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

A decision decides this question when it rules whether the claimant suing for no-fault benefits (usually a provider-assignee, sometimes the injured person) made out its prima facie case. The ruling is made before trial: usually on the claimant's motion or cross motion for summary judgment or a CPLR 3212 (g) application, sometimes on another pretrial motion, or in an Article 75 or default/vacatur ruling that happens to decide the claimant's showing. Rulings at or after trial belong to the topic prima-facie-trial. Under Viviane Etienne (Ct App 2015), the claimant must show that the statutory claim form was mailed to and received by the insurer and that payment is overdue, meaning it was not paid or denied within 30 days. The claimant does not have to prove the merits of the claim. Deciding the question means holding that the claimant's proof on these elements was sufficient or insufficient, or holding that an extra element is or is not required, such as a business-records foundation for the claim forms or proof of medical necessity.

Settled statewide by the Court of Appeals. The Court of Appeals settled the elements in Viviane Etienne Med. Care v Country-Wide (2015). The claimant must show that payment is overdue and that its claim, on the statutory billing form, was mailed to and received by the insurer, with the mailing proved by admissible evidence. The claimant does not have to prove the merits or lay a business-records foundation for the truth of the claim forms. Every department had stated the billing/receipt/overdue formulation before 2015 (the Court of Appeals cites 1st, 2d, 3d and 4th Department decisions). The only real conflict came within the Second Department. From about 2006 to 2013, the Appellate Term (Dan Med.) and then the Appellate Division (Art of Healing, 2008; Carothers, 2010) required a CPLR 4518 foundation for the claim forms. The Second Department overruled Art of Healing in Viviane Etienne (2013), and the Court of Appeals affirmed. Since then, decisions differ in application, not rule. The largest group is Second Department Appellate Term decisions holding the provider's proof insufficient on the overdue element: the provider did not show the claim was not timely denied, or that a timely denial was conclusory, vague or without merit (Westchester v Nationwide, 2010; Ave T, 2011).

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

Leading authorities

Viviane Etienne Med. Care, P.C. v Country-Wide Ins. Co. (2015 NY Slip Op 04787) Court of Appeals, 2015Statewide rule: mailing and receipt of claim, plus payment overdueA provider establishes prima facie entitlement to summary judgment by admissible proof that its statutory claim form was mailed to and received by the insurer and that payment is overdue (not paid or denied within 30 days); it need not prove the merits. The biller's affidavit describing his own mailing practice met that burden.
We hold that a plaintiff demonstrates prima facie entitlement to summary judgment by submitting evidence that payment of no-fault benefits are overdue, and proof of its claim, using the statutory billing form, was mailed to and received by the defendant insurer.
Viviane Etienne Med. Care, P.C. v Country-Wide Ins. Co. (2013 NY Slip Op 08430) Appellate Division, Second Department, 2013Proof of billing suffices; overrules Art of Healing business-records requirementA provider's prima facie case is proof that the billing forms were mailed and received and not paid or denied within 30 days; it need not lay a business-records foundation for the truth of the claim forms or prove the merits (Art of Healing overruled to that extent). The one claim the record showed was timely denied failed the prima facie burden.
We reaffirm the long-standing precedent that, in this context, the plaintiff makes a prima facie showing of entitlement to judgment as a matter of law by submitting evidence, in admissible form, that the prescribed statutory billing forms were mailed to and received by the defendant insurer, which failed to either pay or deny the claim within the prescribed 30-day period.
Later history: Affirmed, Viviane Etienne Med. Care, P.C. v Country-Wide Ins. Co., 25 NY3d 498 (2015) (post 5664)
Mary Immaculate Hosp. v Allstate Ins. Co. (2004 NY Slip Op 02359) Appellate Division, Second Department, 2004Standard formulation: billing forms mailed and received, payment overdueThe hospitals made a prima facie showing of entitlement to summary judgment by evidentiary proof that the prescribed statutory billing forms were mailed and received and that payment was overdue; the insurer's opposition did not raise an issue of fact about a timely partial denial or payment.
Contrary to the defendant’s contention, the plaintiff hospitals made a prima facie showing of their entitlement to judgment as a matter of law by submitting evidentiary proof that the prescribed statutory billing forms had been mailed and received, and that payment of no-fault benefits was overdue
Westchester Med. Ctr. v Nationwide Mut. Ins. Co. (2010 NY Slip Op 08933) Appellate Division, Second Department, 2010No prima facie case where insurer timely paid/denied in partThe provider failed to establish its prima facie entitlement because the evidence showed the insurer made a partial payment and a partial denial within 30 days of receipt; the denial was not invalidated by a minor factual discrepancy and was not conclusory, vague or without merit.
Here, the plaintiff failed to establish its prima facie entitlement to judgment as a matter of law on its claim for benefits since the evidence demonstrates that the defendant made a partial payment and a partial denial of the claim within 30 days after receipt thereof
Ave T MPC Corp. v Auto One Ins. Co. (2011 NY Slip Op 51292(U)) Appellate Term, Second Department, 2011Provider must negate timely denial or show it was legally insufficientA provider must prove submission of the claim form, the fact and amount of the loss, and either that the insurer failed to pay or deny within 30 days or that its timely denial was conclusory, vague or without merit; proof of nonpayment alone was insufficient.
Here, while plaintiff demonstrated that the claims were not paid, it failed to demonstrate either that defendant had failed to deny the claim or that defendant had issued a legally insufficient denial of claim form.
Amaze Med. Supply v Eagle Ins. Co. (2003 NY Slip Op 51701(U)) Appellate Term, Second Department, 2003Properly completed claim form makes out prima facie case; no medical-necessity proofA provider's proof of a properly completed claim form makes out its prima facie case on summary judgment; it need not separately prove medical necessity, particularly where the insurer is precluded by an ineffective denial.
Thus, we reaffirm our holding that a provider’s proof of a properly-completed claim makes out a prima facie case upon its motion for summary judgment
Presbyterian Hosp. in City of N.Y. v Maryland Cas. Co. 90 NY2d 274Preclusion rule for untimely denials; source of the overdue/preclusion reasoning relied on by Viviane Etienne and its pre-2015 Appellate Division line.Not in our database.
Nassau Ins. Co. v Murray 46 NY2d 828Presumption of receipt from proof of a standard office mailing practice; applied in Viviane Etienne to the provider's billing affidavit.Not in our database.
Residential Holding Corp. v Scottsdale Ins. Co. 286 AD2d 679Presumption of mailing by actual mailing or standard office practice. This is the test for the submission element (e.g. NY & Presbyt. Hosp. v Allstate, 2006, post 9834).Not in our database.
Alvarez v Prospect Hosp.; Winegrad v New York Univ. Med. Ctr. 68 NY2d 320; 64 NY2d 851General summary judgment burden: failure of the prima facie showing requires denial regardless of the opposition. Courts cite these when denying providers' motions. Winegrad is 1985.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 proof held to make out its prima facie caseInsufficient: claimant did not prove the claim was submitted (mailed to and received by the insurer)Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Insufficient: claim forms not shown admissible as business records / merits of claim not provedInsufficient for another reason (eligibility, timely submission, own papers defeat the claim)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
Court of Appeals	2	0	0	0	0	2
Appellate Division, First Department	1	0	0	0	0	1
Appellate Division, Second Department	42	3	6	1	2	54
Appellate Division, Third Department	1	0	0	0	0	1
Appellate Division, Fourth Department	1	0	0	0	0	1
Appellate Term, First Department	27	0	1	0	0	28
Appellate Term, Second Department	331	61	229	193	5	819
Trial courts in the First Department	11	2	2	0	1	16
Trial courts in the Second Department	71	13	11	12	8	115
Trial courts in the Fourth Department	1	0	0	0	0	1

Decisions (1,038)

Every decision in our database that rules on this question: highest court first, then by department, newest first. 671 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.

Court of Appeals (2 decisions)

Viviane Etienne Med. Care, P.C. v Country-Wide Ins. Co. (2015 NY Slip Op 04787) Leading case Court of Appeals, June 10, 2015Claimant's proof held to make out its prima facie caseHeld the provider made its prima facie case by admissible proof that the claim forms were mailed to and received by the insurer and that seven claims were unpaid and undenied after 30 days, without proving the merits.
Hospital for Joint Diseases v Travelers Prop. Cas. Ins. Co. (2007 NY Slip Op 09067) Court of Appeals, November 20, 2007Claimant's proof held to make out its prima facie case (also decides)Held that, even assuming an assignment is part of the provider's prima facie case, an assignment form stating the patient's signature was 'on file' satisfied that burden because the insurer never timely sought verification of the assignment.

Appellate Division, First Department (1 decision)

Countrywide Ins. Co. v 563 Grand Med., P.C. (2008 NY Slip Op 03059) Appellate Division, First Department, April 3, 2008Claimant's proof held to make out its prima facie case (also decides)Held the provider established its prima facie case by showing the billing documents were mailed to and received by the insurer and payment was overdue, but summary judgment failed because the insurer raised a triable issue.

Appellate Division, Second Department (54 decisions)

American Tr. Ins. Co. v Beach Med. Rehabilitation, P.C. (2026 NY Slip Op 03771) Appellate Division, Second Department, June 17, 2026Claimant's proof held to make out its prima facie case (also decides)Held the provider, moving for a declaration that the insurer must pay, made its prima facie case because timely mailing of the claim forms was undisputed, shifting to the insurer the burden of raising a triable issue of timely denial.
Hernandez v Merchants Mut. Ins. Co. (2022 NY Slip Op 04156) Appellate Division, Second Department, June 29, 2022Claimant's proof held to make out its prima facie case (also decides)Held the injured claimant showed the billing forms for the surgeon's services were mailed and received and were not paid or validly denied within 30 days, shifting the burden to the insurer.
Bronx Acupuncture Therapy, P.C. v Hereford Ins. Co. (2019 NY Slip Op 06059) Appellate Division, Second Department, August 7, 2019Claimant's proof held to make out its prima facie case (also decides)Held the provider entitled to summary judgment because receipt of the claim form was undisputed and the insurer's denial was without merit as a matter of law.
NYU-Hospital for Joint Diseases v Allstate Ins. Co. (2014 NY Slip Op 08613) Appellate Division, Second Department, December 10, 2014Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed its prima facie burden because its own papers included the insurer's NF-10 denial, which was timely and sufficient despite listing wrong amounts.
Mount Sinai Hosp. v New York Cent. Mut. Fire Ins. Co. (2014 NY Slip Op 05779) Appellate Division, Second Department, August 13, 2014Claimant's proof held to make out its prima facie caseHeld the hospital met its prima facie burden by showing the insurer received its NF-5 and neither paid nor denied it within 30 days, the earlier UB-04 billing not having started the clock.
New York Univ. Hosp.-Tisch Inst. v Government Empls. Ins. Co. (2014 NY Slip Op 03812) Appellate Division, Second Department, May 28, 2014Claimant's proof held to make out its prima facie case (also decides)Held the hospitals made their prima facie case by proof that the billing forms were mailed and received and that the claim was not paid or denied within 30 days; the motion still failed on the insurer's opposition.
Westchester Med. Ctr. v A Cent. Ins. Co. (2014 NY Slip Op 01319) Appellate Division, Second Department, February 26, 2014Claimant's proof held to make out its prima facie case (also decides)Treated the provider as having made its prima facie showing on its motion premised on the insurer's failure to pay or deny within 30 days, but denied the motion because the insurer raised a triable issue.
Wyckoff Hgts. Med. Ctr. v Government Empls. Ins. Co. (2014 NY Slip Op 01166) Appellate Division, Second Department, February 19, 2014Claimant's proof held to make out its prima facie case (also decides)Held the hospital made a prima facie showing by evidence that the statutory billing forms were mailed and received and not paid or denied within 30 days, but the insurer raised a triable issue.

Show all 54 decisions

Westchester Med. Ctr. v Allstate Ins. Co. (2014 NY Slip Op 00655) Appellate Division, Second Department, February 5, 2014Claimant's proof held to make out its prima facie caseHeld the provider showed its billing documents were mailed to and received by the insurer and payment was overdue, rejecting the insurer's argument that its papers were not in sufficient evidentiary form.
Nyack Hosp. v Allstate Ins. Co. (2014 NY Slip Op 00641) Appellate Division, Second Department, February 5, 2014Claimant's proof held to make out its prima facie caseHeld the plaintiffs established prima facie entitlement by proving the billing form was mailed, received and not paid or denied within 30 days, the insurer having waived objections to the claim forms' adequacy.
New York Hosp. Med. Ctr. of Queens v Allstate Ins. Co. (2014 NY Slip Op 00640) Appellate Division, Second Department, February 5, 2014Claimant's proof held to make out its prima facie caseHeld a postal receipt showing the insurer received the NF-5 and the mailer's affidavit that the claim was neither paid nor properly denied within 30 days established the provider's prima facie case.
New York Hosp. Med. Ctr. of Queens v QBE Ins. Corp. (2014 NY Slip Op 00639) Appellate Division, Second Department, February 5, 2014Claimant's proof held to make out its prima facie caseHeld the plaintiffs established prima facie entitlement on one claim by proof that the billing form was mailed, received and not paid or denied in 30 days, without needing a business-records foundation for the bills.
Westchester Med. Ctr. v Government Empls. Ins. Co. (2014 NY Slip Op 00500) Appellate Division, Second Department, January 29, 2014Claimant's proof held to make out its prima facie caseHeld the hospital made its prima facie showing with admissible evidence that the billing form was mailed to and received by the insurer, which neither paid nor denied within 30 days.
Westchester Med. Ctr. v Allstate Ins. Co. (2013 NY Slip Op 08616) Appellate Division, Second Department, December 26, 2013Claimant's proof held to make out its prima facie caseRejected the insurer's primary argument and held the hospital made a prima facie showing of entitlement to judgment on its claim.
Viviane Etienne Med. Care, P.C. v Country-Wide Ins. Co. (2013 NY Slip Op 08430) Leading case Appellate Division, Second Department, December 18, 2013Claimant's proof held to make out its prima facie caseHeld the provider made its prima facie case by proving the claim forms were mailed, received and not paid or denied within 30 days, with no business-records foundation for their contents, except one claim shown timely denied.
Westchester Med. Ctr. v Hereford Ins. Co. (2012 NY Slip Op 04156) Appellate Division, Second Department, May 30, 2012Claimant's proof held to make out its prima facie case (also decides)Held the hospital made its prima facie showing by evidence that the billing form was mailed to and received by the insurer, which neither paid nor denied within 30 days.
Westchester Med. Ctr. v Progressive Cas. Ins. Co. (2011 NY Slip Op 08747) Appellate Division, Second Department, November 29, 2011Claimant's proof held to make out its prima facie case (also decides)Held the hospital showed mailing of its billing forms and nonpayment within 30 days, but summary judgment turned on the insurer's opposition: proof of a timely denial and of timely verification and payment defeated two claims.
NYU-Hospital for Joint Diseases v Esurance Ins. Co. (2011 NY Slip Op 04436) Appellate Division, Second Department, May 24, 2011Claimant's proof held to make out its prima facie case (also decides)Held the hospital established its prima facie case by evidentiary proof that the statutory billing forms were mailed and received and that payment was overdue.
NYU Hosp. for Joint Diseases v Country Wide Ins. Co. (2011 NY Slip Op 04219) Appellate Division, Second Department, May 17, 2011Claimant's proof held to make out its prima facie case (also decides)Held the hospital established its prima facie case through billing forms, its biller's affidavit, certified mail receipt and signed return-receipt card showing mailing, receipt and overdue payment; the result rested on the insurer's defective denial.
Westchester Med. Ctr. v Country Wide Ins. Co. (2011 NY Slip Op 03838) Appellate Division, Second Department, May 3, 2011Claimant's proof held to make out its prima facie case (also decides)Held the hospital established its prima facie case by showing the billing forms were mailed to and received by the insurer and payment was overdue, though the motion failed on a verification issue.
New York Hosp. Med. Ctr. of Queens v Country Wide Ins. Co. (2011 NY Slip Op 01628) Appellate Division, Second Department, March 1, 2011Claimant's proof held to make out its prima facie case (also decides)Held the hospital established its prima facie case through billing forms, biller affidavits, certified mail receipts and a signed return-receipt card showing mailing, receipt and overdue payment.
Westchester Med. Ctr. v New York Cent. Mut. Fire Ins. Co. (2011 NY Slip Op 01458) Appellate Division, Second Department, February 22, 2011Claimant's proof held to make out its prima facie case (also decides)Held the hospital made its prima facie showing by evidence that the billing form was mailed and received and that the insurer failed to pay or deny within 30 days.
Westchester Med. Ctr. v GMAC Ins. Co. Online, Inc. (2011 NY Slip Op 00217) Appellate Division, Second Department, January 11, 2011Claimant's proof held to make out its prima facie case (also decides)Held the hospital established prima facie entitlement by showing the billing documents were mailed to and received by the insurer and payment was overdue.
Westchester Med. Ctr. v Nationwide Mut. Ins. Co. (2010 NY Slip Op 08933) Leading case Appellate Division, Second Department, November 30, 2010Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed its prima facie burden because the evidence showed the insurer made a partial payment and partial denial within 30 days, and the denial was not conclusory, vague or meritless despite a minor factual discrepancy.
Wyckoff Hgts. Med. Ctr. v Country-Wide Ins. Co. (2010 NY Slip Op 02552) Appellate Division, Second Department, March 23, 2010Claimant's proof held to make out its prima facie case (also decides)Held the hospital established its prima facie case by showing the billing forms were mailed to and received by the insurer and that payment was overdue.
LMK Psychological Serv., P.C. v American Tr. Ins. Co. (2009 NY Slip Op 06004) Appellate Division, Second Department, July 28, 2009Insufficient for another reason (eligibility, timely submission, own papers defeat the claim)Held the providers' summary judgment motion was properly denied because they failed to demonstrate prima facie entitlement to judgment, without stating which element was lacking.
Westchester Med. Ctr. v Lincoln Gen. Ins. Co. (2009 NY Slip Op 02589) Appellate Division, Second Department, March 31, 2009Claimant's proof held to make out its prima facie case (also decides)Held the hospital made its prima facie showing by evidence that the billing forms were mailed and received and the insurer failed to pay or deny within 30 days.
Kingsbrook Jewish Med. Ctr. v Allstate Ins. Co. (2009 NY Slip Op 00351) Appellate Division, Second Department, January 20, 2009Claimant's proof held to make out its prima facie case (also decides)Held the hospital made its prima facie case with the billing forms, its biller's affidavit and certified-mail and signed return receipts, and that it bore no burden to prove causation, which is presumed.
Globe Surgical Supply v GEICO Ins. Co. (2008 NY Slip Op 10583) Appellate Division, Second Department, December 30, 2008Claimant's proof held to make out its prima facie case (also decides)Held that class members could easily make out a prima facie case by proof the billing forms were mailed and received and payment was overdue, and need not prove documented costs where no verification of costs was sought.
St. Barnabas Hosp. v American Tr. Ins. Co. (2008 NY Slip Op 09585) Appellate Division, Second Department, December 2, 2008Claimant's proof held to make out its prima facie case (also decides)Held the hospital made a prima facie showing by demonstrating the billing forms were mailed to and received by the insurer and payment was overdue, but the insurer raised a triable issue.
Art of Healing Medicine, P.C. v Travelers Home & Mar. Ins. Co. (2008 NY Slip Op 07846) Appellate Division, Second Department, October 14, 2008Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the providers failed their prima facie burden on partial summary judgment because they did not show their billing records admissible under the CPLR 4518 business-records exception.
Forrest Chen Acupuncture Servs., P.C. v GEICO Ins. Co. (2008 NY Slip Op 07211) Appellate Division, Second Department, September 30, 2008Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed to establish prima facie entitlement because its own submissions showed timely partial denials on prescribed forms that were not factually insufficient or vague.
Westchester Med. Ctr. v Allstate Ins. Co. (2008 NY Slip Op 06146) Appellate Division, Second Department, July 1, 2008Claimant's proof held to make out its prima facie case (also decides)Held the hospital made a prima facie showing by demonstrating the prescribed billing forms were mailed to and received by the insurer and payment was overdue, though the motion failed on a verification issue.
St. Vincent's Hosp. of Richmond v Government Empls. Ins. Co. (2008 NY Slip Op 04072) Appellate Division, Second Department, April 29, 2008Claimant's proof held to make out its prima facie case (also decides)Held the provider made its prima facie showing by proof that the billing forms were mailed and received, payment was overdue and the denial it received was fatally deficient, but the insurer raised triable issues.
Westchester Med. Ctr. v Allstate Ins. Co. (2007 NY Slip Op 08447) Appellate Division, Second Department, November 7, 2007Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed its prima facie burden because its own papers showed a denial issued within 30 days and did not show the denial was too vague or deficient to be a proper response.
New York & Presbyt. Hosp. v Countrywide Ins. Co. (2007 NY Slip Op 07675) Appellate Division, Second Department, October 9, 2007Claimant's proof held to make out its prima facie case (also decides)Held the hospital established prima facie entitlement on both causes of action by showing the billing documents were mailed and received and payment was overdue; on one the insurer raised triable issues.
New York & Presbyt. Hosp. v Selective Ins. Co. of Am. (2007 NY Slip Op 06848) Appellate Division, Second Department, September 18, 2007Claimant's proof held to make out its prima facie case (also decides)Held the hospital made its prima facie showing by proof that it mailed the statutory billing form and did not receive payment within 30 days.
Mary Immaculate Hosp. v Allstate Ins. Co. (2007 NY Slip Op 06461) Appellate Division, Second Department, August 21, 2007Insufficient: claimant did not prove the claim was submitted (mailed to and received by the insurer)Held the hospital failed its prima facie burden because the billing representative's affidavit said only that she billed the insurer, not that anyone mailed the claim forms, and the certified mail receipts were not tied to these claims.
Westchester Med. Ctr. v Liberty Mut. Ins. Co. (2007 NY Slip Op 04483) Appellate Division, Second Department, May 22, 2007Claimant's proof held to make out its prima facie case (also decides)Held the hospital demonstrated entitlement to judgment by showing the billing documents were mailed to and received by the insurer and payment was overdue.
A.B. Med. Servs., PLLC v Liberty Mut. Ins. Co. (2007 NY Slip Op 03636) Appellate Division, Second Department, April 24, 2007Claimant's proof held to make out its prima facie case (also decides)Held the provider made its prima facie showing by evidentiary proof that the statutory billing forms were mailed and received and that payment was overdue, though summary judgment was denied on a triable issue.
A.B. Med. Servs., PLLC v GEICO Cas. Ins. Co. (2007 NY Slip Op 03635) Appellate Division, Second Department, April 24, 2007Insufficient: claimant did not prove the claim was submitted (mailed to and received by the insurer)Held the provider failed to make a prima facie showing of entitlement to summary judgment, so its motion had to be denied regardless of the sufficiency of the opposing papers.
New York & Presbyt. Hosp. v Travelers Prop. Cas. Ins. Co. (2007 NY Slip Op 01537) Appellate Division, Second Department, February 20, 2007Claimant's proof held to make out its prima facie caseHeld the hospital established its prima facie case with the billing forms, a certified mail receipt, a signed return receipt card referencing the patient and forms, and its biller's affidavit, showing receipt and no response within 30 days.
Hospital for Joint Diseases v Travelers Prop. Cas. Ins. Co. (2006 NY Slip Op 08214) Appellate Division, Second Department, November 14, 2006Claimant's proof held to make out its prima facie case (also decides)Held the hospital made a prima facie showing by submitting the bill with a signed certified mail return receipt and its biller's affidavit that the insurer neither paid nor denied the claim.
New York & Presbyt. Hosp. v Allstate Ins. Co. (2006 NY Slip Op 05602) Appellate Division, Second Department, July 11, 2006Claimant's proof held to make out its prima facie case (also decides)Held the hospital made its prima facie showing by proof that the billing forms were mailed and received and not paid or denied within 30 days, but the insurer's proof of a timely verification request and denial defeated the motion.
New York & Presbyt. Hosp. v Allstate Ins. Co. (2006 NY Slip Op 03558) Appellate Division, Second Department, May 2, 2006Insufficient: claimant did not prove the claim was submitted (mailed to and received by the insurer)Held the providers failed their prima facie case because they did not show the hospital bill was mailed to and received by the insurer.
New York & Presbyt. Hosp. v Allstate Ins. Co. (2006 NY Slip Op 02731) Appellate Division, Second Department, April 11, 2006Insufficient for another reason (eligibility, timely submission, own papers defeat the claim) (also decides)Held the hospital failed to establish its entitlement to judgment as a matter of law, without giving a specific reason, while the insurer showed the policy limits were exhausted.
Nyack Hosp. v Encompass Ins. Co. (2005 NY Slip Op 08962) Appellate Division, Second Department, November 21, 2005Claimant's proof held to make out its prima facie case (also decides)Held the hospital made its prima facie showing on interest and fees by proof that the statutory billing forms were mailed and received and that payment was overdue when made.
New York & Presbyt. Hosp. v AIU Ins. Co. (2005 NY Slip Op 06014) Appellate Division, Second Department, July 18, 2005Claimant's proof held to make out its prima facie case (also decides)Held the hospital made a prima facie showing by proof that the billing forms were mailed and received and payment was overdue, but the insurer defeated the motion by showing a prior timely denial of the resubmitted claim.
Nyack Hosp. v Metropolitan Prop. & Cas. Ins. Co. (2005 NY Slip Op 02235) Appellate Division, Second Department, March 21, 2005Claimant's proof held to make out its prima facie case (also decides)Held the hospital made a prima facie showing by evidentiary proof that the statutory billing forms were mailed and received and that payment was overdue, shifting the burden to the insurer.
New York Hosp. Med. Ctr. of Queens v Motor Veh. Acc. Indem. Corp. (2004 NY Slip Op 08087) Appellate Division, Second Department, November 8, 2004Claimant's proof held to make out its prima facie case (also decides)Rejected the insurer's contention and held the hospital made its prima facie showing by evidentiary proof that the statutory billing forms were mailed and received and payment was overdue.
South Nassau Communities Hosp. v Allstate Ins. Co. (2004 NY Slip Op 07818) Appellate Division, Second Department, November 1, 2004Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed its prima facie burden because its own papers showed payments had been received, leaving issues whether the claims were resubmissions of resolved bills to which the 30-day payment rule would not apply.
Mary Immaculate Hosp. v Allstate Ins. Co. (2004 NY Slip Op 02359) Leading case Appellate Division, Second Department, March 29, 2004Claimant's proof held to make out its prima facie caseHeld the hospitals made a prima facie showing by evidentiary proof that the statutory billing forms were mailed and received and that payment was overdue, and the insurer failed to raise a triable issue of timely partial denial or payment.
Newmark v Progressive Ins. Co. (2003 NY Slip Op 18442) Appellate Division, Second Department, November 17, 2003Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the injured claimant failed to make a prima facie showing on his lost-wage claim because he did not eliminate triable issues as to whether the insurer failed to pay or deny it within the 30-day period.
St. Luke's Roosevelt Hosp. v American Tr. Ins. Co. (2003 NY Slip Op 18448) Appellate Division, Second Department, November 17, 2003Claimant's proof held to make out its prima facie caseHeld the hospital plaintiffs made a prima facie showing of entitlement to summary judgment on their no-fault claims, and the insurer's opposition raised no triable issue.

