What must a no-fault claimant prove at trial to make out its prima facie case for overdue benefits?

A decision decides this question when, at or after a trial, it rules whether the claimant suing for no-fault benefits (usually a provider-assignee, sometimes the injured person) proved its prima facie case. The ruling comes as a decision or judgment after a nonjury or jury trial, a directed verdict or CPLR 4401 motion at the close of the claimant's case, a CPLR 4404 motion, a decision on stipulated facts submitted in place of a trial, or an appeal from one of these. Deciding the question means holding that the claimant's trial proof (testimony, claim forms, the insurer's denial forms, interrogatory answers or a notice to admit) was sufficient or insufficient, or holding that the claimant does or does not have to prove an extra element at trial, such as a business-records foundation for its claim forms, an assignment, the absence of a timely denial or, against MVAIC, its assignor's qualified/covered-person status.

Settled at the Appellate Division, no conflicting department. No Court of Appeals decision in the database addresses the trial burden directly. Viviane Etienne (2015) set the elements on summary judgment (claim mailed to and received by the insurer, payment overdue; no proof of the merits and no business-records foundation for the truth of the claim forms), and the appellate courts apply those elements at trial. The First Department Appellate Division did so in Health E. (2025): the insurer's admission of receipt established the prima facie case at trial, and it was the insurer's burden to prove that verification requests tolled the 30 days. The Second Department Appellate Term says the same in its own words: at trial the claimant proves submission/receipt and nonpayment (Alev 2013; V.S. Med. 2015; Healthy Way 2019), and the insurer must prove a defense that is not precluded, i.e. a timely denial (Davydov 2009; Urban Radiology 2013; TAM Med. Supply 2018). That is lighter than the Second Department's summary judgment burden, where the claimant must also show the claim was not timely denied or that the denial was conclusory, vague or without merit (Wave Med. v Hertz 2022 states the contrast expressly). So, on who proves the denial/verification part of the overdue element, the texts show no First/Second Department difference at trial; the one decision that put it on the claimant at trial, the First Department Appellate Term's Health E. (2024), was reversed by the Appellate Division. The real conflict was historical: from 2006 to 2013 the Second Department (Bajaj, App Term 2007; Carothers, App Term 2009 and App Div 2010) required a CPLR 4518 foundation for the claim forms at trial and held that the insurer's admissions or a notice to admit could not supply it, while the First Department Appellate Term accepted such admissions (Fair Price 2007; P.L.P. 2008; Central Nassau 2010, declining to follow Bajaj). Viviane Etienne (2d Dept 2013, overruling Carothers and Art of Healing; affd 2015) ended that split, and the Appellate Term has accepted a biller's testimony or the insurer's denial form since (Peace of Mind 2014, 2015; Eagle Surgical 2014). Against MVAIC, the Second Department Appellate Term treats qualified/covered-person status (timely notice of intention, residency, no other insurance, non-ownership of the vehicle) as part of the claimant's case at trial (Peace of Mind v MVAIC 2011 through 2022); one Kings County Civil Court decision held otherwise (Kipor 2009).

Leading authorities · Authority map · Decisions by court · Plain-text version (Markdown)

Leading authorities

Health E. Ambulatory Surgical Ctr. v Country-Wide Ins. Co. (2025 NY Slip Op 06648) Appellate Division, First Department, 2025First Department: admitted receipt proves case; verification is insurer's burdenAt a nonjury trial, the insurer's judicial admission of receipt in its own summary judgment papers, admitted without a witness, established the provider's prima facie case under Viviane Etienne, and the insurer conceded it did not pay or deny within 30 days. Proving that verification requests were sent (tolling the 30 days) was the insurer's burden at trial, not the provider's burden to disprove.
Defendant’s admission that it had received plaintiff’s notice of claim was sufficient to establish plaintiff’s prima facie case at trial (see Viviane Etienne Med. Care, P.C. v Country-Wide Ins. Co., 25 NY3d 498, 501 [2015]). As to whether defendant’s payment was overdue (see id.), defendant conceded that it did not pay or deny the claim within the prescribed 30-day period.
Central Nassau Diagnostic Imaging, P.C. v GEICO (2010 NY Slip Op 20244) Appellate Term, First Department, 2010First Department: insurer's deemed admissions prove the case without witnessesFacts deemed admitted by the insurer's failure to answer a notice to admit (that the attached bills were true copies of bills it received and that it had not paid them) conclusively established the provider's entitlement at trial, so a directed verdict without witnesses was proper; the court declined to follow Bajaj to the extent it holds otherwise.
Because defendant admitted that the two bills attached to the notice were “true and accurate” copies of the bills received by defendant and that defendant has not paid those bills, plaintiff established its entitlement to recover the overdue assigned first-party no-fault benefits
Urban Radiology, P.C. v GEICO Gen. Ins. Co. (2013 NY Slip Op 50850(U)) Appellate Term, Second Department, 2013Second Department: at trial, unlike summary judgment, insurer proves defensesOnce the provider presented its prima facie case at trial, dismissal for failure to offer an assignment was error, because the insurer had not timely objected to the claim forms or sought verification of the assignment. At trial, unlike on summary judgment, the provider need not show that there is no defense; the insurer must prove a meritorious defense that is not precluded.
at a trial, unlike upon a provider’s motion for summary judgment, a provider is not required to “show that there is no defense to the cause of action or that the cause of action or defense has no merit” (CPLR 3212 [b]). Rather, it is defendant’s burden to show that it has a meritorious defense
Peace of Mind, Social Work, P.C. v Travelers Aetna Prop. Cas. Corp. (2014 NY Slip Op 50475(U)) Appellate Term, Second Department, 2014Second Department: after Viviane Etienne, biller testimony suffices; no CPLR 4518 foundationApplying Viviane Etienne (2d Dept 2013), the testimony of the provider's third-party biller established its prima facie case at trial, rejecting the insurer's argument that the witness had to lay a CPLR 4518 business-records foundation for the claim forms; with no defense offered, the judgment for the provider was affirmed.
Pursuant to the holding in Viviane Etienne Med. Care, P.C. v Country-Wide Ins. Co. ( ___ AD3d ___, 2013 NY Slip Op 08430 [2d Dept 2013]), the testimony of plaintiff’s witness was sufficient to establish plaintiff’s prima facie case.
Alev Med. Supply, Inc. v Geico Gen. Ins. Co. (2013 NY Slip Op 52322(U)) Appellate Term, Second Department, 2013Second Department: trial burden is submission and nonpaymentA witness with personal knowledge of the provider's practices laid a foundation for the claim forms, which were prima facie evidence of the fact and amount of the loss, and testified to their submission and to nonpayment; that made out the prima facie case at trial, and since the insurer offered no defense, judgment for the provider was directed.
The witness also offered testimony pertaining to the submission of the claim forms to defendant and of defendant’s failure to pay the claims. Thus, plaintiff established its prima facie case
Avicenna Med. Arts, P.L.L.C. v MVAIC (2016 NY Slip Op 51535(U)) Appellate Term, Second Department, 2016Against MVAIC: covered-person status is part of the trial caseA provider suing MVAIC failed its prima facie case at trial, despite its billing manager's testimony that the claims were mailed, because it did not show that a timely notice of intention to make claim, a condition of the assignor's covered-person status, was submitted to MVAIC.
As plaintiff did not establish that such an affidavit had been submitted to MVAIC, plaintiff failed to establish its prima facie case (see Insurance Law §§ 5202 [b]; 5208, 5221 [b] [2]).
Presbyterian Hosp. in City of N.Y. v Maryland Cas. Co. 90 NY2d 274Preclusion rule; cited at trial for the insurer's burden to prove that its defense is not precluded, i.e. that it timely denied (Davydov 2009; Urban Radiology 2013; TAM Med. Supply 2018).Not in our database.
Seaboard Sur. Co. v Gillette Co. 64 NY2d 304Cited by Urban Radiology (2013) for the defendant's burden at trial to show a meritorious defense.Not in our database.
Matter of Leon RR 48 NY2d 117Business-records chain (each participant acting in the regular course of business); applied to third-party billers' claim forms at trial before Viviane Etienne (e.g. post 16824, 2013).Not in our database.
Zuckerman v City of New York 49 NY2d 557Proof in admissible form; relied on in Bajaj (2007) to require admissible proof of the claim at trial.Not in our database.
Matter of Union Indem. Ins. Co. of N.Y. 89 NY2d 94Judicial admissions; relied on in Health E. (2025) to admit the insurer's motion papers as proof of receipt at trial without a witness.Not in our database.

