York, Kings County (Carolyn E. Wade, J.), entered January 15, 2010. The order, insofar as appealed from as limited by the brief, implicitly granted the branch of plaintiff’s motion seeking an order finding, for all purposes in the action, that plaintiff had established its prima facie case.
ORDERED that the order, insofar as appealed from, is reversed, without costs, and the branch of plaintiff’s motion seeking an order finding, for all purposes in the action, that plaintiff had established its prima facie case is denied.
In this action by a provider to recover assigned first-party no-fault benefits, defendant appeals from so much of an order as implicitly granted the branch of plaintiff’s motion seeking a finding, pursuant to CPLR 3212 (g), that plaintiff had established its prima facie case for all purposes in the action.
Plaintiff’s motion for summary judgment or, in the alternative, for a finding, pursuant to CPLR 3212 (g), that it had established its prima facie case for all purposes in the action, was supported by an affidavit of the president of a third-party billing company, who did not demonstrate that he possessed personal knowledge of plaintiff’s business practices and procedures so as to establish that the claim forms annexed to plaintiff’s moving papers were admissible under the business records exception to the hearsay rule (CPLR 4518). As a result, the branch of plaintiff’s motion seeking a finding, pursuant to CPLR 3212 (g), that plaintiff had established its prima facie case for all purposes in the action should have been denied (see Matter of Carothers v GEICO Indem. Co., 79 AD3d 864 [2010]; Viviane Etienne Med. Care, P.C. v Country-Wide Ins. Co., 31 Misc 3d 21 [App Term, 2d, 11th & 13th Jud Dists 2011]; see also [*2]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]).
Accordingly, the order, insofar as appealed from, is reversed, and the branch of plaintiff’s motion seeking a finding, pursuant to CPLR 3212 (g), that plaintiff had established its prima facie case for all purposes in the action is denied.
Pesce, P.J., Weston and Rios, JJ., concur.
Decision Date: November 04, 2011
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.
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
Reversed a CPLR 3212 (g) finding that the provider established its prima facie case because the third-party biller lacked personal knowledge of the provider's practices to make the claim forms admissible under CPLR 4518.
Of the 1,063 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.
- Matter of Carothers v GEICO Indem. Co. (2010 NY Slip Op 09256) FollowedThe provider's billing witness failed to establish a business-records foundation for claim forms merely printed and mailed by the billing company.
- Viviane Etienne Med. Care, P.C. v Country-Wide Ins. Co. (2011 NY Slip Op 21039) FollowedThe provider failed to establish its prima facie case because its third-party biller's affidavit lacked a business-record foundation.
- Art of Healing Medicine, P.C. v Travelers Home & Mar. Ins. Co. (2008 NY Slip Op 07846)The 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)The provider failed to establish its prima facie case because its corporate officer did not lay a business-records foundation for the claim documents.
Cited by
A label shows how the later decision treated this one.
- Viviane Etienne Med. Care, P.C. v Country-Wide Ins. Co. (2013 NY Slip Op 08430) Declined to followA provider need not prove a claim's merits for summary judgment where the insurer failed to timely and properly deny the claim.
Similar decisions
- Raz Acupuncture, P.C. v Travelers Prop. Cas. Ins. Co. (2010 NY Slip Op 50065(U))The provider failed to establish admissible business records through its third-party billing company's employee.
- Raz Acupuncture, P.C. v New S. Ins. Co. (2012 NY Slip Op 50865(U))The insurer established full payment under the workers' compensation fee schedule for the four challenged causes of action.
- Raz Acupuncture, P.C. v Praetorian Ins. Co. (2012 NY Slip Op 50305(U))The insurer's unrebutted IME report established lack of medical necessity for acupuncture services from October 30, 2007 through January 30, 2008.
- Acupuncture Now, P.C. v GEICO Ins. Co. (2017 NY Slip Op 51809(U))The insurer's summary judgment cross motion on fee schedule claims was granted after its mailing and fee schedule proof were upheld.
- Downtown Acupuncture, P.C. v Geico Gen. Ins. Co. (2007 NY Slip Op 50660(U))The provider's president failed to establish a business-records foundation, defeating the provider's prima facie summary judgment showing.