Appellate Division, Third Department (1 decision)

LMK Psychological Servs., P.C. v Liberty Mut. Ins. Co. (2006 NY Slip Op 04486) Appellate Division, Third Department, June 8, 2006Claimant's proof held to make out its prima facie caseRejected the insurer's challenge and held the providers met their prima facie burden on mailing through stamped mailing certificates and an officer's affidavit, with no denial of receipt.

Appellate Division, Fourth Department (1 decision)

Sunshine Imaging Assn./WNY MRI v Government Empls. Ins. Co. (2009 NY Slip Op 06984) Appellate Division, Fourth Department, October 2, 2009Claimant's proof held to make out its prima facie case (also decides)Held the provider made a prima facie showing by evidence that the statutory billing forms were received and payment was overdue, though its motion was denied on the insurer's triable issue.

Appellate Term, First Department (28 decisions)

Easy Care Acupuncture, P.C. v ELRAC, Inc. (2017 NY Slip Op 50234(U)) Appellate Term, First Department, February 22, 2017Claimant's proof held to make out its prima facie caseHeld the provider established prima facie that its claims were overdue because they were not denied or paid within the 30-day period, and the insurer raised no triable issue.
PR Med., P.C. v Praetorian Ins. Co. (2016 NY Slip Op 50338(U)) Appellate Term, First Department, March 21, 2016Claimant's proof held to make out its prima facie case (also decides)Held the provider established prima facie that its claims were overdue because they were neither paid nor denied within 30 days, and granted its cross motion as the insurer raised no triable issue.
Pugsley Chiropractic PLLC v Merchants Preferred Ins. Co. (2016 NY Slip Op 50167(U)) Appellate Term, First Department, February 17, 2016Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's cross motion properly denied because it failed to establish that its claims were not denied or paid within the 30-day period.
EMA Acupuncture v Statewide Ins. Co. (2015 NY Slip Op 51622(U)) Appellate Term, First Department, November 12, 2015Claimant's proof held to make out its prima facie case (also decides)Held the provider made its prima facie showing of entitlement to judgment, so the burden shifted to the insurer, which failed to raise a triable issue.
Tutto Anesthesia v American Country Ins. Co. (2015 NY Slip Op 50738(U)) Appellate Term, First Department, May 18, 2015Claimant's proof held to make out its prima facie caseHeld the providers established prima facie entitlement, the insurer's own date-stamped copies of the claim forms establishing receipt and that payment was overdue.
NJ/NY Pain Mgt. v Allstate Ins. Co. (2014 NY Slip Op 51569(U)) Appellate Term, First Department, November 3, 2014Claimant's proof held to make out its prima facie case (also decides)Held the providers established prima facie entitlement by showing that the billing documents were mailed to and received by the insurer and that payment was overdue.
Devonshire Surgical Facility v American Transit Insurance Company (2011 NY Slip Op 51660(U)) Appellate Term, First Department, September 9, 2011Claimant's proof held to make out its prima facie caseHeld the providers made their prima facie showing by proof that the statutory billing forms were mailed to and received by the insurer and that payment was overdue.
Devonshire Surgical Facility v American Tr. Ins. Co. (2011 NY Slip Op 50513(U)) Appellate Term, First Department, April 5, 2011Claimant's proof held to make out its prima facie case (also decides)Held the providers established their prima facie entitlement to summary judgment on their claims, so the burden shifted to the insurer to raise a triable issue.

Show all 28 decisions

Devonshire Surgical Facility v American Tr. Ins. Co. (2011 NY Slip Op 50512(U)) Appellate Term, First Department, April 5, 2011Claimant's proof held to make out its prima facie caseHeld the providers made their prima facie case because the insurer's own documentary submissions established receipt of the claims and that they were overdue.
Socrates Med. Health, P.C. v Motor Veh. Acc. Indem. Corp. (2010 NY Slip Op 51606(U)) Appellate Term, First Department, September 17, 2010Claimant's proof held to make out its prima facie caseHeld the provider made its prima facie showing because an employee's affidavit of standard office mailing procedures and the insurer's acknowledgment of receipt showed the claim was mailed and received and payment was overdue.
Devonshire Surgical Facility v American Tr. Ins. Co. (2010 NY Slip Op 50867(U)) Appellate Term, First Department, May 17, 2010Claimant's proof held to make out its prima facie caseHeld the providers established their prima facie case because the insurer's own submissions established receipt of the claims and the insurer did not dispute that the amounts remained overdue.
Preferred Med. Imaging, P.C. v Countrywide Ins. Co. (2009 NY Slip Op 52577(U)) Appellate Term, First Department, December 18, 2009Claimant's proof held to make out its prima facie caseHeld the arbitrator's requirement that the provider establish the medical necessity of its services was contrary to settled law, since a provider need not prove medical necessity, and upheld vacatur of the award.
Mollins v State Farm Gen. Ins. Co. (2009 NY Slip Op 50763(U)) Appellate Term, First Department, April 22, 2009Claimant's proof held to make out its prima facie case (also decides)Held the provider established prima facie entitlement by evidentiary proof that the statutory billing forms were mailed and received and that payment was overdue.
OS Tigris Acupuncture, P.C. v Liberty Mut. Insurance Co. (2008 NY Slip Op 51996(U)) Appellate Term, First Department, October 7, 2008Claimant's proof held to make out its prima facie case (also decides)Held the provider made its prima facie showing with evidentiary proof that the statutory billing forms were mailed and received and that payment was overdue.
Bronx Multi Med. Care, P.C. v Kemper Cas. Ins. Co. (2008 NY Slip Op 51928(U)) Appellate Term, First Department, September 24, 2008Claimant's proof held to make out its prima facie case (also decides)Held the provider made its prima facie showing with evidentiary proof that the statutory billing forms were mailed and received and that payment was overdue.
Mollins v Allstate Ins. Co. (2008 NY Slip Op 51616(U)) Appellate Term, First Department, July 28, 2008Claimant's proof held to make out its prima facie case (also decides)Held the provider made a prima facie showing by evidentiary proof that the statutory billing forms were mailed and received and that payment was overdue.
Gotham Acupuncture, P.C. v Country Wide Ins. Co. (2008 NY Slip Op 51615(U)) Appellate Term, First Department, July 28, 2008Claimant's proof held to make out its prima facie case (also decides)Treated the provider as having made its prima facie showing of entitlement to no-fault benefits, so the burden passed to the insurer, which failed to raise a precluded-free defense.
Devonshire Surgical Facility v GEICO (2007 NY Slip Op 51308(U)) Appellate Term, First Department, July 2, 2007Claimant's proof held to make out its prima facie case (also decides)Rejected the insurer's challenge to the orthopedic provider's prima facie case because the insurer's own documentary submissions established receipt of the claims.
Aronoff v Motor Veh. Acc. Indem. Corp. (2007 NY Slip Op 50958(U)) Appellate Term, First Department, May 8, 2007Claimant's proof held to make out its prima facie caseRejected the insurer's challenge and held the providers made their prima facie showing with proof that the statutory billing forms were mailed and received and that payment was overdue.
Mollins v Motor Veh. Acc. Indem. Corp. (2007 NY Slip Op 50138(U)) Appellate Term, First Department, January 30, 2007Claimant's proof held to make out its prima facie case (also decides)Held the provider established its prima facie case by evidentiary proof that the statutory billing forms were mailed and received and that payment was overdue.
East Coast Psychological, P.C. v Allstate Ins. Co. (2006 NY Slip Op 52000(U)) Appellate Term, First Department, October 20, 2006Claimant's proof held to make out its prima facie caseHeld the provider established its prima facie case with proof that the billing forms were mailed and received and payment was overdue, including a sufficient description of its standard mailing procedure.
Response Med. Equip. v General Assur. Co. (2006 NY Slip Op 51765(U)) Appellate Term, First Department, September 20, 2006Claimant's proof held to make out its prima facie caseHeld the provider established prima facie entitlement on most assignors' claims, but not on claims first sought in reply or supported by a principal's affidavit that neither stated personal mailing nor described office mailing practice.
West Tremont Med. Diagnostic, P.C. v Allstate Ins. Co. (2006 NY Slip Op 51374(U)) Appellate Term, First Department, July 14, 2006Claimant's proof held to make out its prima facie case (also decides)Held the provider established its prima facie case by proof that it submitted the claim form showing the fact and amount of loss and that payment was overdue, shifting the burden to the insurer.
SZ Med. P.C. v State Farm Mut. Auto. Ins. Co. (2005 NY Slip Op 51842(U)) Appellate Term, First Department, November 16, 2005Claimant's proof held to make out its prima facie case (also decides)Held the providers established prima facie entitlement by proof that they submitted claims setting forth the facts and amounts and that the insurer neither paid nor denied them within 30 days.
Laufer v Lumberman's Mut. Cas. Co. (2005 NY Slip Op 51632(U)) Appellate Term, First Department, October 11, 2005Claimant's proof held to make out its prima facie case (also decides)Treated the claimant as having made its prima facie showing and held the insurer's challenge to technical defects in the assignment waived because it did not object to the claim form within 10 days.
Elite Psychological Servs., P.C. v Trumbull Ins. Co. (2005 NY Slip Op 51427(U)) Appellate Term, First Department, September 9, 2005Claimant's proof held to make out its prima facie case (also decides)Held the provider made its prima facie showing by proof that its claim was mailed and received and that payment was overdue.
North N.Y. Med. Care, P.C. v New York Cent. Mut. Fire Ins. Co. (2004 NY Slip Op 51453(U)) Appellate Term, First Department, November 24, 2004Claimant's proof held to make out its prima facie caseHeld the provider made a prima facie showing that the insurer failed to pay or deny within 30 days of receipt, relying on its billing manager's uncontradicted sworn statement that the claim forms were mailed on their signing dates.
Socrates Psychological Servs. v Lumbermans Mut. Cas. Co. (2004 NY Slip Op 50690(U)) Appellate Term, First Department, June 17, 2004Claimant's proof held to make out its prima facie caseHeld the provider established entitlement to summary judgment by proving it submitted the required claim documents and the insurer neither paid, denied nor sought verification within the required periods.

Appellate Term, Second Department (819 decisions)

New Image Chiropractic, P.C. v Kemper Ins. Co. (2026 NY Slip Op 51306(U)) Appellate Term, Second Department, June 17, 2026Insufficient: claimant did not prove the claim was submitted (mailed to and received by the insurer)Held the provider failed to establish receipt of its claim forms because it submitted no evidence of an address for the insurer, so its cross motion was denied and the prima facie finding struck.
Healthway Med. Care, P.C. v MVAIC (2026 NY Slip Op 50198(U)) Appellate Term, Second Department, January 23, 2026Insufficient: claimant did not prove the claim was submitted (mailed to and received by the insurer)Held that, against the insurer's proof of non-receipt, the billing clerk's mailing-practice affidavit only raised an issue of fact on submission, so the finding that the claimant established proper submission of that claim was struck.
Horizon P.T. Care, P.C. v Kemper Ins. Co. (2025 NY Slip Op 50823(U)) Appellate Term, Second Department, May 2, 2025Insufficient: claimant did not prove the claim was submitted (mailed to and received by the insurer) (also decides)Struck the CPLR 3212 (g) finding that the provider established its prima facie case by timely and properly submitting its bills, holding the record did not support it as incontrovertible.
Trapezius Diagnostic Chiropractic, P.C. v Adirondack Ins. Exch. (2025 NY Slip Op 50173(U)) Appellate Term, Second Department, January 17, 2025Insufficient: claimant did not prove the claim was overdue (not paid or timely denied) (also decides)Held the provider's cross motion should have been denied because its proof failed to show the claims were not timely denied or that timely denials were conclusory, vague or without merit.
Nasrinpay v National Gen. Ins. Co. (2024 NY Slip Op 51188(U)) Appellate Term, Second Department, August 13, 2024Insufficient: claimant did not prove the claim was submitted (mailed to and received by the insurer)Held the provider failed to establish the insurer received the claim form because it submitted no evidence of an address for the insurer, so its summary judgment motion was properly denied.
Bronx Chiropractic Rehabilitation, P.C. v MVAIC (2024 NY Slip Op 50799(U)) Appellate Term, Second Department, June 7, 2024Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed to show prima facie that the claims had not been timely denied or that timely denials were conclusory, vague or without merit, so its summary judgment motion was properly denied.
Akai Acupuncture, P.C. v Foremost Prop. & Cas. Ins. Co. (2024 NY Slip Op 50630(U)) Appellate Term, Second Department, May 17, 2024Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the cross-motion properly denied because the claimant's affidavit failed to establish that the claim had not been timely denied or that the insurer's denials were conclusory, vague or without merit.
Burke Physical Therapy, P.C. v State Farm Mut. Auto. Ins. Co. (2024 NY Slip Op 24111) Appellate Term, Second Department, March 15, 2024Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Upheld denial of the provider's cross motion because it failed to show the absence of a material issue of fact on its entitlement to payment.