Authority map

Each circle is a decision on this question, placed by court and date; its colour is the position it took. Lines are citations between them. Select a circle (or find a decision by name) to see its links and summary. The same decisions are listed by court below the map.

Claimant's trial proof held to make out its prima facie caseInsufficient: claimant did not prove at trial that the claim was submitted (mailed to and received by the insurer)Insufficient: claimant did not prove at trial that payment was overdue (unpaid, or not paid or denied within 30 days)Insufficient: claim forms not admitted as business records / insurer's admissions held not to prove the claimInsufficient at trial for another reason (MVAIC eligibility, assignment, eligibility for benefits)Ring: rules on the question, but another ground decided the caseContrasted, distinguished or limitedDeclined to follow, questioned, overruled or reversedCited Show ordinary citations

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How the rule was applied, by court

Court	Proof sufficient	Mailing/receipt not shown	Overdue not shown	Business-record foundation lacking	Other element missing	Total
Appellate Division, First Department	1	0	0	0	0	1
Appellate Division, Second Department	0	0	0	1	1	2
Appellate Term, First Department	4	0	1	0	2	7
Appellate Term, Second Department	18	2	2	14	22	58
Trial courts in the First Department	1	3	0	1	1	6
Trial courts in the Second Department	22	2	1	6	2	33
Trial courts in the Third Department	1	0	0	0	0	1
Trial courts in the Fourth Department	0	1	0	0	0	1

Decisions (109)

Every decision in our database that rules on this question: highest court first, then by department, newest first. 90 turn on it; the others rule on it alongside a different main ground (marked "also decides"). The one-sentence summaries describe what each court said on this question.

Appellate Division, First Department (1 decision)

Health E. Ambulatory Surgical Ctr. v Country-Wide Ins. Co. (2025 NY Slip Op 06648) Leading case Appellate Division, First Department, December 2, 2025Claimant's trial proof held to make out its prima facie caseHeld the insurer's judicial admission of receipt in its motion papers established the provider's prima facie case at trial, and the insurer conceded it did not pay or deny within 30 days.

Appellate Division, Second Department (2 decisions)

Matter of Carothers v GEICO Indem. Co. (2010 NY Slip Op 09256) Appellate Division, Second Department, December 14, 2010Insufficient: claim forms not admitted as business records / insurer's admissions held not to prove the claimHeld the provider failed its prima facie case at trial because its billing company's employee could not lay a business-records foundation for the claim forms, the company having neither created, incorporated nor relied on them.
State Farm Mut. Auto. Ins. Co. v Stack (2008 NY Slip Op 07651) Appellate Division, Second Department, October 7, 2008Insufficient at trial for another reason (MVAIC eligibility, assignment, eligibility for benefits) (also decides)Held the injured person failed to prove a compensable lost-earnings claim at the de novo trial because his testimony about his self-employment losses, without financial records such as tax returns, did not establish the loss with reasonable certainty.

Appellate Term, First Department (7 decisions)

Health E. Ambulatory Surgical Ctr. v Country-Wide Ins. Co. (2024 NY Slip Op 51346(U)) Appellate Term, First Department, September 30, 2024Insufficient: claimant did not prove at trial that payment was overdue (unpaid, or not paid or denied within 30 days)Held the provider failed to establish at trial that the claim was overdue because the insurer's admissions it relied on also showed the insurer timely sought verification that was never provided.
Omega Diagnostic Imaging, PC v MVAIC (2017 NY Slip Op 50568(U)) Appellate Term, First Department, April 26, 2017Insufficient at trial for another reason (MVAIC eligibility, assignment, eligibility for benefits)Held the claimant could not recover against MVAIC after trial because the evidence showed its assignor failed to report the accident to police within 24 hours, so he was not a covered person, and the claimant offered no rebuttal or excuse.
Pomona Med. Diagnostics, PC v MVAIC (2013 NY Slip Op 51250(U)) Appellate Term, First Department, July 31, 2013Insufficient at trial for another reason (MVAIC eligibility, assignment, eligibility for benefits)Reversed a judgment for the provider against MVAIC and ordered a new trial because the abbreviated trial record left unresolved whether the notice of intention to make claim was timely and whether coverage existed.
Central Nassau Diagnostic Imaging, P.C. v GEICO (2010 NY Slip Op 20244) Leading case Appellate Term, First Department, June 21, 2010Claimant's trial proof held to make out its prima facie caseHeld the provider established its entitlement at trial without witnesses because the insurer, by not responding to a notice to admit, conclusively admitted it received the attached bills and had not paid them.
Globe Med. Care O.L.P.C. v Travelers Ins. Co. (2010 NY Slip Op 50020(U)) Appellate Term, First Department, January 11, 2010Claimant's trial proof held to make out its prima facie case (also decides)Agreed with the trial court that the provider established its prima facie case at the nonjury trial, and, since the insurer offered no medical necessity evidence, directed judgment for the provider.
P.L.P. Acupuncture, P.C. v Travelers Indem. Co. (2008 NY Slip Op 50484(U)) Appellate Term, First Department, March 14, 2008Claimant's trial proof held to make out its prima facie caseHeld that, having admitted receipt of the claims, the insurer could not argue the claimant failed to establish that the claims were mailed and received.
Fair Price Med. Supply, Inc. v St. Paul Travelers Ins. Co. (2007 NY Slip Op 27173) Appellate Term, First Department, May 4, 2007Claimant's trial proof held to make out its prima facie caseHeld the insurer's verified interrogatory answers admitting receipt of the claims and partial payment were party admissions that barred it from arguing the provider failed to prove mailing, receipt and overdue status.

Appellate Term, Second Department (58 decisions)

Masigla v MVAIC (2025 NY Slip Op 51515(U)) Appellate Term, Second Department, August 8, 2025Insufficient at trial for another reason (MVAIC eligibility, assignment, eligibility for benefits)Held the provider failed its prima facie case against MVAIC at trial because the trial stipulation showed the assignor had exclusive possession of the uninsured vehicle for over 30 days, making him its owner and not a qualified person.
Metro Health Prods., Inc. v MVAIC (2022 NY Slip Op 50588(U)) Appellate Term, Second Department, June 10, 2022Insufficient at trial for another reason (MVAIC eligibility, assignment, eligibility for benefits)Held after trial that the provider failed its prima facie case against MVAIC because it showed neither a reasonable justification for the late notice of claim nor leave of court to file it late.
T & S Med. Supply Corp. v MVAIC (2020 NY Slip Op 51327(U)) Appellate Term, Second Department, November 6, 2020Claimant's trial proof held to make out its prima facie caseReversed a dismissal entered because the provider called no witness to prove it supplied the requested verification, holding that burden was wrongly placed on the provider, and ordered a new trial on whether verification remained outstanding.
Maiga Prods. Corp. v MVAIC (2020 NY Slip Op 50993(U)) Appellate Term, Second Department, August 28, 2020Insufficient at trial for another reason (MVAIC eligibility, assignment, eligibility for benefits)Held after trial that the provider failed to make out its prima facie case against MVAIC because it did not establish that its assignor was not the owner of the uninsured vehicle he was driving.
Bronx Acupuncture Therapy, P.C. v MVAIC (2019 NY Slip Op 51694(U)) Appellate Term, Second Department, October 18, 2019Insufficient at trial for another reason (MVAIC eligibility, assignment, eligibility for benefits)Held after trial that the provider failed to make out its prima facie case against MVAIC because it did not establish that a timely notice-of-intention affidavit had been submitted to MVAIC.
Bronx Acupuncture Therapy, P.C. v MVAIC (2019 NY Slip Op 51253(U)) Appellate Term, Second Department, August 2, 2019Insufficient at trial for another reason (MVAIC eligibility, assignment, eligibility for benefits)Held after trial that the provider failed to make out its prima facie case against MVAIC because it did not establish that a timely notice-of-intention affidavit had been submitted to MVAIC.
Lotus Acupuncture, P.C. v Country-Wide Ins. Co. (2019 NY Slip Op 50099(U)) Appellate Term, Second Department, January 18, 2019Insufficient at trial for another reason (MVAIC eligibility, assignment, eligibility for benefits)Reversed the judgment for the provider after a consolidated nonjury trial because no testimony at all was taken as to this action, so nothing supported the award, and ordered a new trial.
Healthy Way Acupuncture, P.C. v Country-Wide Ins. Co. (2019 NY Slip Op 50098(U)) Appellate Term, Second Department, January 18, 2019Insufficient at trial for another reason (MVAIC eligibility, assignment, eligibility for benefits)Reversed the judgment for the provider after a consolidated nonjury trial because no testimony at all was taken as to this action, so nothing supported the award, and ordered a new trial.