Show all 819 decisions

JSJ Anesthesia Pain Mgt., PLLC v Nationwide Ins. Co. (2024 NY Slip Op 50203(U)) Appellate Term, Second Department, February 16, 2024Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's cross motion properly denied because it failed to show the claim had not been timely denied or that the timely denial was conclusory, vague or without merit as a matter of law.
JFL Med. Care, P.C. v MVAIC (2024 NY Slip Op 50202(U)) Appellate Term, Second Department, February 16, 2024Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the claimant's cross motion properly denied because it failed to show the claims had not been timely denied or that the timely denials were conclusory, vague or without merit.
Pain Med., PLLC v State Farm Mut. Auto. Ins. Co. (2024 NY Slip Op 50069(U)) Appellate Term, Second Department, January 12, 2024Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's cross motion properly denied because it failed to show the claim had not been timely denied or that the timely denial was conclusory, vague or without merit as a matter of law.
Blano Med., P.C. v Hertz Co. (2023 NY Slip Op 51406(U)) Appellate Term, Second Department, December 15, 2023Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider did not show, prima facie, that the insurer failed to timely deny the claims or that its denials were conclusory, vague or without merit.
Heaven & Earth Acupuncture, P.C. v Hartford Ins. Co. of Ill. (2023 NY Slip Op 51236(U)) Appellate Term, Second Department, September 22, 2023Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's cross motion properly denied because its affidavit failed to show the claims had not been timely denied or that the timely denials were conclusory, vague or without merit.
Parisien v Esurance (2023 NY Slip Op 51235(U)) Appellate Term, Second Department, September 22, 2023Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed to show that the claims were not timely denied or that the denials were conclusory, vague or without merit, so its summary judgment motion was properly denied.
MSB Physical Therapy v Nationwide Ins. (2022 NY Slip Op 51381(U)) Appellate Term, Second Department, December 23, 2022Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's cross-motion proof failed to establish that the claims had not been timely denied or that timely denials were conclusory, vague or without merit.
JFL Med. Care, P.C. v Wesco Ins. Co. (2022 NY Slip Op 51376(U)) Appellate Term, Second Department, December 23, 2022Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Denied the provider's cross motion because its proof did not show the insurer failed to timely deny the claims or that its timely denials were conclusory, vague or without merit.
FJL Med. Servs., P.C. v Nationwide Ins. (2022 NY Slip Op 51213(U)) Appellate Term, Second Department, December 9, 2022Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's affidavit failed to establish that the claim had not been timely denied or that a timely denial was conclusory, vague or without merit.
American Kinetics Lab, Inc. v Travelers Ins. Co. (2022 NY Slip Op 51212(U)) Appellate Term, Second Department, December 9, 2022Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's cross motion properly denied because its proof failed to show the claims had not been timely denied or that the timely denials were conclusory, vague or without merit.
Spring Rehab, P.T., P.C. v Hereford Ins. Co. (2022 NY Slip Op 51270(U)) Appellate Term, Second Department, December 2, 2022Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's motion properly denied because its proof did not establish that the claims were not timely denied or that the insurer's timely denials were conclusory, vague or without merit.
Parisien v Tri State Consumers Ins. Co. (2022 NY Slip Op 50920(U)) Appellate Term, Second Department, September 16, 2022Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed its prima facie burden on the third through tenth causes of action because it did not show the claims were not timely denied or that timely denials were conclusory, vague or meritless.
Wave Med. Servs., P.C. v Hertz Vehs., LLC (2022 NY Slip Op 50908(U)) Appellate Term, Second Department, August 26, 2022Insufficient: claimant did not prove the claim was submitted (mailed to and received by the insurer)Held the provider was not entitled to a CPLR 3212 (g) finding that it established its prima facie case, because the insurer's non-receipt affidavit put receipt of the claim forms, an element of that case, in dispute.
Hands On Physical Therapy Care v Nationwide Ins. (2022 NY Slip Op 50797(U)) Appellate Term, Second Department, August 12, 2022Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed to establish its prima facie case on the first three claims because its proof did not show the claims had not been timely denied or that timely denials were conclusory, vague or without merit.
PFJ Med. Care, P.C. v Nationwide Ins. (2022 NY Slip Op 50783(U)) Appellate Term, Second Department, August 5, 2022Insufficient: claimant did not prove the claim was submitted (mailed to and received by the insurer)Held the provider's owner's affidavit insufficient to raise a presumption that the claim forms for two causes of action were timely mailed to and received by the insurer. Summary judgment on those claims was therefore properly denied.
Columbus Imaging Ctr., LLC v Nationwide Ins. (2022 NY Slip Op 50620(U)) Appellate Term, Second Department, July 1, 2022Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's cross motion should have been denied because its proof failed to show the claims had not been timely denied or that timely denials were conclusory, vague or without merit.
New York Wellness PT, P.C. v State Farm Mut. Auto. Ins. Co. (2022 NY Slip Op 50608(U)) Appellate Term, Second Department, June 17, 2022Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed to make its prima facie case because its proof did not show the insurer failed to deny within 30 days or that its denials were conclusory, vague or without merit.
JPC Med., P.C. v State Farm Mut. Auto. Ins. Co. (2022 NY Slip Op 50562(U)) Appellate Term, Second Department, June 3, 2022Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Denied the provider's cross motion because its affidavit did not show the claim had not been timely denied or that the timely denial was conclusory, vague or without merit.
Columbus Imaging Ctr., LLC v National Liab. & Fire Ins. Co. (2022 NY Slip Op 50556(U)) Appellate Term, Second Department, June 3, 2022Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed its prima facie burden because its affidavit did not show the claim had not been timely denied or that a timely denial was conclusory, vague or without merit.
Psychology After Acc., P.C. v Nationwide Ins. Co. of N.Y. (2022 NY Slip Op 50366(U)) Appellate Term, Second Department, May 6, 2022Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's cross-motion proof failed to establish that the claims had not been timely denied or that timely denials were conclusory, vague or without merit, so its cross motion was denied.
SK Prime Med. Supply v MVAIC (2021 NY Slip Op 51200(U)) Appellate Term, Second Department, December 10, 2021Claimant's proof held to make out its prima facie case (also decides)Held the provider owner's affidavit sufficient to raise a presumption that the claim forms were mailed and received, but vacated the CPLR 3212 (g) prima facie finding because the insurer's non-receipt showing left receipt for a hearing.
Impulse Imaging, P.C. v State Farm Fire & Cas. Co. (2021 NY Slip Op 51031(U)) Appellate Term, Second Department, October 29, 2021Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed its prima facie burden because it did not show the claims had not been timely denied or that the timely denials were conclusory, vague or without merit.
Total Chiropractic, P.C. v Integon Natl. Ins. Co. (2021 NY Slip Op 50443(U)) Appellate Term, Second Department, May 14, 2021Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed its prima facie burden because its affidavit did not show the claim had not been timely denied or that a timely denial was conclusory, vague or without merit.
JFL Med. Care, P.C. v ELRAC, Inc. (2021 NY Slip Op 50434(U)) Appellate Term, Second Department, May 14, 2021Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's affidavit failed to establish that the claim had not been timely denied or that a timely denial was conclusory, vague or without merit.
Excel Prods., Inc. v Farmington Cas. Co. (2021 NY Slip Op 50441(U)) Appellate Term, Second Department, May 14, 2021Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's proof failed to establish that the claims had not been timely denied or that timely denials were conclusory, vague or without merit.
Wave Med. Servs., P.C. v Global Liberty Ins. (2020 NY Slip Op 51383(U)) Appellate Term, Second Department, November 13, 2020Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the claimant failed its prima facie burden because it did not show the insurer failed to timely deny the claim or that a timely denial was conclusory, vague or without merit.
Total Chiropractic, P.C. v Hereford Ins. Co. (2020 NY Slip Op 51362(U)) Appellate Term, Second Department, November 13, 2020Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed to establish that its claims had not been timely denied or that timely denials were conclusory, vague or without merit, so its summary judgment motion should have been denied.
First Care Med. Equip., LLC v Kemper Ins. Co. (2020 NY Slip Op 51326(U)) Appellate Term, Second Department, November 6, 2020Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed its prima facie burden because it did not show the claim was not timely denied or that the timely denial was conclusory, vague or without merit.
Tsatskis v Travelers Ins. Co. (2020 NY Slip Op 51323(U)) Appellate Term, Second Department, November 6, 2020Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed its prima facie burden on the EUO-related claims because its proof did not show the claims had not been timely denied or that timely denials were conclusory, vague or without merit.
Metro Pain Specialist, P.C. v ELRAC, Inc. (2020 NY Slip Op 51341(U)) Appellate Term, Second Department, November 6, 2020Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's affidavit failed to establish that the claim had not been timely denied or that a timely denial was conclusory, vague or without merit.
JPF Med. Servs., P.C. v Nationwide Ins. (2020 NY Slip Op 51122(U)) Appellate Term, Second Department, September 18, 2020Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the claimant's motion properly denied because its proof did not establish that the claims had not been timely denied or that timely denials were conclusory, vague or without merit.
Quality Health Supply Corp. v Hertz Co. (2020 NY Slip Op 50996(U)) Appellate Term, Second Department, August 28, 2020Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed to establish its prima facie case because its proof did not show the claims were not timely denied or that timely denials were conclusory, vague or without merit.
Clear Water Psychological Servs., P.C. v Hereford Ins. Co. (2020 NY Slip Op 50847(U)) Appellate Term, Second Department, July 10, 2020Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's summary judgment motion should have been denied because its proof failed to show the claims had not been timely denied or that the timely denials were conclusory, vague or without merit.
Parisien v Omni Indem. Co. (2020 NY Slip Op 50729(U)) Appellate Term, Second Department, June 12, 2020Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the claimant failed to establish as a matter of law that the insurer did not deny its claims within the required period, so it did not make out its prima facie case.
Monroe v Omni Indem. Co. (2020 NY Slip Op 50730(U)) Appellate Term, Second Department, June 12, 2020Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the claimant failed to establish as a matter of law that the insurer did not deny its claims in either action within the required period, so it did not make out its prima facie case.
Longevity Med. Supply, Inc. v Global Liberty Ins. Co. (2020 NY Slip Op 50527(U)) Appellate Term, Second Department, May 8, 2020Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's cross motion should have been denied because its proof failed to show the claim was not timely denied or that a timely denial was conclusory, vague or without merit.
Pravel, Inc. v State Farm Mut. Auto. Ins. Co. (2020 NY Slip Op 50457(U)) Appellate Term, Second Department, April 24, 2020Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the claimant's cross motion properly denied because its papers did not show the insurer failed to deny within 30 days or issued a timely denial that was conclusory, vague or without merit.
Active Care Med. Supply Corp. v Titan Ins. Co. (2020 NY Slip Op 50183(U)) Appellate Term, Second Department, January 31, 2020Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the claimant not entitled to summary judgment because its proof did not establish that the claims had not been timely denied or that timely denials were conclusory, vague or without merit.
Monroe v Foremost Signature Ins. Co. (2019 NY Slip Op 52042(U)) Appellate Term, Second Department, December 13, 2019Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the claimant failed to show prima facie entitlement because its proof did not establish that the claim had not been timely denied or that a timely denial was conclusory, vague or without merit.
Longevity Med. Supply, Inc. v 21st Century Ins. Co. (2019 NY Slip Op 52041(U)) Appellate Term, Second Department, December 13, 2019Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the claimant failed to show prima facie entitlement because its proof did not establish that the claim had not been timely denied or that a timely denial was conclusory, vague or without merit.
Success Rehab, PT, P.C. v Hereford Ins. Co. (2019 NY Slip Op 52031(U)) Appellate Term, Second Department, December 13, 2019Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed to establish that the insurer did not deny the claims within 30 days or that timely denials were conclusory, vague or without merit, so its cross motion should have been denied.
Lidas Med. Supply, Inc. v Global Liberty Ins. (2019 NY Slip Op 51733(U)) Appellate Term, Second Department, October 25, 2019Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the claimant's motion should have been denied because its proof did not establish that the claim had not been timely denied or that a timely denial was conclusory, vague or without merit.
Charles Deng Acupuncture, P.C. v Allstate Ins. Co. (2019 NY Slip Op 51693(U)) Appellate Term, Second Department, October 18, 2019Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's cross motion properly denied because it failed to show the claims were not timely denied or that timely denials were conclusory, vague or without merit.
Lida's Med. Supply, Inc. v Global Liberty Ins. (2019 NY Slip Op 51691(U)) Appellate Term, Second Department, October 18, 2019Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the claimant's motion should have been denied because its proof did not establish that the claim had not been timely denied or that a timely denial was conclusory, vague or without merit.
Spine Care of NJ, P.C. v Global Liberty Ins. Co. of N.Y. (2019 NY Slip Op 51632(U)) Appellate Term, Second Department, October 11, 2019Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the claimant's cross motion on two bills should have been denied because its proof did not establish that the claims had not been timely denied or that timely denials were conclusory, vague or without merit.
American Chiropractic Care, P.C. v Hereford Ins. Co. (2019 NY Slip Op 51359(U)) Appellate Term, Second Department, August 16, 2019Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed to make its prima facie showing because its proof did not establish that the claims had not been timely denied or that timely denials were conclusory, vague or without merit.
Lida's Med. Supply, Inc. v Hereford Ins. Co. (2019 NY Slip Op 51356(U)) Appellate Term, Second Department, August 16, 2019Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed to establish as a matter of law that the claims had not been timely denied or that timely denials were conclusory, vague or without merit.
Zen Acupuncture, P.C. v Ameriprise Ins. Co. (2019 NY Slip Op 51262(U)) Appellate Term, Second Department, August 2, 2019Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's proof failed to establish that the claims had not been timely denied or that timely denials were conclusory, vague or without merit, so its cross motion for summary judgment should have been denied.
Acupuncture Now, P.C. v Travelers Ins. Co. (2019 NY Slip Op 51255(U)) Appellate Term, Second Department, August 2, 2019Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's cross motion should have been denied because its proof did not show the claims had not been timely denied or that timely denials were conclusory, vague or without merit.
Parisien v Travelers Ins. Co. (2019 NY Slip Op 51162(U)) Appellate Term, Second Department, July 12, 2019Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed its prima facie burden on the remaining claims because its proof did not show the claims were not timely denied or that the timely denials were conclusory, vague or without merit.
Parisien v Allstate Ins. Co. (2019 NY Slip Op 51154(U)) Appellate Term, Second Department, July 12, 2019Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's motion properly denied because it failed to show the claims were not timely denied or that timely denials were conclusory, vague or without merit.
Masigla v 21st Century Ins. Co. (2019 NY Slip Op 50938(U)) Appellate Term, Second Department, June 7, 2019Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's proof failed to show the remaining claims had not been timely denied or that the timely denials were conclusory, vague or without merit, so its summary judgment motion was properly denied.
Golden Star Acupuncture, P.C. v Erie Ins. Co. of NY (2019 NY Slip Op 50920(U)) Appellate Term, Second Department, June 7, 2019Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's owner's affidavit failed to show the claims had not been timely denied or that timely denials were conclusory, vague or without merit, so its cross motion was denied.
Metro Psychological Servs., P.C. v Allstate Ins. Co. (2019 NY Slip Op 50748(U)) Appellate Term, Second Department, May 10, 2019Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's cross motion properly denied because it failed to show the claims were not timely denied or that timely denials were conclusory, vague or without merit.
Zen Acupuncture, P.C. v Allstate Ins. Co. (2019 NY Slip Op 50699(U)) Appellate Term, Second Department, May 3, 2019Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the claimant's cross motion properly denied because its proof did not establish that the claim had not been timely denied or that a timely denial was conclusory, vague or without merit.
K.O. Med., P.C. v IDS Prop. Cas. Ins. Co. (2019 NY Slip Op 50687(U)) Appellate Term, Second Department, May 3, 2019Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed to establish its prima facie case on four claims because it did not show the insurer failed to deny them within 30 days or that timely denials were conclusory, vague or meritless.
Tyorkin v Park Ins. Co. (2019 NY Slip Op 50682(U)) Appellate Term, Second Department, May 3, 2019Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's proof failed to establish that the claim had not been timely denied or that the timely denial was conclusory, vague or without merit, so its motion should have been denied.
Charles Deng Acupuncture, P.C. v Nationwide Ins. (2019 NY Slip Op 50641(U)) Appellate Term, Second Department, April 26, 2019Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed to establish a prima facie case because its papers did not show the claim was not denied within 30 days or that a timely denial was conclusory, vague or without merit.
North Val. Med., P.C. v Allstate Ins. Co. (2019 NY Slip Op 50904(U)) Appellate Term, Second Department, March 29, 2019Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's affidavit and documents did not establish that the claims had not been timely denied or that timely denials were conclusory, vague or without merit, so its cross motion should have been denied.
Parisien v 21st Century Ins. Co. (2019 NY Slip Op 50275(U)) Appellate Term, Second Department, March 8, 2019Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's motion was properly denied on the EUO claim because its proof did not show the claim had not been timely denied or that a timely denial was conclusory, vague or meritless.
Charles Deng Acupuncture, P.C. v 21st Century Ins. Co. (2018 NY Slip Op 51815(U)) Appellate Term, Second Department, December 7, 2018Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the claimant's motion properly denied because its proof did not establish that the claims had not been timely denied or that timely denials were conclusory, vague or without merit.
Action Potential Chiropractic, PLLC v Travelers Ins. Co. (2018 NY Slip Op 51811(U)) Appellate Term, Second Department, December 7, 2018Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's summary judgment motion should have been denied because its proof did not establish that the claim was not timely denied or that a timely denial was conclusory, vague or without merit.
Veraso Med. Supply Corp. v 21st Century Ins. Co. (2018 NY Slip Op 51696(U)) Appellate Term, Second Department, November 23, 2018Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed its prima facie burden because it did not establish that the claim had not been timely denied or that a timely denial was conclusory, vague or without merit.
Pavlova v Allstate Ins. Co. (2018 NY Slip Op 51654(U)) Appellate Term, Second Department, November 16, 2018Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed to show its claim for the code 20999 services had not been timely denied or that the timely denial was conclusory, vague or without merit, so its summary judgment motion was properly denied.
Gentlecare Ambulatory Anesthesia Servs. v Allstate Ins. Co. (2018 NY Slip Op 51607(U)) Appellate Term, Second Department, November 9, 2018Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's affidavit failed to establish that the claim had not been timely denied or that a timely denial was conclusory, vague or without merit, so its motion was properly denied.
Pavlova v Allstate Ins. Co. (2018 NY Slip Op 51604(U)) Appellate Term, Second Department, November 9, 2018Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed to show its claims had not been timely denied or that the timely denials were conclusory, vague or without merit, so its summary judgment motion was properly denied.
Essential Acupuncture Servs., P.C. v GEICO Indem. Co. (2018 NY Slip Op 51600(U)) Appellate Term, Second Department, November 9, 2018Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's affidavit failed to establish that the claims had not been timely denied or that the timely denials were conclusory, vague or without merit, so its summary judgment motion should have been denied.
Maiga Prods. Corp. v Hertz Co. (2018 NY Slip Op 51448(U)) Appellate Term, Second Department, October 12, 2018Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed its prima facie burden because its proof did not show the claims were not timely denied or that the timely denials were conclusory, vague or without merit.
Neptune Med. Care, P.C. v Allstate Ins. Co. (2018 NY Slip Op 51150(U)) Appellate Term, Second Department, July 20, 2018Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's cross motion should have been denied because it did not show the insurer failed to timely deny the claims or that timely denials were conclusory, vague or without merit.
Acupuncture Now, P.C v GEICO Ins. Co. (2018 NY Slip Op 51084(U)) Appellate Term, Second Department, July 6, 2018Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed to make a prima facie showing because its proof did not establish that the claims were not timely denied or that timely denials were conclusory, vague or without merit.
Parisien v 21st Century Ins. Co. (2018 NY Slip Op 51081(U)) Appellate Term, Second Department, July 6, 2018Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed to show the claims had not been timely denied or that the timely denials were conclusory, vague or without merit, so summary judgment was properly denied.
Jing Luo Acupuncture, P.C. v NY City Tr. Auth. (2018 NY Slip Op 51083(U)) Appellate Term, Second Department, July 6, 2018Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed its prima facie burden because it did not establish that the bills were not timely denied or that timely denials were conclusory, vague or without merit.
Comprehensive Care Physical Therapy, P.C. v Allstate Ins. Co. (2018 NY Slip Op 50848(U)) Appellate Term, Second Department, June 1, 2018Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's affidavit failed to establish that the claims had not been timely denied or that timely denials were conclusory, vague or without merit, so its motion was properly denied.
Gl Acupuncture, P.C. v Allstate Ins. Co. (2018 NY Slip Op 50842(U)) Appellate Term, Second Department, June 1, 2018Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's affidavit failed to show the claims were not timely denied or that timely denials were conclusory, vague or without merit, so its motion was properly denied.
Gl Acupuncture, P.C. v Allstate Ins. Co. (2018 NY Slip Op 50830(U)) Appellate Term, Second Department, June 1, 2018Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's affidavit failed to show the claims were not timely denied or that timely denials were conclusory, vague or without merit, so its motion was properly denied.
Gl Acupuncture, P.C. v Allstate Ins. Co. (2018 NY Slip Op 50829(U)) Appellate Term, Second Department, June 1, 2018Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's affidavit failed to show the claims were not timely denied or that timely denials were conclusory, vague or without merit, so its motion was properly denied.
FEMA Med. Supply, Inc. v Country-Wide Ins. Co. (2018 NY Slip Op 50782(U)) Appellate Term, Second Department, May 25, 2018Insufficient: claimant did not prove the claim was submitted (mailed to and received by the insurer)Held the provider's motion properly denied because it failed to establish as a matter of law that it had mailed its bills to the insurer.
Irina Acupuncture, P.C. v Auto One Ins. Co. (2018 NY Slip Op 50781(U)) Appellate Term, Second Department, May 25, 2018Claimant's proof held to make out its prima facie case (also decides)Treated the provider's standard-mailing-practice proof as raising a presumption of receipt, but denied summary judgment because the insurer's proof of late receipt raised a triable issue on timely mailing.
Mind & Body Acupuncture, P.C. v Allstate Ins. Co. (2018 NY Slip Op 50779(U)) Appellate Term, Second Department, May 25, 2018Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's affidavit failed to show the claims were not timely denied or that timely denials were conclusory, vague or without merit, so its motion was properly denied.
Parisien v Maya Assur. Co. (2018 NY Slip Op 50766(U)) Appellate Term, Second Department, May 25, 2018Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's affidavit failed to establish that the claim had not been timely denied or that a timely denial was conclusory, vague or without merit.
Healthway Med. Care, P.C. v American Commerce Ins. Co. (2018 NY Slip Op 50733(U)) Appellate Term, Second Department, May 18, 2018Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed to establish that its claims had not been timely denied or that timely denials were conclusory, vague or without merit, so its motion was properly denied.
Active Care Med. Supply Corp. v Amica Mut. Ins. Co. (2018 NY Slip Op 50500(U)) Appellate Term, Second Department, April 6, 2018Claimant's proof held to make out its prima facie case (also decides)Held the provider's employee's affidavit that he personally mailed the claim raised a presumption of receipt, but the insurer's non-receipt affidavit raised a triable issue defeating summary judgment.
Arnica Acupuncture, P.C. v Allstate Ins. Co. (2018 NY Slip Op 50415(U)) Appellate Term, Second Department, March 23, 2018Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed its prima facie burden on its cross motion because it did not show the claims were not denied within 30 days or that timely denials were conclusory, vague or meritless.
TAM Med. Supply Corp. v Travelers Ins. Co. (2018 NY Slip Op 50315(U)) Appellate Term, Second Department, March 9, 2018Claimant's proof held to make out its prima facie caseHeld that although the provider bore the burden at trial of proving its prima facie case, compliance with the insurer's verification requests was not part of that burden because the insurer must prove its defense, and struck the contrary ruling.
Thomas J. Tesi, M.S., D.C., P.C. v Hereford Ins. Co. (2018 NY Slip Op 50252(U)) Appellate Term, Second Department, February 16, 2018Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed to establish that its claims had not been timely denied or that timely denials were conclusory, vague or without merit, so its summary judgment motion should have been denied.
Motionpro Physical Therapy v Hereford Ins. Co. (2018 NY Slip Op 50251(U)) Appellate Term, Second Department, February 16, 2018Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed to make a prima facie showing because it did not establish that its claims had not been timely denied or that timely denials were conclusory, vague or without merit.
Acupuncture Healthcare Plaza I, P.C. v Allstate Ins. Co. (2017 NY Slip Op 51903(U)) Appellate Term, Second Department, December 22, 2017Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's affidavit failed to show the claims had not been timely denied or that timely denials were conclusory, vague or meritless, so its summary judgment motion was properly denied.
Renelique v Allstate Ins. Co. (2017 NY Slip Op 51884(U)) Appellate Term, Second Department, December 22, 2017Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's affidavit failed to show the claim had not been timely denied or that a timely denial was conclusory, vague or meritless, so its summary judgment motion was properly denied.
Acuhealth Acupuncture, P.C. v Hereford Ins. Co. (2017 NY Slip Op 51871(U)) Appellate Term, Second Department, December 22, 2017Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed to show the code 97039 claim had not been timely denied or that the timely denial was conclusory, vague or without merit, so its cross motion was properly denied.
Silver Acupuncture, P.C. v GEICO (Gov Employees) (2017 NY Slip Op 51876(U)) Appellate Term, Second Department, December 22, 2017Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's proof failed to establish that the claims had not been timely denied or that timely denials were conclusory, vague or without merit.
Island Life Chiropractic, P.C. v National Liab. & Fire Ins. Co. (2017 NY Slip Op 51843(U)) Appellate Term, Second Department, December 19, 2017Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed its prima facie burden because its papers did not establish that the claims had not been timely denied or that timely denials were conclusory, vague or without merit.
Island Life Chiropractic, P.C. v 21st Century Ins. Co. (2017 NY Slip Op 51824(U)) Appellate Term, Second Department, December 19, 2017Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the claimant failed to establish prima facie entitlement because its proof did not show the claims had not been timely denied or that timely denials were conclusory, vague or without merit.
Acupuncture Choice, P.C. v American Tr. Ins. Co. (2017 NY Slip Op 51822(U)) Appellate Term, Second Department, December 19, 2017Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed its prima facie burden because the record showed timely denials on the IME no-show ground and the provider did not show its assignor appeared or that the denials lacked merit as a matter of law.
Healing Art Acupuncture, P.C. v Allstate Ins. Co. (2017 NY Slip Op 51821(U)) Appellate Term, Second Department, December 19, 2017Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's affidavit failed to show the claims had not been timely denied or that a timely denial was conclusory, vague or meritless, so its summary judgment motion was properly denied.
Island Life Chiropractic, P.C. v 21st Century Ins. Co. (2017 NY Slip Op 51820(U)) Appellate Term, Second Department, December 19, 2017Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the claimant failed to establish prima facie entitlement because its proof did not show the claims had not been timely denied or that timely denials were conclusory, vague or without merit.
Healthway Med. Care, P.C. v Global Liberty Ins. (2017 NY Slip Op 51807(U)) Appellate Term, Second Department, December 19, 2017Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed its prima facie burden because it did not show the claims had not been timely denied or that timely denials were conclusory, vague or without merit.
Lynbrook PT & OT, PLLC v Ameriprise Ins. Co. (2017 NY Slip Op 51801(U)) Appellate Term, Second Department, December 19, 2017Claimant's proof held to make out its prima facie caseHeld the provider established its prima facie case on four claims and, the insurer's defense having failed, was entitled to summary judgment on them.
Beal-Medea Prods., Inc. v ELRAC, Inc. (2017 NY Slip Op 51793(U)) Appellate Term, Second Department, December 19, 2017Insufficient: claimant did not prove the claim was submitted (mailed to and received by the insurer) (also decides)Affirmed denial of the provider's cross motion because, against the insurer's showing that it never received the claim, the provider failed even to raise a triable issue that it had mailed the claim.
Renelique v American Tr. Ins. Co. (2017 NY Slip Op 51759(U)) Appellate Term, Second Department, December 15, 2017Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed to establish entitlement to any amount beyond the conceded $11.45 because its proof did not show the claim had not been timely denied or that the timely denial was conclusory, vague or without merit.
Logic Chiropractic, P.C. v Hereford Ins. Co. (2017 NY Slip Op 51754(U)) Appellate Term, Second Department, December 15, 2017Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed to make a prima facie showing on the remaining causes of action because, among other reasons, it did not show the claims had not been timely denied or that the denials were conclusory, vague or without merit.
Sama Physical Therapy, P.C. v Global Liberty Ins. (2017 NY Slip Op 51736(U)) Appellate Term, Second Department, December 8, 2017Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's affidavit failed to establish that the claims had not been timely denied or that timely denials were conclusory, vague or without merit, so it did not make its prima facie showing.
Wellness Plaza Acupuncture, P.C. v Erie Ins. (2017 NY Slip Op 51729(U)) Appellate Term, Second Department, December 8, 2017Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed to make a prima facie showing because its affidavit did not establish the claim had not been timely denied or that a timely denial was conclusory, vague or meritless.
Charles Deng Acupuncture, P.C. v Allstate Ins. Co. (2017 NY Slip Op 51716(U)) Appellate Term, Second Department, December 8, 2017Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed its prima facie burden because its affidavit did not establish the claims had not been timely denied or that timely denials were conclusory, vague or meritless.
Adelaida M. Laga, P.T. v GEICO Ins. Co. (2017 NY Slip Op 51715(U)) Appellate Term, Second Department, December 8, 2017Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's proof failed to establish that the claim had not been timely denied or that a timely denial was conclusory, vague or without merit.
Adelaida M. Laga, Pt v GEICO Ins. Co. (2017 NY Slip Op 51713(U)) Appellate Term, Second Department, December 8, 2017Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's affidavit failed to show the claims had not been timely denied or that the timely denials were conclusory, vague or without merit, so it was not entitled to summary judgment.
KHL Acupuncture, P.C. v Allstate Ins. Co. (2017 NY Slip Op 51709(U)) Appellate Term, Second Department, December 8, 2017Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's affidavit failed to show the claims had not been timely denied or that a timely denial was conclusory, vague or meritless, so its summary judgment motion was properly denied.
K.O. Med., P.C. v Mercury Cas. Co. (2017 NY Slip Op 51614(U)) Appellate Term, Second Department, November 17, 2017Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's cross-moving papers failed to show the claims were not denied within 30 days or that timely denials were conclusory, vague or without merit.
Chapa Prods. Corp. v Nationwide Ins. (2017 NY Slip Op 51457(U)) Appellate Term, Second Department, October 27, 2017Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed to show the claims had not been timely denied or that timely denials were conclusory, vague or without merit, so its motion was properly denied.
Acupuncture Approach, P.C. v NY Cent. Mut. Fire Ins. Co. (2017 NY Slip Op 51455(U)) Appellate Term, Second Department, October 27, 2017Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's affidavit failed to show the claims had not been timely denied or that the timely denials were conclusory, vague or without merit, so its cross motion was properly denied.
Bronx Acupuncture Therapy, P.C. v Hereford Ins. Co. (2017 NY Slip Op 51452(U)) Appellate Term, Second Department, October 27, 2017Claimant's proof held to make out its prima facie caseHeld the record showed the insurer received the claim form and that its denial, based on missing documentation it never requested, was without merit as a matter of law, so the provider was granted summary judgment.
Charles Deng Acupuncture, P.C. v Allstate Ins. Co. (2017 NY Slip Op 51451(U)) Appellate Term, Second Department, October 27, 2017Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's affidavit failed to show the claims had not been timely denied or that a timely denial was conclusory, vague or meritless, so its summary judgment motion was properly denied.
Charles Deng Acupuncture, P.C. v 21st Century Ins. Co. (2017 NY Slip Op 51252(U)) Appellate Term, Second Department, September 22, 2017Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed its prima facie burden because its proof did not show the claims were not timely denied or that the timely denials were conclusory, vague or without merit.
Laga v American Commerce Ins. Co. (2017 NY Slip Op 51250(U)) Appellate Term, Second Department, September 22, 2017Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the claimant not entitled to summary judgment on the remaining claim because it did not establish that the claim had not been timely denied or that a timely denial was conclusory, vague or without merit.
AL Acupuncture, P.C. v Geico Ins. Co. (2017 NY Slip Op 51249(U)) Appellate Term, Second Department, September 22, 2017Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed to show the IME-denied claim had not been timely denied or that the denial was conclusory, vague or without merit, so its motion on that claim was denied.
Compas Med., P.C. v American Tr. Ins. Co. (2017 NY Slip Op 51239(U)) Appellate Term, Second Department, September 22, 2017Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed to establish its prima facie case on the sixth and seventh causes of action because its proof did not show the claims were not timely denied or that the denials were conclusory, vague or meritless.
Compas Med., P.C. v 21st Century Ins. Co. (2017 NY Slip Op 51228(U)) Appellate Term, Second Department, September 22, 2017Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's proof did not establish that the claim had not been timely denied or that the timely denial was conclusory, vague or without merit, so it was not entitled to summary judgment.
Fema Med. Supply, Inc. v American Commerce Ins. Co. (2017 NY Slip Op 51160(U)) Appellate Term, Second Department, September 8, 2017Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's motion properly denied because it did not show the insurer failed to deny the claims within 30 days or that timely denials were conclusory, vague or without merit.
Compas Med., P.C. v American Tr. Ins. Co. (2017 NY Slip Op 51142(U)) Appellate Term, Second Department, September 8, 2017Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's proof failed to show the claims had not been timely denied or that the timely denials were conclusory, vague or without merit, so its summary judgment motion was properly denied.
K.O. Med., P.C. v ELRAC, Inc. (2017 NY Slip Op 51151(U)) Appellate Term, Second Department, September 8, 2017Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's cross motion properly denied because it did not establish that the insurer's denial forms were conclusory, vague or without merit as a matter of law.
Shur v Unitrin Advantage Ins. Co. (2017 NY Slip Op 51011(U)) Appellate Term, Second Department, August 10, 2017Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's cross motion properly denied because it failed to show the claim was not denied within 30 days or that a timely denial was conclusory, vague or without merit.
Acupuncture Healthcare Plaza I, P.C. v Allstate Ins. Co. (2017 NY Slip Op 50939(U)) Appellate Term, Second Department, July 21, 2017Claimant's proof held to make out its prima facie caseHeld the provider's cross-motion papers established its prima facie case, the insurer having admitted receipt of the claim, entitling it to summary judgment.
Sharp View Diagnostic Imaging, P.C. v GEICO Gen. Ins. Co. (2017 NY Slip Op 50855(U)) Appellate Term, Second Department, June 23, 2017Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held that although mailing was shown, the provider's conclusory affidavit failed to establish the claim had not been timely denied or that a timely denial was conclusory, vague or meritless.
Progressive Health Chiropractic, P.C. v American Tr. Ins. Co. (2017 NY Slip Op 50603(U)) Appellate Term, Second Department, April 27, 2017Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider was not entitled to summary judgment on one claim because the record did not establish that the insurer's no-show denial was untimely or lacked merit.
Maiga Prods. Corp. v Unitrin Auto & Home Ins. Co. (2017 NY Slip Op 50113(U)) Appellate Term, Second Department, January 20, 2017Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed to establish that the claim was not denied within 30 days or that a timely denial was conclusory, vague or without merit.
Healthway Med. Care, P.C. v Infinity Group (2016 NY Slip Op 51780(U)) Appellate Term, Second Department, December 7, 2016Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the claimant failed to establish prima facie entitlement because its papers did not show that the claim was not denied within 30 days or that a timely denial was conclusory, vague or without merit.
Neptune Med. Care, P.C. v Dairyland Ins. Co. (2016 NY Slip Op 51705(U)) Appellate Term, Second Department, November 25, 2016Claimant's proof held to make out its prima facie case (also decides)Held the provider's employee affidavit sufficient to establish prima facie entitlement to summary judgment, but the motion failed because an issue of fact existed on whether the insurer timely paid.
Art of Healing Medicine, P.C. v Allstate Ins. Co. (2016 NY Slip Op 26387) Appellate Term, Second Department, November 17, 2016Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's proof failed to show that the claims had not been timely denied or that timely denials were conclusory, vague or without merit, so its summary judgment motion was properly denied.
New Capital Supply, Inc. v Chubb Ins. Co. (2016 NY Slip Op 51677(U)) Appellate Term, Second Department, November 15, 2016Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed to make a prima facie showing on the claim because its papers did not establish that the claim was not timely denied or that the denial was conclusory, vague or without merit.
Daily Med. Equip. Distrib. Ctr., Inc. v American Tr. Ins. Co. (2016 NY Slip Op 51621(U)) Appellate Term, Second Department, November 1, 2016Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's affidavit failed to establish that the claims had not been timely denied or that timely denials were conclusory, vague or without merit.
Renelique v National Liab. & Fire Ins. Co. (2016 NY Slip Op 51615(U)) Appellate Term, Second Department, November 1, 2016Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's affidavit failed to establish that the claim had not been timely denied or that a timely denial was conclusory, vague or without merit, so its prima facie case failed.