Show all 58 decisions

Lotus Acupuncture, P.C. v Country-Wide Ins. Co. (2019 NY Slip Op 50097(U)) Appellate Term, Second Department, January 18, 2019Insufficient at trial for another reason (MVAIC eligibility, assignment, eligibility for benefits)Reversed the judgment for the provider after a consolidated nonjury trial because no testimony at all was taken as to this action, so nothing supported the award, and ordered a new trial.
Lotus Acupuncture, P.C. v Country-Wide Ins. Co. (2019 NY Slip Op 50096(U)) Appellate Term, Second Department, January 18, 2019Insufficient at trial for another reason (MVAIC eligibility, assignment, eligibility for benefits)Reversed the judgment for the provider after a consolidated nonjury trial because no testimony at all was taken as to this action, so nothing supported the award, and ordered a new trial.
Lotus Acupuncture, P.C. v Country-Wide Ins. Co. (2019 NY Slip Op 50095(U)) Appellate Term, Second Department, January 18, 2019Insufficient at trial for another reason (MVAIC eligibility, assignment, eligibility for benefits)Reversed the judgment for the provider after a consolidated nonjury trial because no testimony at all was taken as to this action, so nothing supported the award, and ordered a new trial.
Healthy Way Acupuncture, P.C. v Country-Wide Ins. Co. (2019 NY Slip Op 50094(U)) Appellate Term, Second Department, January 18, 2019Claimant's trial proof held to make out its prima facie caseRejected the insurer's challenge and held after trial that the provider established its prima facie case on all seven claims by showing the bills were received by the insurer and not paid.
A & S Med. Supply, Inc. v MVAIC Ins. Co. (2019 NY Slip Op 29019) Appellate Term, Second Department, January 11, 2019Insufficient at trial for another reason (MVAIC eligibility, assignment, eligibility for benefits) (also decides)Held, after a nonjury trial against MVAIC, that the provider failed to show it had exhausted its remedies against a potential other carrier, once MVAIC's seized liquidated-insurer records showed potential coverage, and dismissed the complaint.
Acupuncture Approach, P.C. v MVAIC (2018 NY Slip Op 51776(U)) Appellate Term, Second Department, November 30, 2018Insufficient at trial for another reason (MVAIC eligibility, assignment, eligibility for benefits)Held after trial that the provider failed to make out its prima facie case against MVAIC because it did not establish that a timely notice-of-intention affidavit had been submitted, a condition of covered-person status.
New Millennium Med. Imaging, P.C. v MVAIC (2018 NY Slip Op 51684(U)) Appellate Term, Second Department, November 23, 2018Insufficient at trial for another reason (MVAIC eligibility, assignment, eligibility for benefits)Held after trial that the provider failed its prima facie case because it did not establish that the motorcycle its assignor drove was a class C motorcycle not required to carry insurance.
Medical Diversified Servs., Inc. v MVAIC (2017 NY Slip Op 51848(U)) Appellate Term, Second Department, December 22, 2017Insufficient at trial for another reason (MVAIC eligibility, assignment, eligibility for benefits)Held the provider failed to establish its prima facie case at trial because it did not show that a timely affidavit giving MVAIC notice of intention to file a claim had been submitted.
Orlin & Cohen Orthopedic Assoc. v Motor Veh. Acc. Indem. Corp. (2017 NY Slip Op 51778(U)) Appellate Term, Second Department, December 15, 2017Insufficient at trial for another reason (MVAIC eligibility, assignment, eligibility for benefits)Held the claimant failed to establish its assignor's covered-person status against MVAIC at trial because the assignor knew the identity of the striking vehicle's driver and the claimant did not show it had exhausted remedies against other potential insurers.
Advanced Chiropractic of NY, P.C. v MVAIC (2017 NY Slip Op 50955(U)) Appellate Term, Second Department, July 21, 2017Insufficient at trial for another reason (MVAIC eligibility, assignment, eligibility for benefits)Held at trial that the provider failed to establish its prima facie case because it did not prove the assignor's New York residence was shown to MVAIC or that no other coverage was available.
Avicenna Med. Arts, P.L.L.C. v MVAIC (2016 NY Slip Op 51535(U)) Leading case Appellate Term, Second Department, October 11, 2016Insufficient at trial for another reason (MVAIC eligibility, assignment, eligibility for benefits)Held at trial that the billing manager's testimony of mailing did not make out a prima facie case because the provider did not show a timely notice of intention affidavit was submitted to MVAIC.
Village Med. Supply, Inc. v MVAIC (2016 NY Slip Op 51421(U)) Appellate Term, Second Department, September 27, 2016Insufficient at trial for another reason (MVAIC eligibility, assignment, eligibility for benefits)Held at trial that the provider failed its prima facie case because it did not show MVAIC was given proof of the assignor's New York residence or that a notice of intention was submitted.
Yklik, Inc. v Mvaic (2016 NY Slip Op 50874(U)) Appellate Term, Second Department, June 3, 2016Insufficient at trial for another reason (MVAIC eligibility, assignment, eligibility for benefits)Held at trial that the provider failed to establish its prima facie case because it did not show a notice of intention to make claim form had been submitted to MVAIC.
Brand Med. Supply, Inc. v Infinity Ins. Co. (2016 NY Slip Op 50738(U)) Appellate Term, Second Department, May 5, 2016Claimant's trial proof held to make out its prima facie case (also decides)Held at trial that the provider made its prima facie case because its bill and proof of mailing were admitted through the owner, who testified he personally mailed the bill and it was unpaid.
Beal-Medea Prods., Inc. v Geico Gen. Ins. Co. (2016 NY Slip Op 50594(U)) Appellate Term, Second Department, April 8, 2016Claimant's trial proof held to make out its prima facie caseHeld the CPLR 4401 dismissal at the jury trial erroneous because a no-fault plaintiff need not put an executed assignment of benefits in evidence to make out its prima facie case unless the insurer timely raised the assignment.
V.S. Med. Servs., P.C. v Travelers Ins. Co. (2015 NY Slip Op 51760(U)) Appellate Term, Second Department, December 1, 2015Claimant's trial proof held to make out its prima facie caseHeld at trial that the provider proved its prima facie case because its bills and proof of mailing were admitted through its owner, who testified the bills were unpaid.
SK Prime Med. Supply, Inc. v MVAIC (2015 NY Slip Op 51663(U)) Appellate Term, Second Department, November 12, 2015Insufficient at trial for another reason (MVAIC eligibility, assignment, eligibility for benefits)Held at trial that proof of mailing and nonpayment was not enough because the provider did not show proof of the assignor's New York residence or submission of a notice of intention to MVAIC.
Peace of Mind Social Work, P.C. v Travelers Ins. Co. (2015 NY Slip Op 50777(U)) Appellate Term, Second Department, May 18, 2015Claimant's trial proof held to make out its prima facie caseHeld the third-party biller's trial testimony established the provider's prima facie case, rejecting the insurer's argument that a CPLR 4518 business-record foundation for the claim forms was required.
Peace of Mind, Social Work, P.C. v Travelers Aetna Prop. Cas. Corp. (2014 NY Slip Op 50475(U)) Leading case Appellate Term, Second Department, March 17, 2014Claimant's trial proof held to make out its prima facie caseHeld the third-party biller's trial testimony sufficient to establish the claimant's prima facie case, rejecting the insurer's argument that a CPLR 4518 business-records foundation for the claim forms was required.
Eagle Surgical Supply, Inc. v Allstate Ins. Co. (2014 NY Slip Op 50343(U)) Appellate Term, Second Department, February 28, 2014Claimant's trial proof held to make out its prima facie caseReversing a trial dismissal, held the insurer's denial form was admissible as its admission of receipt, not as the provider's business record, so with proof of nonpayment the provider established its case.
Alev Med. Supply, Inc. v Geico Gen. Ins. Co. (2013 NY Slip Op 52322(U)) Leading case Appellate Term, Second Department, November 12, 2013Claimant's trial proof held to make out its prima facie caseHeld at trial that the witness laid a business-records foundation for the claim forms and testified to their submission and nonpayment, establishing the provider's prima facie case, and the insurer offered no defense.
Alev Med. Supply, Inc. v Geico Gen. Ins. Co. (2013 NY Slip Op 51915(U)) Appellate Term, Second Department, November 12, 2013Claimant's trial proof held to make out its prima facie caseHeld the provider's trial witness had enough personal knowledge of its business practices to lay a business-records foundation for the claim forms and prove nonpayment, so directing judgment for the insurer before the forms were offered was error.
All Borough Group Med. Supply, Inc. v GEICO Ins. Co. (2013 NY Slip Op 23262) Appellate Term, Second Department, July 12, 2013Claimant's trial proof held to make out its prima facie caseHeld the provider's trial witness, an employee familiar with its office routine, laid a proper CPLR 4518 (a) foundation for the delivery receipt and claim form, and the assignment needed only authentication, so excluding them was error.
Peace of Mind, Social Work, P.C. v Travelers Prop. Cas. (2013 NY Slip Op 51119(U)) Appellate Term, Second Department, July 5, 2013Insufficient: claim forms not admitted as business records / insurer's admissions held not to prove the claimHeld the claim form inadmissible at trial under CPLR 4518 (a) because the third-party biller witness did not show the documents she relied on were business records incorporated into her employer's records, so the claimant failed to establish entitlement.
V.S. Med. Servs., P.C. v Travelers Ins. Co. (2013 NY Slip Op 50973(U)) Appellate Term, Second Department, June 6, 2013Insufficient: claimant did not prove at trial that the claim was submitted (mailed to and received by the insurer)Held the provider failed to make out a prima facie case at trial because it offered no claim forms or evidence identifying the claims sued upon and did not show they remained unpaid.