Renelique v National Liab. & Fire Ins. Co. (2016 NY Slip Op 51613(U)) Appellate Term, Second Department, November 1, 2016Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed its prima facie burden because its papers did not establish that the claim had not been timely denied or that a timely denial was conclusory, vague or without merit.
Omphil Care, Inc. v Allstate Ins. Co. (2016 NY Slip Op 51602(U)) Appellate Term, Second Department, November 1, 2016Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's affidavit failed to establish that the claim had not been timely denied or that a timely denial was conclusory, vague or without merit.
Daily Med. Equip. Distrib. Ctr., Inc. v MVAIC (2016 NY Slip Op 51622(U)) Appellate Term, Second Department, November 1, 2016Insufficient: claimant did not prove the claim was overdue (not paid or timely denied) (also decides)Held the provider's affidavit failed to show prima facie that the claims had not been timely denied or that timely denials were conclusory, vague or meritless, though summary judgment was granted because the insurer's own papers showed no timely denial.
New Way Acupuncture, P.C. v New York Cent. Mut. Fire Ins. Co. (2016 NY Slip Op 51527(U)) Appellate Term, Second Department, October 13, 2016Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's cross-motion proof failed to establish that the claim had not been timely denied or that a timely denial was conclusory, vague or without merit.
Bob Acupuncture, P.C. v New York Cent. Mut. Fire Ins. Co. (2016 NY Slip Op 51434(U)) Appellate Term, Second Department, September 27, 2016Claimant's proof held to make out its prima facie case (also decides)Held the provider entitled to a CPLR 3212(g) finding that it submitted the claim forms, because the insurer's denials annexed by both sides admitted receipt of those claims.
Raymond Semente, D.C., P.C. v Geico Gen. Ins. Co. (2016 NY Slip Op 51426(U)) Appellate Term, Second Department, September 27, 2016Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's affidavit did not establish that the claim had not been timely denied or that a timely denial was conclusory, vague or without merit, so summary judgment for the provider was reversed.
TAM Med. Supply Corp. v National Liab. & Fire Ins. Co. (2016 NY Slip Op 51423(U)) Appellate Term, Second Department, September 27, 2016Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's affidavit failed to show that the claim had not been timely denied or that a timely denial was conclusory, vague or without merit, so its summary judgment motion was properly denied.
Arguelles, M.D., P.C. v American Tr. Ins. Co. (2016 NY Slip Op 51422(U)) Appellate Term, Second Department, September 27, 2016Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's proof failed to establish that the claims had not been timely denied or that timely denials were conclusory, vague or without merit.
Daily Med. Equip. Distrib. Ctr., Inc. v Allstate Ins. Co. (2016 NY Slip Op 51410(U)) Appellate Term, Second Department, September 27, 2016Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's proof did not show that the insurer failed to deny the claim within 30 days or issued a conclusory, vague or meritless denial, so it did not make its prima facie showing.
Charles Deng Acupuncture, P.C. v Allstate Ins. Co. (2016 NY Slip Op 51405(U)) Appellate Term, Second Department, September 27, 2016Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed its prima facie burden because its affidavit did not show the claim was not timely denied or that a timely denial was conclusory, vague or without merit.
Arguelles, M.D., P.C. v American Tr. Ins. Co. (2016 NY Slip Op 51366(U)) Appellate Term, Second Department, September 19, 2016Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed its prima facie burden on the seventh and eighth causes of action because it did not show those claims were not timely denied or that the denials lacked merit, including not showing its assignor attended the IMEs.
Compas Med., P.C. v American Tr. Ins. Co. (2016 NY Slip Op 51360(U)) Appellate Term, Second Department, September 19, 2016Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's papers failed to establish that the claims had not been timely denied or that timely denials were conclusory, vague or without merit.
Sama Physical Therapy, P.C. v American Tr. Ins. Co. (2016 NY Slip Op 51359(U)) Appellate Term, Second Department, September 19, 2016Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's affidavit failed to show the claims had not been timely denied or that the timely denials were conclusory, vague or without merit, so its summary judgment motion was properly denied.
Renelique v Allstate Ins. Co. (2016 NY Slip Op 51357(U)) Appellate Term, Second Department, September 19, 2016Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's affidavit failed to show that the claim had not been timely denied or that a timely denial was conclusory, vague or without merit, so it did not establish prima facie entitlement.
Compas Med., P.C. v Allstate Ins. Co. (2016 NY Slip Op 51356(U)) Appellate Term, Second Department, September 19, 2016Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's affidavit failed to show that the claim had not been timely denied or that a timely denial was conclusory, vague or without merit, so its motion was properly denied.
Alleviation Med. Servs., P.C. v 21st Century Ins. Co. (2016 NY Slip Op 51347(U)) Appellate Term, Second Department, September 19, 2016Claimant's proof held to make out its prima facie case (also decides)Treated the provider owner's affidavit as demonstrating mailing of the claim form, but denied summary judgment because the insurer's proof of non-receipt raised an issue of fact whether its time to pay or deny began.
TAM Med. Supply Corp. v American Tr. Ins. Co. (2016 NY Slip Op 51318(U)) Appellate Term, Second Department, September 15, 2016Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed its prima facie burden on the second claim because its affidavit did not show the claim had not been timely denied or that a timely denial was conclusory, vague or meritless.
Bay LS Med. Supplies, Inc. v Allstate Ins. Co. (2016 NY Slip Op 51244(U)) Appellate Term, Second Department, August 18, 2016Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's moving papers failed to show that the insurer did not pay or deny within 30 days or issued a conclusory, vague or meritless denial, so summary judgment on the first cause was vacated.
Compas Med., P.C. v Praetorian Ins. Co. (2016 NY Slip Op 51000(U)) Appellate Term, Second Department, June 22, 2016Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed to show the claims were not denied within 30 days or that timely denials were conclusory, vague or without merit, so its summary judgment motion was properly denied.
IMA Acupuncture, P.C. v Allstate Ins. Co. (2016 NY Slip Op 50926(U)) Appellate Term, Second Department, June 6, 2016Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed its prima facie burden because it did not establish that the insurer's defense lacked merit as a matter of law.
New Way Med. Supply Corp. v American Tr. Ins. Co. (2016 NY Slip Op 50917(U)) Appellate Term, Second Department, June 6, 2016Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed its prima facie burden because its papers did not show the insurer failed to deny within 30 days or that a timely denial was conclusory, vague or without merit.
New Beginnings Chiropractic, P.C. v Allstate Ins. Co. (2016 NY Slip Op 50916(U)) Appellate Term, Second Department, June 6, 2016Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed to make its prima facie showing because it did not establish that the insurer's defense lacked merit as a matter of law, so its summary judgment was vacated.
Alleviation Med. Servs., P.C. v Hertz Co. (2016 NY Slip Op 50909(U)) Appellate Term, Second Department, June 6, 2016Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed its prima facie burden because it did not establish that the insurer's defense lacked merit as a matter of law.
MB Advanced Equip., Inc. v New York Cent. Mut. Fire Ins. Co. (2016 NY Slip Op 50863(U)) Appellate Term, Second Department, June 3, 2016Claimant's proof held to make out its prima facie case (also decides)Left intact the finding that the provider established its prima facie case, because the insurer gave no sufficient basis to strike the CPLR 3212 (g) findings in the provider's favor.
Metropolitan Diagnostic Med. Care, P.C. v American Tr. Ins. Co. (2016 NY Slip Op 50699(U)) Appellate Term, Second Department, April 25, 2016Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed its prima facie burden because it did not show the insurer failed to deny the claim within 30 days or that a timely denial was conclusory, vague or without merit.
Beal-Medea Prods., Inc. v Geico Gen. Ins. Co. (2016 NY Slip Op 50594(U)) Appellate Term, Second Department, April 8, 2016Claimant's proof held to make out its prima facie caseHeld a provider need not put an executed assignment of benefits in evidence to make its prima facie case at trial unless the insurer first timely and properly raised an assignment issue, so dismissal was error.
Tam Med. Supply Corp. v 21st Century Ins. Co. (2016 NY Slip Op 50402(U)) Appellate Term, Second Department, March 23, 2016Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed to establish a prima facie case because its papers did not show the claim was not timely denied or that a timely denial was conclusory, vague or without merit.
Alleviation Med. Servs., P.C. v Hertz Co. (2016 NY Slip Op 50399(U)) Appellate Term, Second Department, March 23, 2016Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's affidavit failed to establish that the claim had not been timely denied or that a timely denial was conclusory, vague or without merit.
Alleviation Med. Servs., P.C. v Farmers New Century Ins. Co. (2016 NY Slip Op 50379(U)) Appellate Term, Second Department, March 17, 2016Claimant's proof held to make out its prima facie caseHeld the provider made out its prima facie case on one claim because it showed submission of the claim form and the insurer's own adjuster stated the claim was not denied within 30 days.
Great Health Care Chiropractic, P.C. v Unitrin Direct Ins. Co. (2016 NY Slip Op 50373(U)) Appellate Term, Second Department, March 16, 2016Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's affidavit failed to establish that the claim had not been timely denied or that a timely denial was conclusory, vague or without merit, so its cross motion was properly denied.
Alleviation Med. Servs., P.C. v Hertz Co. (2016 NY Slip Op 50371(U)) Appellate Term, Second Department, March 16, 2016Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed its prima facie burden because, having not shown it appeared for the EUOs, it did not establish that the denial was conclusory, vague or without merit as a matter of law.
EMC Health Prods., Inc. v Allstate Ins. Co. (2016 NY Slip Op 50313(U)) Appellate Term, Second Department, March 11, 2016Claimant's proof held to make out its prima facie caseRejected the insurer's argument that the provider had to prove delivery of the supplies to the assignor and by whom, holding those facts are not part of the provider's prima facie case.
Great Health Care Chiropractic, P.C. v Maya Assur. Co. (2016 NY Slip Op 50308(U)) Appellate Term, Second Department, March 11, 2016Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's affidavit failed to establish that the claim had not been timely denied or that a timely denial was conclusory, vague or without merit.
Compas Med., P.C. v Fiduciary Ins. Co. of Am. (2016 NY Slip Op 26062) Appellate Term, Second Department, February 26, 2016Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed to show that the insurer did not pay or deny within 30 days or issued a conclusory, vague or meritless timely denial, so it did not establish prima facie entitlement.
Careplus Med. Supply, Inc. v Allstate Ins. Co. (2016 NY Slip Op 50196(U)) Appellate Term, Second Department, February 22, 2016Claimant's proof held to make out its prima facie caseHeld the provider made its prima facie showing because it need not establish that its claim forms were admissible as business records under CPLR 4518, rejecting the lower court's contrary ruling.
J.C. Healing Touch Rehab, P.C. v American Tr. Ins. Co. (2016 NY Slip Op 50033(U)) Appellate Term, Second Department, January 8, 2016Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider not entitled to summary judgment because its papers did not show the claims were not paid or denied within 30 days or that timely denials were conclusory, vague or without merit.
Natural Therapy Acupuncture, P.C. v Geico Ins. Co. (2015 NY Slip Op 25425) Appellate Term, Second Department, December 14, 2015Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider's summary judgment motion properly denied because, under the governing New Jersey law, it failed to establish medical necessity in the first instance and failed to show the claims were not paid within 60 days.
New Way Acupuncture, P.C. v New York Cent. Mut. Fire Ins. Co. (2015 NY Slip Op 51706(U)) Appellate Term, Second Department, November 19, 2015Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's cross motion did not show the unpaid portions of the claims were not paid or denied within 30 days, or that timely denials were conclusory, vague or without merit.
Compas Med., P.C. v Farm Family Cas. Ins. Co. (2015 NY Slip Op 51704(U)) Appellate Term, Second Department, November 19, 2015Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed its prima facie burden on two claims because its papers did not show the claims were not paid or denied within 30 days or that timely denials were conclusory, vague or meritless.
Gutierrez v Tri State Consumers Ins. Co. (2015 NY Slip Op 51703(U)) Appellate Term, Second Department, November 19, 2015Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed its prima facie case because it did not show the insurer failed to deny the claim within 30 days or that a timely denial was conclusory, vague or without merit.
Compas Med., P.C. v Praetorian Ins. Co. (2015 NY Slip Op 51679(U)) Appellate Term, Second Department, November 13, 2015Claimant's proof held to make out its prima facie case (also decides)Held the provider established its prima facie case, though summary judgment was defeated by the insurer's no-show defense and, for one claim, by proof of non-receipt.
New Way Med. Supply Corp. v State Farm Mut. Auto. Ins. Co. (2015 NY Slip Op 51678(U)) Appellate Term, Second Department, November 13, 2015Claimant's proof held to make out its prima facie caseHeld the provider entitled to summary judgment on one claim because the insurer conceded receipt and failed to timely deny, seek verification or explain its inaction, the claimed illegibility being unfounded.
Delta Diagnostic Radiology, P.C. v Praetorian Ins. Co. (2015 NY Slip Op 51676(U)) Appellate Term, Second Department, November 13, 2015Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed its prima facie burden because its affidavit did not show the claim was not timely denied or that a timely denial was conclusory, vague or without merit.
Compas Med., P.C. v Farm Family Cas. Ins. Co. (2015 NY Slip Op 51631(U)) Appellate Term, Second Department, November 9, 2015Claimant's proof held to make out its prima facie case (also decides)Treated the provider owner's affidavit as showing the claim forms were mailed, but denied summary judgment on three causes because the insurer's non-receipt proof raised an issue whether its time to pay or deny began.
Alleviation Med. Servs., P.C. v American Tr. Ins. Co. (2015 NY Slip Op 51628(U)) Appellate Term, Second Department, November 9, 2015Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed its prima facie burden because it did not show the claim was not paid or denied within 30 days or that a timely denial was conclusory, vague or without merit, so the burden never shifted.
Bay LS Med. Supplies, Inc. v Allstate Ins. Co. (2015 NY Slip Op 51626(U)) Appellate Term, Second Department, November 9, 2015Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's moving papers failed to show that the insurer did not deny within 30 days or issued a conclusory, vague or meritless denial, so summary judgment on the second cause was vacated.
Village Med. Supply, Inc. v Travco Ins. Co. (2015 NY Slip Op 51599(U)) Appellate Term, Second Department, October 30, 2015Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's cross motion properly denied because it failed to show that it had appeared for either EUO, so it did not show the insurer's no-show denial was without merit.
Gutierrez v Allstate Ins. Co. (2015 NY Slip Op 51596(U)) Appellate Term, Second Department, October 30, 2015Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed its prima facie burden because it did not show the insurer failed to deny the claim within 30 days or that a timely denial was conclusory, vague or without merit.
Alleviation Med. Servs., P.C. v Allstate Ins. Co. (2015 NY Slip Op 51591(U)) Appellate Term, Second Department, October 30, 2015Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed to make its prima facie showing because its affidavit did not establish that the claim had not been timely denied or that a timely denial was conclusory, vague or without merit.
Compas Med., P.C. v Geico Ins. Co. (2015 NY Slip Op 51590(U)) Appellate Term, Second Department, October 30, 2015Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed to establish its prima facie case because its papers did not show the claim was not paid or denied within 30 days or that a timely denial was conclusory, vague or without merit.
Healthy Way Acupuncture, P.C. v Farmington Cas. Co. (2015 NY Slip Op 51595(U)) Appellate Term, Second Department, October 30, 2015Insufficient: claimant did not prove the claim was submitted (mailed to and received by the insurer)Held the provider's cross motion failed because its only support was an unsigned counsel 'affirmation' and, in any event, it did not show the claim was not timely denied or that a timely denial was conclusory or meritless.
Compas Med., P.C. v Fiduciary Ins. Co. of Am. (2015 NY Slip Op 51472(U)) Appellate Term, Second Department, September 17, 2015Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed its prima facie burden because it did not show the insurer failed to deny the claim within 30 days or that a timely denial was conclusory, vague or without merit.
Queens Med. Supply, Inc. v IDS Prop. & Cas. Ins. Co. (2015 NY Slip Op 51272(U)) Appellate Term, Second Department, August 26, 2015Claimant's proof held to make out its prima facie caseRejected the insurer's challenge and held the provider's affidavit established its prima facie case, with the insurer admitting receipt and the claims undisputedly not paid or denied within 30 days.
A.B. Med. Servs., PLLC v Amex Assur. Co. (2015 NY Slip Op 51271(U)) Appellate Term, Second Department, August 26, 2015Claimant's proof held to make out its prima facie caseRejected the insurer's argument that the billing manager's affidavit had to lay a foundation making the annexed documents admissible, holding such proof not required, and affirmed partial summary judgment for the claimants.
GL Acupuncture, P.C. v Geico Ins. Co. (2015 NY Slip Op 51239(U)) Appellate Term, Second Department, August 6, 2015Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's moving papers did not show the insurer failed to deny the claim within 30 days or that a timely denial was conclusory, vague or without merit, so its motion was properly denied.
Right Aid Med. Supply Corp. v Hartford Ins. Co. (2015 NY Slip Op 51236(U)) Appellate Term, Second Department, August 6, 2015Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's cross motion properly denied because it failed to show that its assignor appeared for either EUO, so it did not show the insurer's no-show denial was without merit.
Neptune Med. Care, P.C. v Ameriprise Auto & Home Ins. (2015 NY Slip Op 51220(U)) Appellate Term, Second Department, August 5, 2015Claimant's proof held to make out its prima facie caseHeld the provider's cross motion properly granted because the record showed the insurer received the bills but did not timely deny them, with no toll established.
Delta Diagnostic Radiology, P.C. v Allstate Ins. Co. (2015 NY Slip Op 51216(U)) Appellate Term, Second Department, August 5, 2015Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's moving papers did not show the insurer failed to deny the claim within 30 days or that a timely denial was conclusory, vague or without merit, so its motion was properly denied.
South Nassau Orthopedic Surgery & Sports Medicine, P.C. v Farm Family Cas. Ins. Co. (2015 NY Slip Op 51211(U)) Appellate Term, Second Department, August 5, 2015Claimant's proof held to make out its prima facie caseRejected the insurer's challenge and held the provider's affidavit sufficient to establish its prima facie entitlement to summary judgment for the services at issue.
Starlite Acupuncture, P.C. v Praetorian Ins. Co. (2015 NY Slip Op 51209(U)) Appellate Term, Second Department, August 5, 2015Claimant's proof held to make out its prima facie caseHeld the provider made a prima facie showing that the bills were mailed and not timely denied, which the insurer failed to rebut by addressing the earlier mailing of the originals.
Delta Diagnostic Radiology, P.C. v Auto One Ins. Co. (2015 NY Slip Op 51032(U)) Appellate Term, Second Department, July 7, 2015Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's cross motion properly denied because it failed to show that the claim was not denied within 30 days or that a timely denial was conclusory, vague or without merit.
Metro Health Prods., Inc. v Nationwide Ins. (2015 NY Slip Op 25203) Appellate Term, Second Department, June 16, 2015Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's affidavit failed to show the claims were not timely denied or that timely denials were conclusory, vague or without merit, so its summary judgment motion was properly denied.
Bay Ls Med. Supplies, Inc. v Allstate Ins. Co. (2015 NY Slip Op 50802(U)) Appellate Term, Second Department, May 19, 2015Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed to make a prima facie showing because it did not establish the claim had not been timely denied or that a timely denial was conclusory, vague or without merit.
Gutierrez v Allstate Ins. Co. (2015 NY Slip Op 50799(U)) Appellate Term, Second Department, May 19, 2015Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's unopposed motion properly denied because its papers did not show the claim was not paid or denied within 30 days or that a timely denial was conclusory, vague or without merit.