Urban Radiology, P.C. v GEICO Gen. Ins. Co. (2013 NY Slip Op 50850(U)) Leading case Appellate Term, Second Department, May 14, 2013Claimant's trial proof held to make out its prima facie caseHeld the provider made out its prima facie case at trial without offering an assignment of benefits, because the insurer waived that defense by not objecting to the claim forms or seeking verification, and need not negate defenses at trial.
Olmecs Med. Supplies, Inc. v MVAIC (2013 NY Slip Op 50218(U)) Appellate Term, Second Department, January 30, 2013Insufficient at trial for another reason (MVAIC eligibility, assignment, eligibility for benefits)Held at trial that the provider failed to establish its prima facie case because it did not prove a timely sworn notice of intention to make a claim was submitted to MVAIC.
Park Slope Med. & Surgical Supply, Inc. v Travelers Ins. Co. (2012 NY Slip Op 22200) Appellate Term, Second Department, July 12, 2012Claimant's trial proof held to make out its prima facie case (also decides)Held the provider established its prima facie case by a properly completed claim form without proving the facts underlying the claim or affirmatively demonstrating medical necessity, which shifted the burden to the insurer.
Vista Surgical Supplies, Inc. v Clarendon Natl. Ins. Co. (2012 NY Slip Op 51056(U)) Appellate Term, Second Department, June 11, 2012Insufficient: claimant did not prove at trial that the claim was submitted (mailed to and received by the insurer)Upheld the trial finding that the provider did not prove a timely mailing of the claim form, so it failed to make out its prima facie case.
Five Boro Psychological Servs., P.C. v GEICO Gen. Ins. Co. (2011 NY Slip Op 51877(U)) Appellate Term, Second Department, October 18, 2011Insufficient: claimant did not prove at trial that payment was overdue (unpaid, or not paid or denied within 30 days)Affirmed a directed verdict dismissing the complaint after trial because the provider's witness testified without personal knowledge and so did not establish that the claim was overdue.
Peace of Mind, Social Work, P.C. v MVAIC (2011 NY Slip Op 51834(U)) Appellate Term, Second Department, October 11, 2011Insufficient at trial for another reason (MVAIC eligibility, assignment, eligibility for benefits)Held at trial that the provider failed its prima facie case because its billing witness did not establish that a notice of intention to make claim form was submitted to MVAIC.
Carothers v GEICO Indem. Co. (2010 NY Slip Op 51718(U)) Appellate Term, Second Department, October 1, 2010Insufficient: claim forms not admitted as business records / insurer's admissions held not to prove the claimHeld at trial the provider did not set forth a prima facie case because its billing company's manager was not competent to lay a CPLR 4518 foundation for the claim documents, which should not have been admitted.
Speciality Surgical Servs. v Travelers Ins. Co. (2010 NY Slip Op 50715(U)) Appellate Term, Second Department, April 16, 2010Claimant's trial proof held to make out its prima facie case (also decides)Held the provider need not establish a valid assignment at trial because the insurer, though the defect was apparent on the assignment sent with the claim, neither sought verification nor denied the claim on that ground.
Progressive Med., Inc. v Allstate Ins. Co. (2010 NY Slip Op 50219(U)) Appellate Term, Second Department, February 5, 2010Claimant's trial proof held to make out its prima facie caseHeld the trial court erred in dismissing for failure to present a prima facie case, because the parties agreed the only issue was medical necessity and the provider was not required to prove medical necessity through a claim form.
Andrew Carothers, M.D., P.C. v GEICO Indem. Co. (2009 NY Slip Op 52596(U)) Appellate Term, Second Department, December 15, 2009Insufficient: claim forms not admitted as business records / insurer's admissions held not to prove the claimHeld at trial the provider did not set forth a prima facie case because its billing company's manager lacked personal knowledge of the provider's practices and could not lay a CPLR 4518 foundation for the admitted documents.
Davydov v Progressive Ins. Co. (2009 NY Slip Op 29299) Appellate Term, Second Department, July 9, 2009Claimant's trial proof held to make out its prima facie caseHeld at trial that the dentist's testimony and exhibits proved the billing forms were mailed and received and payment was overdue, rejecting the argument that the elements differ by type of service.
Bath Med. Supply, Inc. v Utica Mut. Ins. Co. (2009 NY Slip Op 51030(U)) Appellate Term, Second Department, May 22, 2009Insufficient: claim forms not admitted as business records / insurer's admissions held not to prove the claimAffirmed a directed verdict dismissing the complaint because at trial the provider called no witness to lay a business-records foundation for its claim forms, so it did not establish a prima facie case.
Omni Chiropractic, P.C. v Travelers Ins. Co. (2009 NY Slip Op 52505(U)) Appellate Term, Second Department, May 8, 2009Insufficient: claimant did not prove at trial that payment was overdue (unpaid, or not paid or denied within 30 days)Held after a nonjury trial that the provider failed to prove payment was overdue, since admitting its bills into evidence and suing on them did not raise an inference that the bills were unpaid or untimely denied.
Andrew Carothers, M.D., P.C. v GEICO Indem. Co. (2009 NY Slip Op 29155) Appellate Term, Second Department, April 10, 2009Insufficient: claim forms not admitted as business records / insurer's admissions held not to prove the claimHeld at trial the provider did not establish a prima facie case because its billing company's witness could not lay a CPLR 4518 foundation for the claim forms, the company having merely printed and mailed the provider's records.
PDG Psychological, P.C. v Travelers Ins. Co. (2009 NY Slip Op 50437(U)) Appellate Term, Second Department, March 10, 2009Insufficient: claim forms not admitted as business records / insurer's admissions held not to prove the claimAffirmed dismissal after trial because the provider's witness, not involved in billing, lacked personal knowledge of its office practices to lay a business-records foundation for the claim forms.
PDG Psychological, P.C. v Progressive Cas. Ins. Co. (2009 NY Slip Op 50436(U)) Appellate Term, Second Department, March 10, 2009Insufficient: claim forms not admitted as business records / insurer's admissions held not to prove the claimAffirmed a directed verdict because neither the provider's file clerk nor the insurer's litigation specialist, who admitted receipt, could lay a business-records foundation for the bill.
Dilon Med. Supply Corp. v Travelers Ins. Co. (2009 NY Slip Op 50389(U)) Appellate Term, Second Department, March 5, 2009Insufficient: claim forms not admitted as business records / insurer's admissions held not to prove the claimAffirmed a directed verdict because the provider called no witness to lay a business-records foundation for its claim forms, relying instead on notice-to-admit responses and motion papers.
V.S. Med. Servs., P.C. v Travelers Ins. Co. (2009 NY Slip Op 50048(U)) Appellate Term, Second Department, January 9, 2009Insufficient: claim forms not admitted as business records / insurer's admissions held not to prove the claimHeld at trial that the provider failed its prima facie case because its witness gave no testimony about how the claim forms were generated, so the forms were inadmissible as business records under CPLR 4518.
Vista Surgical Supplies, Inc. v State Farm Mut. Ins. Co. (2009 NY Slip Op 50047(U)) Appellate Term, Second Department, January 9, 2009Insufficient: claim forms not admitted as business records / insurer's admissions held not to prove the claimHeld at trial that the insurer's admission of receipt of the claim form did not concede its contents, and the provider, calling no witness, failed to lay a business-records foundation, so it made no prima facie showing.
All Mental Care Medicine, P.C. v State Farm Mut. Ins. Co. (2009 NY Slip Op 50042(U)) Appellate Term, Second Department, January 9, 2009Insufficient: claim forms not admitted as business records / insurer's admissions held not to prove the claimAffirmed dismissal after a nonjury trial because the provider, offering only a notice to admit and the insurer's attorney's affirmation and calling no witness, failed to make out its prima facie case, for the reasons stated in a prior Appellate Term decision.
Psychmetrics Med., P.C. v Travelers Ins. Co. (2008 NY Slip Op 52466(U)) Appellate Term, Second Department, December 4, 2008Insufficient: claim forms not admitted as business records / insurer's admissions held not to prove the claimHeld at trial that the provider, relying on a notice to admit without calling a witness, failed to lay a foundation showing its claim form was admissible as a business record, so it made no prima facie case.
Bajaj v General Assur. (2007 NY Slip Op 27487) Appellate Term, Second Department, October 22, 2007Insufficient: claim forms not admitted as business records / insurer's admissions held not to prove the claimHeld the claimant failed its prima facie case at trial because the deemed admission of the insurer's denial form did not make the claim form admissible as a business record, and no witness laid that foundation.
Pine Hollow Med., P.C. v Progressive Cas. Ins. Co. (2006 NY Slip Op 51870(U)) Appellate Term, Second Department, September 21, 2006Claimant's trial proof held to make out its prima facie caseHeld at trial that the billing company employee laid an adequate business-records foundation for the claim forms built from the provider's information, and that the insurer waived proof of assignment by not seeking verification.
Empire State Psychological Servs., P.C. v Travelers Ins. Co. (2006 NY Slip Op 51869(U)) Appellate Term, Second Department, September 21, 2006Insufficient: claim forms not admitted as business records / insurer's admissions held not to prove the claimHeld at trial that the insurer's interrogatory answer showing only receipt of bills and their timely denial did not prove the fact and amount of loss or overdue payment through statutory billing forms.
Damadian MRI in Canarsie, P.C. v General Assur. Co. (2006 NY Slip Op 51048(U)) Appellate Term, Second Department, June 2, 2006Claimant's trial proof held to make out its prima facie caseRejected the insurer's argument that, without the assignment forms, the claimant failed to make out its prima facie case at trial, holding that the insurer waived assignment defenses by not objecting or seeking verification in time.

Trial courts in the First Department (6 decisions)

Country-Wide Ins. Co. v Yao Jian Ping (2024 NY Slip Op 24033) Civil Court of the City of New York, New York County, January 22, 2024Insufficient: claimant did not prove at trial that the claim was submitted (mailed to and received by the insurer) (also decides)Held at trial that the injured person never submitted a claim form or substantial equivalent, since a statement of account in the arbitration demand lacked the prescribed form's information, and the insurer's denial did not excuse submission.
Metro 8 Med. Equip. Inc. v MVAIC (2019 NY Slip Op 51841(U)) Civil Court of the City of New York, New York County, August 16, 2019Insufficient at trial for another reason (MVAIC eligibility, assignment, eligibility for benefits)Held the provider could not recover after a bench trial because the credited MVAIC witness showed no notarized notice of intention to make claim was received, so the assignor was not a qualified, covered person.
Open MRI of Tarrytown v GEICO Ins. Co. (2009 NY Slip Op 50874(U)) Civil Court of the City of New York, Bronx County, April 30, 2009Insufficient: claim forms not admitted as business records / insurer's admissions held not to prove the claimHeld that the insurer's deemed admission of receipt via notice to admit did not concede the facts in the claim forms, and the providers, calling no witnesses, failed to establish the forms as business records.
Prime Psychological Servs., P.C. v Auto One Ins. Co. (2008 NY Slip Op 50162(U)) Civil Court of the City of New York, Bronx County, January 28, 2008Insufficient: claimant did not prove at trial that the claim was submitted (mailed to and received by the insurer)Held at trial that the provider did not establish its prima facie case because, although its notice to admit was proper and unanswered, it failed to append the claim forms and bills the notice said were attached.
RJ Med., P.C. v All-State Ins. Co. (2007 NY Slip Op 51061(U)) Civil Court of the City of New York, Bronx County, May 23, 2007Insufficient: claimant did not prove at trial that the claim was submitted (mailed to and received by the insurer)Held at trial that an unanswered notice to admit could not establish the provider's prima facie case, because it could not concede ultimate material facts and no bills or claim forms were offered to prove submission or nonpayment.
Fair Price Med. Supply, Inc. v St. Paul Travelers Ins. Co. (2006 NY Slip Op 52598(U)) Civil Court of the City of New York, Bronx County, January 5, 2006Claimant's trial proof held to make out its prima facie caseHeld at trial that the provider met its prima facie burden because the insurer's interrogatory answers established receipt of the bills and an outstanding balance, and proof of assignment was not required where the insurer never objected.