Compas Med., P.C. v Hartford Ins. Co. (2015 NY Slip Op 50784(U)) Appellate Term, Second Department, May 18, 2015Claimant's proof held to make out its prima facie caseHeld the provider's moving papers established submission of three claims and nonpayment, and the claims were not timely denied, entitling it to summary judgment on those causes of action.
Great Health Care Chiropractic, P.C. v Unitrin Advantage Ins. Co. (2015 NY Slip Op 50782(U)) Appellate Term, Second Department, May 18, 2015Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed its prima facie burden because it did not show the claim was not paid or denied within 30 days or that a timely denial was conclusory, vague or without merit.
Health Needles Acupuncture, P.C. v Allstate Ins. Co. (2015 NY Slip Op 50776(U)) Appellate Term, Second Department, May 18, 2015Claimant's proof held to make out its prima facie case (also decides)Held the provider owner's affidavit showed the claims were mailed and received and not paid or denied within 30 days, but the motion failed because the insurer raised a triable issue.
T & J Chiropractic, P.C. v Geico Ins. Co. (2015 NY Slip Op 50772(U)) Appellate Term, Second Department, May 18, 2015Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held that, although submission and nonpayment within 30 days were found, the provider did not show that the insurer failed to deny the claims or issued a legally insufficient denial.
Delta Diagnostic Radiology, P.C. v Maya Assur. Co. (2015 NY Slip Op 50786(U)) Appellate Term, Second Department, May 18, 2015Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's affidavit failed to establish that the claim had not been timely denied or that a timely denial was conclusory, vague or without merit.
Alleviation Med. Servs., P.C. v Hertz Co. (2015 NY Slip Op 50788(U)) Appellate Term, Second Department, May 18, 2015Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the claimant's moving papers failed to show that the insurer did not pay or deny within 30 days or that a timely denial was conclusory, vague or without merit, so its motion was properly denied.
First Care Chiropractic of NJ, P.C. v Mvaic (2015 NY Slip Op 50677(U)) Appellate Term, Second Department, May 1, 2015Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed to establish that the claim was not timely denied or that a timely denial was conclusory, vague or without merit, so its cross motion was properly denied.
EMC Health Prods., Inc. v Travelers Ins. Co. (2015 NY Slip Op 50475(U)) Appellate Term, Second Department, March 26, 2015Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's affidavit failed to establish that the claim had not been timely denied or that a timely denial was conclusory, vague or without merit, so its motion was properly denied.
New Way Med. Supply Corp. v American Tr. Ins. Co. (2015 NY Slip Op 50422(U)) Appellate Term, Second Department, March 17, 2015Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed its prima facie burden because it did not show the claim was not paid or denied within 30 days or that a timely denial was conclusory, vague or without merit.
Longevity Med. Supply, Inc. v Praetorian Ins. Co. (2015 NY Slip Op 50401(U)) Appellate Term, Second Department, March 17, 2015Claimant's proof held to make out its prima facie caseHeld the provider's owner's affidavit sufficient to establish prima facie entitlement to summary judgment on the first cause of action, and the insurer's mere denial of receipt did not raise a triable issue.
Parkview Med. & Surgical, P.C. v Allstate Ins. Co. (2015 NY Slip Op 50400(U)) Appellate Term, Second Department, March 17, 2015Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the owner's affidavit proved mailing and nonpayment within 30 days but not that the claims were not denied within 30 days or that timely denials were conclusory, vague or without merit.
Alleviation Med. Servs., P.C. v Geico Ins. Co. (2015 NY Slip Op 50396(U)) Appellate Term, Second Department, March 16, 2015Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's unopposed motion properly denied because its papers did not show the claim was not paid or denied within 30 days or that a timely denial was conclusory, vague or without merit.
Compas Med., P.C. v 21st Century Ins. Co. (2015 NY Slip Op 50388(U)) Appellate Term, Second Department, March 16, 2015Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's motion failed because its papers did not show the claims were not paid or denied within 30 days or that timely denials were conclusory, vague or without merit.
Avicenna Med. Arts, PLLC v Unitrin Advantage Ins. Co. (2015 NY Slip Op 50382(U)) Appellate Term, Second Department, March 12, 2015Insufficient: claimant did not prove the claim was overdue (not paid or timely denied) (also decides)Held the provider did not show the claims were not paid or denied within 30 days or that a timely denial was conclusory, vague or without merit, though judgment was affirmed on the insurer's own papers.
Quality Psychological Servs., P.C. v Avis Rent-A-Car Sys., LLC (2015 NY Slip Op 50378(U)) Appellate Term, Second Department, March 12, 2015Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the claimant not entitled to summary judgment because it did not deny receiving a denial, and the EUO no-show denial was not conclusory, vague or without merit merely for omitting the scheduled examination dates.
Healthway Med. Care, P.C. v Travelers Ins. Co. (2014 NY Slip Op 51870(U)) Appellate Term, Second Department, December 22, 2014Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider not entitled to summary judgment because it failed to show either that the insurer did not timely deny the claims or that its denials were conclusory, vague or without merit.
Compas Med., P.C. v GEICO Ins. Co. (2014 NY Slip Op 51857(U)) Appellate Term, Second Department, December 19, 2014Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed to establish its prima facie case on two claims because its affidavit did not show they were not timely denied or that the timely denials were conclusory, vague or without merit.
Health Needles Acupuncture, P.C. v Praetorian Ins. Co. (2014 NY Slip Op 51831(U)) Appellate Term, Second Department, December 17, 2014Claimant's proof held to make out its prima facie caseHeld the owner's affidavit established that the claim form for the first cause of action was mailed to and received by the insurer and not paid or denied within 30 days, and the insurer showed no timely denial or toll.
Compas Med., P.C. v Nationwide Ins. (2014 NY Slip Op 51824(U)) Appellate Term, Second Department, December 17, 2014Claimant's proof held to make out its prima facie case (also decides)Held the provider established its prima facie case, but summary judgment was defeated by the insurer's no-show defense and, for one claim, its proof of non-receipt.
New York Diagnostic Med. Care, P.C. v Geico Gen. Ins. Co. (2014 NY Slip Op 51808(U)) Appellate Term, Second Department, December 17, 2014Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held that although the employee's affidavit established mailing and nonpayment within 30 days, it failed to show the claims were not timely denied or that timely denials were conclusory, vague or without merit.
Optimal Well-Being Chiropractic, P.C. v Chubb Indem. Ins. Co. (2014 NY Slip Op 51807(U)) Appellate Term, Second Department, December 17, 2014Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's motion should have been denied because its moving papers did not establish that the claim was not paid or denied within 30 days or that a timely denial was conclusory, vague or without merit.
Great Health Care Chiropractic, P.C. v Maya Assur. Co. (2014 NY Slip Op 51803(U)) Appellate Term, Second Department, December 17, 2014Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's affidavit failed to establish that the claim had not been timely denied or that a timely denial was conclusory, vague or without merit.
New Way Med. Supply Corp. v MVAIC (2014 NY Slip Op 51805(U)) Appellate Term, Second Department, December 17, 2014Claimant's proof held to make out its prima facie case (also decides)Held the affidavit of the provider's employee sufficient to establish its prima facie entitlement to summary judgment.
Great Health Care Chiropractic, P.C. v Hertz Co. (2014 NY Slip Op 51814(U)) Appellate Term, Second Department, December 17, 2014Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider not entitled to summary judgment because the insurer proved timely mailing of its denial and the provider did not show the denial was conclusory, vague or without merit.
Great Health Care Chiropractic, P.C. v American Tr. Ins. Co. (2014 NY Slip Op 51324(U)) Appellate Term, Second Department, August 20, 2014Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's moving papers failed to show that the insurer did not pay or deny within 30 days or that a timely denial was conclusory, vague or without merit, so its prima facie case failed.
(2014 NY Slip Op 51267(U)) Appellate Term, Second Department, August 8, 2014Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's unopposed motion properly denied because its papers did not establish that the claim was not paid or denied within 30 days or that a timely denial was conclusory, vague or without merit.
Compas Med., P.C. v Geico Ins. Co. (2014 NY Slip Op 51259(U)) Appellate Term, Second Department, August 8, 2014Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed its prima facie burden because its papers did not show the insurer failed to pay or deny within 30 days or that a timely denial was conclusory, vague or without merit.
J.C. Healing Touch Rehab, P.C. v Amica Mut. Ins. Co. (2014 NY Slip Op 50969(U)) Appellate Term, Second Department, June 13, 2014Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held that the billing agent's affidavit proved mailing and nonpayment but not that the claims were not timely denied or that timely denials were conclusory, vague or without merit, so the prima facie burden was unmet.
Promed Durable Equip., Inc. v GEICO Ins. (2014 NY Slip Op 50872(U)) Appellate Term, Second Department, May 22, 2014Claimant's proof held to make out its prima facie case (also decides)Upheld the implicit CPLR 3212(g) findings in the provider's favor, holding the insurer gave no sufficient basis to strike them, with medical necessity left for trial.
EMC Health Prods., Inc. v Geico Ins. Co. (2014 NY Slip Op 50786(U)) Appellate Term, Second Department, April 30, 2014Claimant's proof held to make out its prima facie case (also decides)Upheld CPLR 3212(g) findings for the provider because the insurer's denials admitted receipt of the bills and the provider did not need a CPLR 4518 foundation for them, leaving only medical necessity for trial.
Right Aid Med. Supply Corp. v Allstate Ins. Co. (2014 NY Slip Op 50627(U)) Appellate Term, Second Department, April 7, 2014Claimant's proof held to make out its prima facie case (also decides)Upheld CPLR 3212(g) findings for the provider, rejecting the insurer's claim that submission of the claim forms was not shown because the insurer had admitted receiving each of them.
Amega, Inc. v Allstate Ins. Co. (2014 NY Slip Op 50626(U)) Appellate Term, Second Department, April 7, 2014Claimant's proof held to make out its prima facie case (also decides)Upheld CPLR 3212(g) findings in the provider's favor, limiting trial to the timeliness and propriety of the denials, because the insurer gave no sufficient basis to strike them.
Compas Med., P.C. v MVAIC (2014 NY Slip Op 50465(U)) Appellate Term, Second Department, March 17, 2014Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed its prima facie burden because it did not show MVAIC failed to pay or deny within 30 days or that its timely denials were conclusory, vague or without merit.
LMS Acupuncture, P.C. v Geico Ins. Co. (2014 NY Slip Op 50416(U)) Appellate Term, Second Department, March 11, 2014Claimant's proof held to make out its prima facie case (also decides)Held the provider owner's affidavit sufficient to establish prima facie entitlement, rejecting the insurer's contrary contention, which left one unopposed claim payable.
Ema Acupuncture, P.C. v Geico Ins. Co. (2014 NY Slip Op 50415(U)) Appellate Term, Second Department, March 11, 2014Claimant's proof held to make out its prima facie case (also decides)Held the provider owner's affidavit sufficient to establish prima facie entitlement to summary judgment, rejecting the insurer's contrary contention.
Great Health Care Chiropractic, P.C. v Hanover Ins. Co. (2014 NY Slip Op 50359(U)) Appellate Term, Second Department, February 28, 2014Claimant's proof held to make out its prima facie case (also decides)Held the provider established its prima facie entitlement and the insurer did not show a timely denial, so the insurer was precluded from its garaging-misrepresentation defense.
Bay Med. P.C. v Geico Ins. Co. (2013 NY Slip Op 52084(U)) Appellate Term, Second Department, December 9, 2013Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld that under New Jersey law, which governed the policy, the provider failed to establish medical necessity in the first instance and failed to show the claims were not properly paid within 60 days, so its motion failed.
Queens Arthroscopy & Sports Medicine v Unitrin Direct Ins. Co (2013 NY Slip Op 52021(U)) Appellate Term, Second Department, November 29, 2013Claimant's proof held to make out its prima facie case (also decides)Rejected the insurer's challenge and held the provider established its prima facie case by proof of submission of the claim forms, the fact and amount of the loss, and nonpayment or denial within 30 days.
Avicenna Med. Arts, P.L.L.C. v GEICO Ins. Co. (2013 NY Slip Op 52010(U)) Appellate Term, Second Department, November 26, 2013Claimant's proof held to make out its prima facie case (also decides)Held the provider established submission of the bills and the fact and amount of the loss, leaving the implicit CPLR 3212(g) findings undisturbed, with medical necessity left for trial.
20th Ave Acupuncture, P.C. v MVAIC (2013 NY Slip Op 51741(U)) Appellate Term, Second Department, October 10, 2013Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed its prima facie burden because its affidavit showed neither that the insurer failed to deny the claim nor that the insurer issued a legally insufficient denial.
Shara Acupuncture, P.C. v Allstate Ins. Co. (2013 NY Slip Op 51731(U)) Appellate Term, Second Department, October 8, 2013Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed its prima facie burden on the initial evaluation claim because the insurer showed a timely denial and the provider did not show the denial was conclusory, vague or without merit.
New York Diagnostic Med. Care, P.C. v GEICO Gen. Ins. Co. (2013 NY Slip Op 23360) Appellate Term, Second Department, October 8, 2013Claimant's proof held to make out its prima facie case (also decides)Granted a CPLR 3212 (g) finding that the provider established submission of the claim forms, through denials admitting receipt, and the fact and amount of the loss, through claim forms admissible under CPLR 4518 (a).
Flushing Traditional Acupuncture, P.C. v Geico Ins. Co. (2013 NY Slip Op 51538(U)) Appellate Term, Second Department, September 13, 2013Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider not entitled to summary judgment on the initial-evaluation claim because its affidavit did not show the claim was not timely denied or that a timely denial was conclusory, vague or without merit.
Right Aid Diagnostic Medicine, P.C. v Geico Ins. Co. (2013 NY Slip Op 51458(U)) Appellate Term, Second Department, August 26, 2013Claimant's proof held to make out its prima facie case (also decides)Held the provider established the fact and amount of the loss by showing that its claim form was admissible as a business record under CPLR 4518(a), so the 3212(g) finding stood.
Promed Durable Equip., Inc. v GEICO Ins. (2013 NY Slip Op 51375(U)) Appellate Term, Second Department, August 16, 2013Claimant's proof held to make out its prima facie case (also decides)Rejected the insurer's argument and upheld the CPLR 3212 (g) finding that the provider established submission of the bills and the fact and amount of the loss, leaving medical necessity for trial.
Promed Durable Equip., Inc. v GEICO Ins. (2013 NY Slip Op 51374(U)) Appellate Term, Second Department, August 16, 2013Claimant's proof held to make out its prima facie case (also decides)Rejected the insurer's argument and upheld the CPLR 3212 (g) finding that the provider established submission of the bills and the fact and amount of the loss, leaving medical necessity for trial.
Promed Durable Equip., Inc. v GEICO Ins. (2013 NY Slip Op 51373(U)) Appellate Term, Second Department, August 16, 2013Claimant's proof held to make out its prima facie case (also decides)Rejected the insurer's argument and upheld the CPLR 3212 (g) finding that the provider established submission of the bills and the fact and amount of the loss, leaving medical necessity for trial.
Promed Durable Equip., Inc. v GEICO Ins. (2013 NY Slip Op 51372(U)) Appellate Term, Second Department, August 16, 2013Claimant's proof held to make out its prima facie case (also decides)Rejected the insurer's argument and upheld the CPLR 3212 (g) finding that the provider established submission of the bills and the fact and amount of the loss, leaving medical necessity for trial.
Promed Durable Equip., Inc. v GEICO Ins. (2013 NY Slip Op 51371(U)) Appellate Term, Second Department, August 16, 2013Claimant's proof held to make out its prima facie case (also decides)Rejected the insurer's argument and upheld the CPLR 3212 (g) finding that the provider established submission of the bills and the fact and amount of the loss, leaving medical necessity for trial.
Promed Durable Equip., Inc. v GEICO Ins. (2013 NY Slip Op 23283) Appellate Term, Second Department, August 16, 2013Claimant's proof held to make out its prima facie case (also decides)Rejected the insurer's argument and upheld the CPLR 3212 (g) finding that the provider established submission of the bills and the fact and amount of the loss, leaving medical necessity for trial.
Westchester Med. Ctr. v Allstate Ins. Co. (2013 NY Slip Op 51383(U)) Appellate Term, Second Department, August 8, 2013Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the hospital provider failed to demonstrate its prima facie entitlement to summary judgment, so its motion was properly denied.
Colonia Med., P.C. v New York Cent. Mut. Fire Ins. Co. (2013 NY Slip Op 51266(U)) Appellate Term, Second Department, July 12, 2013Insufficient: claim forms not shown admissible as business records / merits of claim not provedStruck the implicit finding that the provider established its prima facie case because its proof did not lay a CPLR 4518 business-records foundation for the claim forms.
Top Choice Med., P.C. v Republic W. Ins. Co. (2013 NY Slip Op 51108(U)) Appellate Term, Second Department, July 1, 2013Claimant's proof held to make out its prima facie case (also decides)Rejected the insurer's argument on appeal and held the provider established its prima facie entitlement to summary judgment.
Art of Healing Medicine, P.C. v New York Cent. Mut. Fire Ins. Co. (2013 NY Slip Op 50766(U)) Appellate Term, Second Department, May 6, 2013Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed to establish its prima facie case because it did not show the annexed claim form was admissible under CPLR 4518 to prove the fact and amount of the loss.
Compas Med., P.C. v New York Cent. Mut. Fire Ins. Co. (2013 NY Slip Op 50762(U)) Appellate Term, Second Department, May 6, 2013Claimant's proof held to make out its prima facie caseRejected the insurer's arguments that the provider failed to prove mailing of the claims and to lay a CPLR 4518 foundation, holding the provider satisfied both prongs of its prima facie case.
LOF Med. Supply, Inc. v GEICO Gen. Ins. Co. (2013 NY Slip Op 50595(U)) Appellate Term, Second Department, April 15, 2013Claimant's proof held to make out its prima facie caseHeld the provider established its prima facie case: denials admitting receipt proved submission, the claim forms were shown admissible under CPLR 4518 (a), and the precluded medical-necessity defense was without merit as a matter of law.
Jamaica Med. Plaza, P.C. v Interboro Ins. Co. (2013 NY Slip Op 50475(U)) Appellate Term, Second Department, March 29, 2013Claimant's proof held to make out its prima facie case (also decides)Upheld the CPLR 3212 (g) finding that the provider established its prima facie case, holding its billing administrator's affidavit sufficient to make the claim forms admissible as business records under CPLR 4518 (a).
Five Boro Psychological Servs., P.C. v GEICO Gen. Ins. Co. (2013 NY Slip Op 50454(U)) Appellate Term, Second Department, March 20, 2013Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider was not entitled to summary judgment on the Lugaro claim because it failed to show that the insurer's denial was conclusory, vague or without merit as a matter of law.
New York Diagnostic Med. Care, P.C. v GEICO Gen. Ins. Co. (2013 NY Slip Op 50419(U)) Appellate Term, Second Department, March 15, 2013Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider showed nonpayment but failed to show the basis of the denial was conclusory, vague or lacked merit as a matter of law, so it did not establish its prima facie case.
Dayna Physical Therapy, P.C. v Travelers Ins. Co. (2013 NY Slip Op 50322(U)) Appellate Term, Second Department, March 5, 2013Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie burden because its billing supervisor's affidavit, missing several paragraphs, did not establish that the annexed documents proved the fact and amount of the loss under CPLR 4518 (a).
All Boro Psychological Servs., P.C. v Allstate Ins. Co. (2013 NY Slip Op 50307(U)) Appellate Term, Second Department, February 20, 2013Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's affidavit failed to show the claim had not been timely denied or that a timely denial was conclusory, vague or without merit, so its summary judgment motion failed.
Compas Med., P.C. v Farm Family Cas. Ins. Co. (2013 NY Slip Op 50254(U)) Appellate Term, Second Department, February 19, 2013Claimant's proof held to make out its prima facie caseHeld the provider president's affidavit established mailing of the claim forms and laid a CPLR 4518 foundation proving the fact and amount of the loss, making out the prima facie case.
Compas Med., P.C. v Praetorian Ins. Co. (2013 NY Slip Op 50249(U)) Appellate Term, Second Department, February 19, 2013Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed its prima facie burden on two claims because it did not show they were not denied within 30 days or that the denials were conclusory, vague or meritless.