Trial courts in the Second Department (33 decisions)

Masigla v MVAIC (2020 NY Slip Op 51612(U)) Civil Court of the City of New York, Kings County, May 3, 2021Claimant's trial proof held to make out its prima facie case (also decides)Held after trial that a provider suing MVAIC must also prove its assignor was a qualified person, and found that shown by the stipulation that the vehicle was uninsured; the result rested on MVAIC's failure to prove de facto ownership with admissible evidence.
Right Aid Med. Supply, Corp. v State Farm Mut. Auto. Ins. Co. (2017 NY Slip Op 27181) Civil Court of the City of New York, Kings County, May 30, 2017Claimant's trial proof held to make out its prima facie case (also decides)Held after trial that, with the prima facie case established by a prior order, the provider did not have to prove the verification requests were answered; the insurer bore that burden as an affirmative defense and offered no witness.
AR Med. Rehabilitation v State-Wide Ins. Co. (2015 NY Slip Op 25287) Civil Court of the City of New York, Kings County, July 1, 2015Claimant's trial proof held to make out its prima facie caseHeld the provider established its prima facie case at trial by putting in the insurer's denial form, an admission of receipt that need not satisfy the business-records exception.
MB Advanced Equip., Inc. v MVAIC (2015 NY Slip Op 25199) Civil Court of the City of New York, Kings County, June 1, 2015Insufficient at trial for another reason (MVAIC eligibility, assignment, eligibility for benefits)Held the provider failed to make out its prima facie case at trial because the assignor never submitted a notarized notice of intention to make a claim to MVAIC.
AR Med. Rehabilitation, P.C. v State-Wide Ins. Co. (2015 NY Slip Op 50631(U)) Civil Court of the City of New York, Kings County, April 27, 2015Claimant's trial proof held to make out its prima facie caseHeld at trial that the provider proved submission, receipt and overdue payment through the insurer's claims examiner and its denial admitting receipt, without its own witness or a business-records foundation for the bills.
AR Med. Rehabilitation, P.C. v GEICO Gen. Ins. Co. (2013 NY Slip Op 50510(U)) Civil Court of the City of New York, Kings County, March 27, 2013Insufficient: claim forms not admitted as business records / insurer's admissions held not to prove the claimHeld after a bench trial that the provider's owner could not lay a business-records foundation for the claim forms because an outside billing company prepared them and his testimony was inconsistent, so the insurer received the verdict.
Allstate Social Work & Psychological Servs., PLLC v GEICO Gen. Ins. Co. (2011 NY Slip Op 21234) Civil Court of the City of New York, Kings County, July 7, 2011Insufficient: 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.
Elmont Open MRI & Diagnostic Radiology, PC v New York Cent. Mut. Fire Ins. Co. (2010 NY Slip Op 51588(U)) District Court of Nassau County, Second District, August 31, 2010Claimant's trial proof held to make out its prima facie caseHeld at trial that the biller's business-record testimony for the bills, together with the insurer's own admissions of receipt dates and denials, made out the provider's prima facie case without separate proof of mailing.

Show all 33 decisions

Meridan Health Acupuncture, P.C. v Auto One Ins. Co. (2010 NY Slip Op 51263(U)) District Court of Suffolk County, Third District, June 23, 2010Claimant's trial proof held to make out its prima facie caseHeld at trial that the insurer's improper non-answer to a notice to admit left receipt, nonpayment and absence of verification requests admitted, establishing that the claim was mailed, received and overdue.
Advanced Tempromandibular Disorder & Dental Surgery v Progressive Northeastern Ins. Co. (2010 NY Slip Op 20047) District Court of Suffolk County, Third District, February 17, 2010Claimant's trial proof held to make out its prima facie caseHeld at trial that the insurer's failure to respond to a notice to admit receipt of the claim, its denial and nonpayment established the provider's prima facie case without witness testimony, so judgment was entered for the provider.
Health Care Assoc. in Medicine v Geico Ins. Co. (2010 NY Slip Op 50094(U)) Civil Court of the City of New York, Richmond County, January 6, 2010Claimant's trial proof held to make out its prima facie caseDenied a directed verdict, holding the provider need not prove as part of its prima facie case that bills were mailed within 45 days; untimely submission is the insurer's defense, proven through its timely denials.
Kipor Medicine P.C. v MVAIC (2009 NY Slip Op 29085) Civil Court of the City of New York, Kings County, February 23, 2009Claimant's trial proof held to make out its prima facie caseHeld on stipulated facts that a provider suing MVAIC need not prove its assignor's New York residence as part of its prima facie case; proof of a submitted claim not timely paid or denied sufficed.
All-Boro Med. Supplies, Inc. v Progressive Northeastern Ins. Co. (2008 NY Slip Op 28207) Civil Court of the City of New York, Kings County, May 27, 2008Claimant's trial proof held to make out its prima facie case (also decides)Held the provider established entitlement to judgment because the billing documents were mailed to and received by the insurer and payment was overdue.
Second Med., P.C. v Auto One Ins. Co. (2008 NY Slip Op 28169) Civil Court of the City of New York, Kings County, May 2, 2008Insufficient: claim forms not admitted as business records / insurer's admissions held not to prove the claimHeld at trial that the provider failed its prima facie case because its billing company witness showed no familiarity with the provider's record-keeping, so the claim form built on its hearsay medical records was inadmissible under CPLR 4518.
All-Boro Med. Supplies, Inc. v Progressive Northeastern Ins. Co. (2008 NY Slip Op 50766(U)) Civil Court of the City of New York, Kings County, April 11, 2008Insufficient: claimant did not prove at trial that payment was overdue (unpaid, or not paid or denied within 30 days)Held on stipulated facts that the claimant failed to prove benefits were overdue because the insurer's proper requests for a prescribed NF-3 form, never supplied, tolled the 30-day period, making the claim premature.
Andrew Carothers, M.D., P.C. v GEICO Indem. Co. (2008 NY Slip Op 50456(U)) Civil Court of the City of New York, Kings County, March 10, 2008Claimant's trial proof held to make out its prima facie case (also decides)Held the provider made out its prima facie case at trial through its billing manager's detailed testimony, based on personal knowledge of office practice, that the bills were timely mailed and payment was not received.
NY First Acupuncture, P.C. v General Assur. Co. (2008 NY Slip Op 50750(U)) Civil Court of the City of New York, Queens County, March 6, 2008Insufficient: claim forms not admitted as business records / insurer's admissions held not to prove the claimHeld at trial that deemed admissions from an unanswered notice to admit did not establish the claimant's prima facie case, because binding precedent required a business-records foundation for the claim forms, which was not laid.
Custom Orthotics of NY, Inc. v State Farm Mut. Auto Ins. Co. (2007 NY Slip Op 27549) District Court of Suffolk County, Fourth District, November 1, 2007Insufficient: claim forms not admitted as business records / insurer's admissions held not to prove the claimHeld at trial that the provider, calling no witness, could not make out its prima facie case from the insurer's qualified notice-to-admit answers admitting receipt, because business-record formalities for its documents had to be observed.
Seaside Med., P.C. v General Assur. Co. (2007 NY Slip Op 27258) District Court of Suffolk County, First District, May 9, 2007Claimant's trial proof held to make out its prima facie caseHeld at trial that the claimant established its prima facie case of coverage, assignment, presentation of claims and failure to deny within 30 days through facts deemed admitted by the insurer's untimely response to a notice to admit.
New York Massage Therapy P.C. v State Farm Mut. Ins. Co. (2006 NY Slip Op 52573(U)) Civil Court of the City of New York, Kings County, December 22, 2006Claimant's trial proof held to make out its prima facie case (also decides)Held at trial that the provider established its prima facie case through its notice to admit served on the insurer, shifting the burden to the insurer.
Andrew Carothers, M.D., P.C. v Progressive Ins. Co. (2006 NY Slip Op 52479(U)) Civil Court of the City of New York, Kings County, December 21, 2006Claimant's trial proof held to make out its prima facie caseDenied the insurer's directed-verdict motion, holding the billing company's manager laid a proper business-records foundation and the claim was timely received and neither paid nor timely denied.
Andrew Carothers, M.D., P.C. v Travelers Ins. Co. (2006 NY Slip Op 52328(U)) Civil Court of the City of New York, Kings County, November 14, 2006Claimant's trial proof held to make out its prima facie case (also decides)Held the provider made out its prima facie case at trial because its billing company's office manager laid a proper business-records foundation for the claim forms, and the insurer's denial form showed timely receipt.
Andrew Carothers, M.D., P.C. v Travelers Ins. Co. (2006 NY Slip Op 52154(U)) Civil Court of the City of New York, Kings County, November 2, 2006Claimant's trial proof held to make out its prima facie caseHeld at trial that the billing agent's testimony and records admitted as business records established the provider's prima facie case, and that bills omitting the provider-physician relationship did not undermine it.
PDG Psychological, P.C. v State Farm Ins. Co. (2006 NY Slip Op 51398(U)) Civil Court, Kings County, July 14, 2006Insufficient: claim forms not admitted as business records / insurer's admissions held not to prove the claimGranted the insurer a directed verdict at trial because the provider called no witness and its bills and assignment could not be proved through a notice to admit, leaving no evidence of the loss, submission or nonpayment.
Elite Med. Care, P.C. v Travelers Prop. & Cas. Ins. Co. (2006 NY Slip Op 51397(U)) Civil Court, Kings County, July 13, 2006Insufficient at trial for another reason (MVAIC eligibility, assignment, eligibility for benefits)Granted a directed verdict for the insurer after a bench trial because the provider introduced no evidence of a properly executed assignment of benefits, which was required before it could recover assigned benefits.
Marigliano v State Farm Mut. Auto Ins. Co. (2006 NY Slip Op 51349(U)) Civil Court, Richmond County, July 3, 2006Insufficient: claimant did not prove at trial that the claim was submitted (mailed to and received by the insurer)Held the provider failed to make out its case at trial because the claim forms were never received in evidence or annexed to the notice to admit, so what was sent to and received by the insurer was not shown.
Sea Side Med., P.C. v State Farm Mut. Auto Ins. Co. (2006 NY Slip Op 26246) Civil Court of the City of New York, Richmond County, June 22, 2006Claimant's trial proof held to make out its prima facie case (also decides)Held the provider entitled to judgment because it established submission of the claims and that payment was overdue once the insurer's verification toll lapsed and its denials were untimely.
V.S. Med. Servs., P.C. v Allstate Ins. Co. (2006 NY Slip Op 26000) Civil Court, Kings County, January 3, 2006Claimant's trial proof held to make out its prima facie case (also decides)Held the provider made out its prima facie case at trial for one assignor through the insurer's claims examiner's admission of receipt, and that coverage is not part of the claimant's case; judgment rested on the staged-accident defense.
West Tremont Med. Diagnostics, P.C. v GEICO (2005 NY Slip Op 25176) Civil Court, Richmond County, February 23, 2005Claimant's trial proof held to make out its prima facie case (also decides)Held at trial that the provider proved its prima facie case by submitting completed statutory claim forms that the insurer did not pay, shifting the burden to the insurer on its defense.
Ultimate Med. Supplies v Lancer Ins. Co. (2004 NY Slip Op 51860(U)) Civil Court, Kings County, December 17, 2004Claimant's trial proof held to make out its prima facie case (also decides)Rejected the insurer's argument that no prima facie case was shown, because mailing was stipulated and the insurer conceded at trial that the delivery receipt, which the principal saw the assignor sign, was admissible as the assignment.
East Way Chiropractic, P.C. v Allstate Ins. Co. (2004 NY Slip Op 50642(U)) Civil Court of the City of New York, Queens County, June 23, 2004Claimant's trial proof held to make out its prima facie case (also decides)Found the prima facie case established at trial through the biller's testimony about the patient and billing files and about nonpayment, with the claim forms and all but one assignment received in evidence.
Queens Blvd. Med. v Travelers Indem. Co. (2004 NY Slip Op 24101) Civil Court of the City of New York, Queens County, April 5, 2004Claimant's trial proof held to make out its prima facie case (also decides)Held at trial that the provider established its prima facie case by showing proper proof of claim was submitted and timely denied, shifting the burden to the insurer.
Advanced Med. Rehabilitation, P.C. v Travelers Prop. Cas. Ins. Co. (2004 NY Slip Op 50141(U)) Civil Court of the City of New York, Kings County, March 16, 2004Insufficient: claim forms not admitted as business records / insurer's admissions held not to prove the claimAfter trial, held the claimant failed to make out its prima facie case because its witness could not lay a business-records foundation for the bills, lacked knowledge of their mailing, and could not authenticate the assignment.

Trial courts in the Third Department (1 decision)

Gokey v Blue Ridge Ins. Co. (2009 NY Slip Op 50361(U)) Supreme Court, Ulster County, January 21, 2009Claimant's trial proof held to make out its prima facie caseHeld after a nonjury trial that the injured person proved submission of a claim by the admitted, fully executed NF-2 application, rejecting the insurer's contention that no proper claim form was filed.

Trial courts in the Fourth Department (1 decision)

Daniel C. Cox D.C., P.C. v Erie Ins. Co. (2011 NY Slip Op 51194(U)) City Court of Buffalo, June 13, 2011Insufficient: claimant did not prove at trial that the claim was submitted (mailed to and received by the insurer)Dismissed three causes of action because the provider offered no evidence that those bills were transmitted to the insurer; the prima facie case on the remaining claims was stipulated.

How this page is made: the decisions are those in our case-law database that cite this question's leading cases or were tagged with its subject. A language model read each one in full and recorded whether it rules on the question, the position it took and a one-sentence summary; a second, independent reading checked every entry. Court, department, date and the citation links come from the database. Read the decision before relying on it.