Medical Assoc., P.C. v Clarendon Natl. Ins. Co. (2013 NY Slip Op 50248(U)) Appellate Term, Second Department, February 19, 2013Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's affidavit failed to establish that the claims had not been timely denied or that timely denials were conclusory, vague or without merit, so no CPLR 3212 (g) prima facie finding was warranted.
Bonavera Acupuncture, P.C. v GEICO Indem. Co. (2013 NY Slip Op 50200(U)) Appellate Term, Second Department, February 11, 2013Claimant's proof held to make out its prima facie caseHeld the provider's affidavit was properly sworn and in admissible form despite the notarization objection, and sufficed under CPLR 4518 to establish its prima facie case on the unopposed motion.
A.B. Med., PLLC v GEICO (2013 NY Slip Op 50203(U)) Appellate Term, Second Department, February 11, 2013Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed its prima facie showing because its affidavit did not demonstrate that the insurer's denials were untimely or without merit as a matter of law.
Complete Radiology, P.C. v GEICO Ins. Co. (2013 NY Slip Op 50220(U)) Appellate Term, Second Department, February 8, 2013Claimant's proof held to make out its prima facie caseHeld the provider established the fact and amount of its loss because its claim form was shown admissible under CPLR 4518, rejecting the insurer's challenge to its prima facie case.
Advanced Med. Diagnostics of Queens, P.C. v GEICO Ins. Co. (2013 NY Slip Op 50219(U)) Appellate Term, Second Department, February 1, 2013Insufficient: claim forms not shown admissible as business records / merits of claim not provedApplied New Jersey law under a center-of-gravity analysis, which requires the provider to prove medical necessity in the first instance, and held the provider's summary judgment motion failed because it offered no such proof.
All Boro Psychological Servs., P.C. v Allstate Ins. Co. (2013 NY Slip Op 50069(U)) Appellate Term, Second Department, January 14, 2013Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider showed nonpayment but failed to show the insurer had not denied the claim or had issued a legally insufficient denial, so it did not establish prima facie entitlement.
Quality Psychological Servs., P.C. v New York Cent. Mut. Fire Ins. Co. (2013 NY Slip Op 50063(U)) Appellate Term, Second Department, January 14, 2013Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider showed nonpayment but failed to show that the insurer had not denied the claim or that its denial was legally insufficient, so its cross motion was denied.
Lenox Hill Hosp. v Allstate Ins. Co. (2012 NY Slip Op 52411(U)) Appellate Term, Second Department, December 21, 2012Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the hospital providers failed to demonstrate their prima facie entitlement to summary judgment, so their motion was properly denied.
New York Diagnostic Med. Care, P.C. v GEICO Cas. Ins. Co. (2012 NY Slip Op 52409(U)) Appellate Term, Second Department, December 21, 2012Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the billing manager's affidavit failed to establish that the insurer did not pay or deny within 30 days, or that its timely denials were conclusory, vague or without merit as a matter of law.
Brooklyn Hgts. Physical Therapy, P.C. v New York Cent. Mut. Fire Ins. Co. (2012 NY Slip Op 52398(U)) Appellate Term, Second Department, December 21, 2012Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed to show the claims were untimely denied or that the denials were conclusory, vague or without merit, so its cross motion should have been denied.
Avenue I Med., P.C. v GEICO Indem. Co. (2012 NY Slip Op 52399(U)) Appellate Term, Second Department, December 21, 2012Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie showing because its affidavit did not establish under CPLR 4518 that the annexed documents proved the fact and amount of the loss.
Lenox Hill Hosp. v Tower Ins. Co. of N.Y. (2012 NY Slip Op 52391(U)) Appellate Term, Second Department, December 20, 2012Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the hospital provider failed to demonstrate its prima facie entitlement to summary judgment, so its motion was properly denied.
NYU-Hospital for Joint Diseases v American Tr. Ins. Co. (2012 NY Slip Op 52387(U)) Appellate Term, Second Department, December 20, 2012Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the hospital provider failed to demonstrate its prima facie entitlement to summary judgment, so its motion was properly denied.
NYU Hosp. for Joint Diseases v State Farm Mut. Auto. Ins. Co. (2012 NY Slip Op 22379) Appellate Term, Second Department, December 18, 2012Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the hospital had to prove the fact and amount of loss through claim documents admissible under CPLR 4518 (a), rejecting a lesser standard for hospitals; affidavits of counsel and a third-party biller lacking knowledge of the records' truth were insufficient.
Arco Med. NY, P.C. v Country-Wide Ins. Co. (2012 NY Slip Op 51815(U)) Appellate Term, Second Department, September 13, 2012Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the providers' affidavit failed to establish that the bills had not been timely denied or that the timely denials were conclusory, vague or without merit as a matter of law.
Right Aid Med. Supply Corp. v Geico Ins. Co. (2012 NY Slip Op 51717(U)) Appellate Term, Second Department, August 31, 2012Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed its prima facie burden because the denial it annexed was timely on its face and it did not show the denial was untimely or conclusory, vague or meritless as a matter of law.
Essential Acupuncture Servs., P.C. v NY Cent. Mut. Fire Ins. Co. (2012 NY Slip Op 51623(U)) Appellate Term, Second Department, August 7, 2012Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed its prima facie burden on five of six claims because it did not prove the insurer failed to pay or deny within 30 days or that timely denials were conclusory, vague or meritless.
Perfect Point Acupuncture, P.C. v Auto One Ins. Co. (2012 NY Slip Op 51486(U)) Appellate Term, Second Department, August 6, 2012Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's summary judgment motion properly denied because it did not show the claims were overdue, the insurer having asserted timely denials.
W.H.O. Acupuncture, P.C. v Progressive Preferred Ins. Co. (2012 NY Slip Op 51335(U)) Appellate Term, Second Department, July 12, 2012Insufficient: claim forms not shown admissible as business records / merits of claim not provedNoted the provider likewise failed to establish prima facie entitlement on the fully denied 97811 claims, relying on the business-records line of authority.
Horizon Med., P.C. v Travelers Prop. Cas. Ins. Co. (2012 NY Slip Op 51288(U)) Appellate Term, Second Department, June 28, 2012Insufficient: claimant did not prove the claim was submitted (mailed to and received by the insurer) (also decides)Held that, having been precluded by an enforced discovery stipulation from offering evidence of its claims, the provider could not make out its prima facie case, so the complaint was struck.
BR Clinton Chiropractic, P.C. v New York Cent. Mut. Fire Ins. Co. (2012 NY Slip Op 51270(U)) Appellate Term, Second Department, June 27, 2012Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the billing supervisor's affidavit failed to show the claims were not paid or denied within 30 days or that timely denials were conclusory, vague or without merit, so the provider's motion was denied.
A.M. Med., P.C. v General Assur. Co. (2012 NY Slip Op 51272(U)) Appellate Term, Second Department, June 27, 2012Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie burden because its supporting affidavit did not establish that the annexed claim documents were admissible as business records under CPLR 4518.
BR Clinton Chiropractic, P.C. v New York Cent. Mut. Fire Ins. Co. (2012 NY Slip Op 50880(U)) Appellate Term, Second Department, May 11, 2012Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed its prima facie burden on the remaining claim because it did not show the insurer's denial, annexed to its own cross motion, was untimely mailed or conclusory, vague or without merit.
Top Choice Med., P.C. v Geico Gen. Ins. Co. (2012 NY Slip Op 50778(U)) Appellate Term, Second Department, April 27, 2012Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed to establish its prima facie case because it did not show that the insurer's denials were untimely or without merit as a matter of law.
Jamhil Med., P.C. v Allstate Ins. Co. (2012 NY Slip Op 50775(U)) Appellate Term, Second Department, April 27, 2012Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld 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).
Ortho-Med Surgical Supply, Inc. v American Tr. Ins. Co. (2012 NY Slip Op 22119) Appellate Term, Second Department, April 27, 2012Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld that the insurer's preclusion did not relieve the provider of its burden, and the provider's moving papers failed to establish prima facie entitlement under CPLR 4518 and Insurance Law 5106 (a), so summary judgment was properly denied.
Westchester Med. Ctr. v New York Cent. Mut. Fire Ins. Co. (2012 NY Slip Op 50685(U)) Appellate Term, Second Department, April 10, 2012Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the hospital failed to demonstrate its prima facie entitlement to summary judgment, so its motion was properly denied. The court relied solely on precedent requiring a business-records foundation for the claim forms.
New York Diagnostic Med. Care, P.C. v Geico Cas. Ins. Co. (2012 NY Slip Op 50681(U)) Appellate Term, Second Department, April 10, 2012Claimant's proof held to make out its prima facie caseHeld the billing manager's affidavit established the claim forms' admissibility, their mailing within 45 days, and that the late-submission denials lacked merit, so the provider made its prima facie case.
Five Boro Psychological Servs., P.C. v MVAIC (2012 NY Slip Op 50677(U)) Appellate Term, Second Department, April 10, 2012Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider's billing and collection supervisor's affidavit insufficient to establish its prima facie case under the CPLR 4518 business-records rule.
Westchester Med. Ctr. v Progressive Cas. Ins. Co. (2012 NY Slip Op 50590(U)) Appellate Term, Second Department, April 2, 2012Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the hospital providers failed to demonstrate their prima facie entitlement to summary judgment, so their motion was properly denied.
Westchester Med. Ctr. v Travelers Prop. Cas. Ins. Co. (2012 NY Slip Op 50589(U)) Appellate Term, Second Department, April 2, 2012Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the hospital provider failed to demonstrate its prima facie entitlement to summary judgment, so its motion was properly denied.
Complete Radiology, P.C. v Progressive Ins. Co. (2012 NY Slip Op 50583(U)) Appellate Term, Second Department, April 2, 2012Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed its prima facie burden because its affidavit did not state unequivocally that the insurer's denials were untimely or without merit as a matter of law.
Flatlands Med., P.C. v Allstate Ins. Co. (2012 NY Slip Op 50582(U)) Appellate Term, Second Department, April 2, 2012Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's summary judgment motion properly denied because, although nonpayment was shown, the provider did not show the claims were not denied within 30 days or that the denials were conclusory, vague or meritless.
Vincent Med. Servs., P.C. v Clarendon Natl. Ins. Co. (2012 NY Slip Op 50431(U)) Appellate Term, Second Department, March 6, 2012Claimant's proof held to make out its prima facie caseHeld the provider established its prima facie case on the two $309.42 claim forms, and judgment on them was affirmed because the insurer did not address them.
Quality Psychological Servs., P.C. v MVAIC (2012 NY Slip Op 50404(U)) Appellate Term, Second Department, March 5, 2012Insufficient: claimant did not prove the claim was submitted (mailed to and received by the insurer)Held the claimant's cross-motion failed because, against the insurer's showing of non-receipt, the claimant did not establish that it had submitted the claim form to the insurer.
Westchester Med. Ctr. v Government Empls. Ins. Co. (2012 NY Slip Op 50398(U)) Appellate Term, Second Department, March 2, 2012Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the hospital failed its prima facie burden because a third-party biller's affidavit did not show the NF-5 and incorporated UB-04 were the hospital's business records admissible under CPLR 4518 as proof the services were rendered.
Superior Oxygen & Ortho Supplies, Ltd. v Auto One Ins. Co. (2012 NY Slip Op 50348(U)) Appellate Term, Second Department, February 21, 2012Claimant's proof held to make out its prima facie case (also decides)Held the provider established its prima facie case by proof of submission of the claim forms and that the insurer did not pay or deny within 30 days, shifting the burden to the insurer.
Raz Acupuncture, P.C. v Praetorian Ins. Co. (2012 NY Slip Op 50305(U)) Appellate Term, Second Department, February 14, 2012Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the third-party biller's president's affidavit failed to show the annexed documents were admissible under CPLR 4518 (a), so the provider did not establish its prima facie case and the CPLR 3212 (g) finding was struck.
Second Med., P.C. v GEICO (2012 NY Slip Op 50236(U)) Appellate Term, Second Department, February 9, 2012Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed to prove the fact and amount of the loss because its third-party biller's affidavit did not show incorporation of and reliance on the provider's records, and the owner's documents did not reflect the billed procedures.
Jae Ook Park v GEICO Gen. Ins. Co. (2011 NY Slip Op 52379(U)) Appellate Term, Second Department, December 23, 2011Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed its prima facie case because it did not establish that the bill was not timely denied or that the denial was conclusory, vague or without merit as a matter of law.
Bath Med. Supply, Inc. v Auto One Ins. Co. (2011 NY Slip Op 52376(U)) Appellate Term, Second Department, December 23, 2011Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider proved non-payment but failed to show the claims were not denied within 30 days or that the denials were conclusory, vague or meritless, so it made no prima facie case.
Friendly Physician, P.C. v GEICO Ins. Co. (2011 NY Slip Op 52359(U)) Appellate Term, Second Department, December 21, 2011Claimant's proof held to make out its prima facie case (also decides)Held, rejecting the insurer's only challenges, that the provider showed the bills were submitted and set forth the fact and amount of the loss.
Comfort Supply, Inc. v GEICO Gen. Ins. Co. (2011 NY Slip Op 52358(U)) Appellate Term, Second Department, December 21, 2011Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the supplier's motion properly denied because its affiant described two alternative delivery practices without saying which was used, so the affidavit did not establish the supplies were delivered to the assignor.
Richmond Univ. Med. Ctr. v New York Cent. Mut. Fire Ins. Co. (2011 NY Slip Op 52303(U)) Appellate Term, Second Department, December 19, 2011Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the hospital's summary judgment motion should have been denied because a third-party affidavit did not show the UB-04 incorporated into the NF-5 was the hospital's business record admissible to prove the services were rendered.
Alrof, Inc. v Country Wide Ins. Co. (2011 NY Slip Op 52297(U)) Appellate Term, Second Department, December 19, 2011Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider proved nonpayment but did not show that the insurer's denial of one claim was conclusory, vague or without merit, so it did not establish its prima facie case for that claim.
Colonia Med., P.C. v Liberty Mut. Fire Ins. Co. (2011 NY Slip Op 52283(U)) Appellate Term, Second Department, December 16, 2011Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld that although the insurer was precluded from offering evidence, the provider was not entitled to summary judgment because its moving papers failed to establish prima facie entitlement under CPLR 4518 and Insurance Law 5106 (a).
Allstate Social Work & Psychological Svcs, PLLC v NY City Tr. Auth. (2011 NY Slip Op 52278(U)) Appellate Term, Second Department, December 16, 2011Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the claimant's affidavit failed to show that the bills were not timely denied or that a timely denial was conclusory, vague or without merit, so no prima facie entitlement to summary judgment was shown.
City Dental Servs., P.C. v New York Cent. Mut. (2011 NY Slip Op 52285(U)) Appellate Term, Second Department, December 16, 2011Insufficient: claim forms not shown admissible as business records / merits of claim not provedVacated the implicit CPLR 3212 (g) finding that the provider established every element of its case, because its submissions failed to establish proof of the fact and the amount of the loss sustained.
Megacure Acupuncture, P.C. v Clarendon Natl. Ins. Co. (2011 NY Slip Op 52199(U)) Appellate Term, Second Department, November 30, 2011Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider was not entitled to summary judgment because it failed to establish that the denial was untimely or conclusory, vague or otherwise defective.
Raz Acupuncture, P.C. v GEICO Gen. Ins. Co. (2011 NY Slip Op 52064(U)) Appellate Term, Second Department, November 4, 2011Insufficient: claim forms not shown admissible as business records / merits of claim not provedReversed 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.
Top Choice Med., P.C. v GEICO Gen. Ins. Co. (2011 NY Slip Op 52063(U)) Appellate Term, Second Department, November 4, 2011Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider established its case on four claims but failed on four others because it did not show they were unpaid and undenied within 30 days or that the denials were legally insufficient.
New York Hosp. Med. Ctr. of Queens v Statewide Ins. Co. (2011 NY Slip Op 51863(U)) Appellate Term, Second Department, October 14, 2011Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the hospital failed its prima facie burden because a third-party affidavit did not show the NF-5 and incorporated UB04 were its business records admissible under CPLR 4518 to prove the services were rendered.
PMR Physical Therapy v GEICO Gen. Ins. Co. (2011 NY Slip Op 51852(U)) Appellate Term, Second Department, October 12, 2011Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider's unopposed motion properly denied because the third-party biller lacked personal knowledge of the provider's practices to make the annexed documents admissible under CPLR 4518.
Points of Health Acupuncture, P.C. v GEICO Ins. Co. (2011 NY Slip Op 51843(U)) Appellate Term, Second Department, October 11, 2011Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's motion should have been denied because it admitted the insurer issued timely partial payments and denials and failed to show those denials were conclusory, vague or without merit.
Z.A. Acupuncture, P.C. v Geico Ins. Co. (2011 NY Slip Op 51842(U)) Appellate Term, Second Department, October 11, 2011Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's motion should have been denied because it admitted the insurer issued timely partial payments and denials and failed to show those denials were conclusory, vague or without merit.
Lynbrook Med., P.C. v GEICO Gen. Ins. Co. (2011 NY Slip Op 51841(U)) Appellate Term, Second Department, October 11, 2011Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the providers failed to make a prima facie showing because, once the insurer showed timely mailed denials, they did not show the denials' grounds were conclusory, vague or without merit as a matter of law.
Complete Med. Servs. of NY, P.C. v MVAIC (2011 NY Slip Op 51835(U)) Appellate Term, Second Department, October 11, 2011Claimant's proof held to make out its prima facie caseRejected the argument that the provider's prima facie case failed for lack of residency proof and held it established mailing, nonpayment, no timely denial and the claim form's CPLR 4518 admissibility.
Turnpike Med., P.C. v MVAIC (2011 NY Slip Op 51717(U)) Appellate Term, Second Department, September 16, 2011Claimant's proof held to make out its prima facie caseHeld the provider established its prima facie entitlement against MVAIC without first proving the assignor's qualified status or absence of other insurance.
South Nassau Orthopedic Surgery and Sports Medicine, P.C. v Auto One Ins. Co. (2011 NY Slip Op 51300(U)) Appellate Term, Second Department, July 7, 2011Claimant's proof held to make out its prima facie case (also decides)Rejected the insurer's challenge, holding the doctor's affidavit made the annexed documents admissible under CPLR 4518 and, with the insurer's concession of receipt and proof of nonpayment within 30 days, established the prima facie case.
Ave T MPC Corp. v Auto One Ins. Co. (2011 NY Slip Op 51292(U)) Leading case Appellate Term, Second Department, July 5, 2011Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed its prima facie burden because it proved only nonpayment and did not show that the insurer failed to deny the claim or issued a legally insufficient denial.
Lifex Med. Care, P.C. v Safeco Natl. Ins. Co. (2011 NY Slip Op 51221(U)) Appellate Term, Second Department, June 28, 2011Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held that proof of nonpayment was not enough: the provider failed to show the grounds of the insurer's denials of five claims were conclusory, vague or meritless, and timely mailed denials defeated two others.
Jesa Med. Supply, Inc. v Republic W. Ins. Co. (2011 NY Slip Op 51127(U)) Appellate Term, Second Department, June 15, 2011Claimant's proof held to make out its prima facie case (also decides)Rejected the insurer's challenge and held the billing manager's affidavit laid a CPLR 4518 foundation, showed she personally mailed the claim, and showed no denial within 30 days, establishing the provider's prima facie case.
LDE Med. Servs., P.C. v Encompass Ins. (2011 NY Slip Op 50979(U)) Appellate Term, Second Department, May 24, 2011Claimant's proof held to make out its prima facie case (also decides)Rejected the insurer's challenge and held the billing administrator's affidavit sufficient to make the annexed claim documents admissible under CPLR 4518, though summary judgment was vacated on the EUO no-show defense.
Yklik, Inc. v GEICO Ins. Co. (2011 NY Slip Op 50868(U)) Appellate Term, Second Department, May 12, 2011Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed to establish its prima facie case because it did not demonstrate that the insurer had failed to pay or deny the claim within the 30-day period.
Quality Health Prods. v Country-Wide Ins. Co. (2011 NY Slip Op 50328(U)) Appellate Term, Second Department, March 3, 2011Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed its prima facie showing because the annexed portion of the insurer's denial form omitted its date and stated reason and the affiant gave no receipt date, so it did not show the claim went undenied for 30 days.
ARCO Med. NY, P.C. v New York Cent. Mut. Fire Ins. Co. (2011 NY Slip Op 50184(U)) Appellate Term, Second Department, February 14, 2011Insufficient: claimant did not prove the claim was submitted (mailed to and received by the insurer)Held the providers made no prima facie case because their billing supervisor's affidavit concerned the claims in another action, not the claims at issue.
Viviane Etienne Med. Care, P.C. v Country-Wide Ins. Co. (2011 NY Slip Op 21039) Appellate Term, Second Department, February 8, 2011Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie case because its third-party biller's owner lacked knowledge of the provider's record-keeping and did not show incorporation and reliance, so the claim forms were not admissible business records.
Jamaica Med. Supply, Inc. v Kemper Cas. Ins. Co. (2011 NY Slip Op 50315(U)) Appellate Term, Second Department, January 28, 2011Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the supplier's motion papers failed to make out a prima facie case because neither the billing records nor the owner's affidavit showed the supplies had actually been delivered to the assignor.
Fortune Med., P.C. v Country Wide Ins. Co. (2010 NY Slip Op 52154(U)) Appellate Term, Second Department, December 10, 2010Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed to make a prima facie showing because its officer's affidavit did not establish that the annexed documents were admissible under CPLR 4518 (a).
Vincent Med. Servs., P.C. v GEICO Ins. Co. (2010 NY Slip Op 52153(U)) Appellate Term, Second Department, December 8, 2010Claimant's proof held to make out its prima facie case (also decides)Held the provider made its prima facie showing because its billing manager's affidavit made the annexed documents admissible under CPLR 4518 and the insurer's claims representative conceded receipt of the claim forms.
Quality Med. Healthcare of NY, P.C. v NY Cent. Mut. Fire Ins. Co. (2010 NY Slip Op 20493) Appellate Term, Second Department, December 3, 2010Insufficient: claimant did not prove the claim was submitted (mailed to and received by the insurer) (also decides)Held the record did not show as incontrovertible that the provider submitted proof of claim and went unpaid for 30 days, so its prima facie elements could not be deemed established under CPLR 3212 (g).
Axis Chiropractic, PLLC v Geico Gen. Ins. Co. (2010 NY Slip Op 51963(U)) Appellate Term, Second Department, November 12, 2010Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie case because the billing company president did not show personal knowledge of the provider's practices to make the supporting documents admissible under CPLR 4518.
Olga Bard Acupuncture, P.C. v Geico Ins. Co. (2010 NY Slip Op 51898(U)) Appellate Term, Second Department, November 8, 2010Claimant's proof held to make out its prima facie case (also decides)Held the provider established its prima facie entitlement to summary judgment, shifting the burden to the insurer, though the outcome rested on the insurer's fee schedule and medical necessity defenses.
Park Slope Med. & Surgical Supply, Inc. v GEICO Ins. Co. (2010 NY Slip Op 51771(U)) Appellate Term, Second Department, October 5, 2010Claimant's proof held to make out its prima facie case (also decides)Rejected the insurer's challenge and held the billing manager's affidavit sufficient to make the provider's annexed documents admissible under CPLR 4518; the motion still failed on medical necessity.
Friendly Physician, P.C. v GEICO Ins. Co. (2010 NY Slip Op 51770(U)) Appellate Term, Second Department, October 5, 2010Claimant's proof held to make out its prima facie caseRejected the insurer's appellate challenge and held the billing administrator's affidavit sufficient to make the annexed claim documents admissible under CPLR 4518, supporting the provider's prima facie case.
Manhattan Med. Imaging, P.C. v GEICO Ins. Co. (2010 NY Slip Op 51737(U)) Appellate Term, Second Department, October 1, 2010Claimant's proof held to make out its prima facie case (also decides)Rejected the insurer's challenge and held the billing manager's affidavit sufficient to make the provider's documents admissible under CPLR 4518, shifting the burden to the insurer.
Irina Kazanskaya, Ac v GEICO Ins. Co. (2010 NY Slip Op 51735(U)) Appellate Term, Second Department, October 1, 2010Claimant's proof held to make out its prima facie case (also decides)Rejected the insurer's argument that the billing manager's affidavit could not establish the claim documents as business records under CPLR 4518, but the result rested on the insurer's timely denial and full fee schedule payment.
MIA Acupuncture, P.C. v GEICO Ins. Co. (2010 NY Slip Op 51731(U)) Appellate Term, Second Department, October 1, 2010Claimant's proof held to make out its prima facie case (also decides)Held the provider established its prima facie entitlement to summary judgment, shifting the burden to the insurer, but its motion was denied on the insurer's defenses.
PMR Physical Therapy v Country-Wide Ins. Co. (2010 NY Slip Op 51729(U)) Appellate Term, Second Department, October 1, 2010Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the unopposed motion failed because the billing company president did not show personal knowledge of the provider's practices to make the annexed documents admissible under CPLR 4518.
Neomy Med., P.C. v Auto One Ins. Co. (2010 NY Slip Op 51727(U)) Appellate Term, Second Department, October 1, 2010Claimant's proof held to make out its prima facie case (also decides)Rejected the insurer's contention and held the billing supervisor's affidavit sufficient to make the provider's documents admissible under CPLR 4518; no other prima facie issue was passed on.
Axis Chiropractic, PLLC v GEICO Gen. Ins. Co. (2010 NY Slip Op 51339(U)) Appellate Term, Second Department, July 22, 2010Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie showing because the billing company president did not demonstrate personal knowledge of the provider's practices to render the documents admissible under CPLR 4518.
Alfa Med. Supplies, Inc. v GEICO Gen. Ins. Co. (2010 NY Slip Op 51332(U)) Appellate Term, Second Department, July 22, 2010Claimant's proof held to make out its prima facie case (also decides)Held the provider made its prima facie case because its employee's affidavit laid a CPLR 4518 foundation for the annexed documents and showed submission of the claim forms and overdue payment.
D & R Med. Supply, Inc. v Safeco Ins. Co. (2010 NY Slip Op 51179(U)) Appellate Term, Second Department, July 7, 2010Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld summary judgment improperly granted because the billing manager's affidavit did not establish that the annexed documents were admissible under CPLR 4518.
Raz Acupuncture, P.C. v AIG Indem. Ins. Co. (2010 NY Slip Op 51177(U)) Appellate Term, Second Department, July 7, 2010Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie case because it submitted no claim forms, and the insurer's submission of them did not lay a CPLR 4518 foundation since acknowledging receipt does not concede their admissibility.
Alur Med. Supply, Inc. v GEICO Ins. Co. (2010 NY Slip Op 51053(U)) Appellate Term, Second Department, June 11, 2010Insufficient: claimant did not prove the claim was submitted (mailed to and received by the insurer)Held the provider failed to establish its prima facie case because its billing manager's affidavit conflicted with the annexed certificate of mailing showing the claim form was mailed to a different insurer.
We Care Med., P.C. v GEICO Ins. Co. (2010 NY Slip Op 50831(U)) Appellate Term, Second Department, May 10, 2010Claimant's proof held to make out its prima facie caseRejected the insurer's only challenge, holding the billing manager's affidavit sufficient to make the annexed claim documents admissible under CPLR 4518, so the provider's prima facie case stood.
D.S. Chiropractic, P.C. v Country-Wide Ins. Co. (2010 NY Slip Op 50649(U)) Appellate Term, Second Department, April 9, 2010Claimant's proof held to make out its prima facie case (also decides)Held the billing manager's affidavit made the annexed documents admissible under CPLR 4518 and rejected the insurer's claim that submission was unproven, so the provider made its prima facie showing.
First Aid Occupational Therapy, PLLC v Country-Wide Ins. Co. (2010 NY Slip Op 50594(U)) Appellate Term, Second Department, April 2, 2010Claimant's proof held to make out its prima facie case (also decides)Held the provider made its prima facie showing because the insurer's claims representative conceded receipt of the claims and the billing manager's affidavit made the annexed documents admissible under CPLR 4518.
563 Grand Med., P.C. v Kemper Auto & Home Ins. Co. (2010 NY Slip Op 50582(U)) Appellate Term, Second Department, March 31, 2010Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie case because the billing company employee's affidavit did not show personal knowledge of the provider's practices to lay a business-records foundation for the annexed documents.
St. Vincent Med. Care, P.C. v Country Wide Ins. Co. (2010 NY Slip Op 50488(U)) Appellate Term, Second Department, March 19, 2010Claimant's proof held to make out its prima facie case (also decides)Rejected the insurer's challenge to the provider's prima facie case, holding the billing manager's affidavit sufficient to make the annexed documents admissible under CPLR 4518 and to establish mailing of the bills.
Right Aid Diagnostic Medicine, P.C. v Geico Ins. Co. (2010 NY Slip Op 50445(U)) Appellate Term, Second Department, March 10, 2010Claimant's proof held to make out its prima facie case (also decides)Held the provider established its prima facie case because the insurer's claims representative conceded receipt of the claim and the billing manager's affidavit made the annexed documents admissible under CPLR 4518.
St. Vincent Med. Care, P.C. v Country-Wide Ins. Co. (2010 NY Slip Op 50444(U)) Appellate Term, Second Department, March 10, 2010Claimant's proof held to make out its prima facie case (also decides)Held the provider made its prima facie showing because the insurer's claims representative conceded receipt of the claims and the billing manager's affidavit made the annexed documents admissible under CPLR 4518.
Bath Med. Supply, Inc. v Allstate Indem. Co. (2010 NY Slip Op 20059) Appellate Term, Second Department, February 19, 2010Claimant's proof held to make out its prima facie caseHeld the provider made its prima facie case, rejecting the insurer's contrary contention, because it proved submission of the claim forms and overdue payment and its affidavit made the annexed forms admissible business records.
A.B. Med. Servs., PLLC v Geico Cas. Ins. Co. (2010 NY Slip Op 50224(U)) Appellate Term, Second Department, February 5, 2010Insufficient: claim forms not shown admissible as business records / merits of claim not provedUpheld denial of a CPLR 3212 (g) order deeming the prima facie case established because the billing manager's affidavit did not establish the annexed documents were admissible under CPLR 4518.
First Aid Occupational Therapy, PLLC v Country-Wide Ins. Co. (2010 NY Slip Op 50149(U)) Appellate Term, Second Department, January 29, 2010Claimant's proof held to make out its prima facie case (also decides)Rejected the insurer's challenge, holding the billing manager's affidavit laid a CPLR 4518 foundation for the claim documents and the insurer's own claims representative conceded receipt of the claims.
Innovative Chiropractic, P.C. v Progressive Ins. Co. (2010 NY Slip Op 50148(U)) Appellate Term, Second Department, January 29, 2010Claimant's proof held to make out its prima facie case (also decides)Rejected the insurer's challenge, holding the billing manager's affidavit complied with CPLR 4518, she personally mailed the claim form, and the insurer conceded receipt.
WJJ Acupuncture, P.C. v Liberty Mut. Fire Ins. Co. (2010 NY Slip Op 50146(U)) Appellate Term, Second Department, January 29, 2010Insufficient: claimant did not prove the claim was submitted (mailed to and received by the insurer)Held the provider failed its prima facie case because its owner's affidavit was unsigned and thus not admissible evidence, and counsel's affirmation alone could not establish the claim.
Canarsie Family Med. Practice, PLLC v American Tr. Ins. Co. (2010 NY Slip Op 50070(U)) Appellate Term, Second Department, January 12, 2010Claimant's proof held to make out its prima facie caseHeld the provider made out its prima facie case because its billing manager stated he personally mailed the claims and his affidavit made the annexed claim forms admissible as business records.
Amercure Acupuncture, P.C. v GEICO Ins. Co. (2010 NY Slip Op 50068(U)) Appellate Term, Second Department, January 12, 2010Claimant's proof held to make out its prima facie case (also decides)Rejected the insurer's sole challenge, holding the billing manager's affidavit sufficient to make the claim documents admissible under CPLR 4518, but the result rested on the insurer's timely denial and full fee schedule payment.
Quality Rehab & P.T., P.C. v GEICO Ins. Co. (2010 NY Slip Op 50067(U)) Appellate Term, Second Department, January 12, 2010Claimant's proof held to make out its prima facie case (also decides)Rejected the insurer's argument that the billing manager's affidavit failed to make the annexed claim documents admissible as business records, but the result rested on outstanding verification.
Metropolitan Med. Supplies, LLC v GEICO Ins. Co. (2010 NY Slip Op 50066(U)) Appellate Term, Second Department, January 12, 2010Claimant's proof held to make out its prima facie case (also decides)Rejected the insurer's sole challenge to the provider's prima facie case, holding the billing manager's affidavit sufficient to make the annexed documents admissible under CPLR 4518.
Raz Acupuncture, P.C. v Travelers Prop. Cas. Ins. Co. (2010 NY Slip Op 50065(U)) Appellate Term, Second Department, January 12, 2010Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed to make a prima facie showing because the billing company employee did not show personal knowledge of the provider's practices to make the annexed documents admissible under CPLR 4518.
Right Aid Diagnostic Medicine, P.C. v GEICO Ins. Co. (2009 NY Slip Op 52635(U)) Appellate Term, Second Department, December 23, 2009Claimant's proof held to make out its prima facie case (also decides)Rejected the insurer's only challenge, holding the billing manager's affidavit sufficient to make the annexed documents admissible under CPLR 4518.
Staten Is. Advanced Surgical Supply v GEICO Ins. Co. (2009 NY Slip Op 52633(U)) Appellate Term, Second Department, December 23, 2009Claimant's proof held to make out its prima facie case (also decides)Held the provider established its prima facie case because the insurer's claims representative conceded receipt and the billing manager's affidavit made the annexed documents admissible under CPLR 4518.
Quality Rehab & P.T., P.C. v GEICO Ins. Co. (2009 NY Slip Op 52632(U)) Appellate Term, Second Department, December 23, 2009Claimant's proof held to make out its prima facie case (also decides)Rejected the insurer's only challenge, holding the billing manager's affidavit sufficient to make the annexed documents admissible under CPLR 4518.
Crotona Hgts. Med., P.C. v GEICO Ins. Co. (2009 NY Slip Op 52466(U)) Appellate Term, Second Department, December 7, 2009Claimant's proof held to make out its prima facie caseRejected the insurer's challenges, holding the billing manager's affidavit complied with CPLR 4518 and the claim that submission was not proved lacked merit.
Points of Health Acupuncture, P.C. v GEICO Ins. Co. (2009 NY Slip Op 52445(U)) Appellate Term, Second Department, December 1, 2009Claimant's proof held to make out its prima facie caseRejected the insurer's challenge, holding the billing supervisor's affidavit established that the documents annexed to the motion were admissible under CPLR 4518.
Excel Radiology Servs., P.C. v Clarendon Natl. Ins. Co. (2009 NY Slip Op 52444(U)) Appellate Term, Second Department, December 1, 2009Claimant's proof held to make out its prima facie caseHeld the affirmations of the provider's president were sufficient under CPLR 4518 to support its prima facie case, rejecting the insurer's challenge.
New Wave Oriental Acupuncture, P.C. v Government Employees Ins. Co. (2009 NY Slip Op 52211(U)) Appellate Term, Second Department, October 23, 2009Claimant's proof held to make out its prima facie case (also decides)Held the provider established its prima facie entitlement to summary judgment, but its motion was denied because the insurer raised a triable issue.
Right Aid Diagnostic Medicine, P.C. v Geico Ins. Co. (2009 NY Slip Op 52122(U)) Appellate Term, Second Department, October 13, 2009Claimant's proof held to make out its prima facie case (also decides)Rejected the insurer's argument that the billing manager's affidavit failed to make the annexed documents admissible as business records, holding it complied with CPLR 4518 and shifted the burden.
Med-Tech Prods., Inc. v Geico Ins. Co. (2009 NY Slip Op 52111(U)) Appellate Term, Second Department, October 13, 2009Claimant's proof held to make out its prima facie case (also decides)Held the provider made its prima facie case because its president's affidavits laid a CPLR 4518 foundation and the insurer's denials acknowledging receipt cured any gap in proof of mailing.
A.B. Med. Servs., PLLC v American Tr. Ins. Co. (2009 NY Slip Op 52067(U)) Appellate Term, Second Department, October 6, 2009Insufficient: claim forms not shown admissible as business records / merits of claim not proved (also decides)Held, as an alternative ground, that the providers failed their prima facie case because the billing manager's affidavit did not establish the annexed documents were admissible business records under CPLR 4518.
Great Wall Acupuncture, P.C. v GEICO Ins. Co. (2009 NY Slip Op 52308(U)) Appellate Term, Second Department, August 31, 2009Claimant's proof held to make out its prima facie case (also decides)Rejected the insurer's argument and held the billing manager's affidavit sufficient to make the annexed claim documents admissible under CPLR 4518.
Psychology YM, P.C. v Nationwide Mut. Ins. Co. (2009 NY Slip Op 51634(U)) Appellate Term, Second Department, July 24, 2009Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed to make a prima facie showing because its motion rested on an affidavit of a third-party billing company employee that did not satisfy CPLR 4518.
Andromeda Med. Care, P.C. v Utica Mut. Ins. Co. (2009 NY Slip Op 51629(U)) Appellate Term, Second Department, July 24, 2009Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider's cross motion was properly denied because it failed to establish that its billing records were admissible under CPLR 4518.
D.S. Chiropractic, P.C. v Country-Wide Ins. Co. (2009 NY Slip Op 51584(U)) Appellate Term, Second Department, July 14, 2009Claimant's proof held to make out its prima facie caseHeld the billing manager's affidavit laid a sufficient CPLR 4518 foundation for the claim documents, and any gap in proof of mailing was cured by the insurer's claims representative conceding receipt.
D.S. Chiropractic, P.C. v Country-Wide Ins. Co. (2009 NY Slip Op 51579(U)) Appellate Term, Second Department, July 14, 2009Claimant's proof held to make out its prima facie case (also decides)Rejected the insurer's challenge because the billing manager's affidavit made the claim documents admissible as business records and the insurer's conceded receipt cured any defect in proof of mailing.
Crossbay Acupuncture, P.C. v Nationwide Mut. Ins. Co. (2009 NY Slip Op 51496(U)) Appellate Term, Second Department, July 9, 2009Claimant's proof held to make out its prima facie caseHeld the provider's unopposed motion established its prima facie entitlement to summary judgment, so the motion should have been granted.
AKS Med., P.C. v Progressive Ins. Co. (2009 NY Slip Op 51494(U)) Appellate Term, Second Department, July 9, 2009Insufficient: claimant did not prove the claim was submitted (mailed to and received by the insurer)Held the provider failed to establish its prima facie case on one claim because contradictions between its billing manager's affidavit and the annexed post office ledger left submission of the claim unproven.
Craigg Total Health Family Chiropractic Care, P.C. v QBE Ins. Corp. (2009 NY Slip Op 51400(U)) Appellate Term, Second Department, June 29, 2009Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the providers failed to make a prima facie showing because their billing manager's affidavit did not establish that the annexed documents were admissible under CPLR 4518.
Careplus Med. Supply, Inc. v Allstate Ins. Co. (2009 NY Slip Op 51398(U)) Appellate Term, Second Department, June 29, 2009Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed to make a prima facie showing because its billing manager's affidavit did not establish that the annexed documents were admissible as business records under CPLR 4518.
Inwood Hill Med., P.C. v Progressive Cas. Ins. Co. (2009 NY Slip Op 51397(U)) Appellate Term, Second Department, June 29, 2009Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the providers failed to make a prima facie showing because the biller's affidavit did not establish that the annexed documents were admissible under CPLR 4518.
Fiveborough Chiropractic & Acupuncture, PLLC v American Employers' Ins. Co. Div. of Onebeacon Am. Ins. Co. (2009 NY Slip Op 51395(U)) Appellate Term, Second Department, June 29, 2009Insufficient: claimant did not prove the claim was submitted (mailed to and received by the insurer)Held the provider failed its prima facie case because its principal's affirmation showed neither actual mailing nor a standard office mailing practice, and counsel's affirmation lacked personal knowledge of mailing.
Westchester Neurodiagnostic, P.C. v Allstate Ins. Co. (2009 NY Slip Op 51385(U)) Appellate Term, Second Department, June 29, 2009Claimant's proof held to make out its prima facie case (also decides)Rejected the insurer's argument that proof of the assignment of benefits form is an element of the provider's prima facie case, declining to reach the unpreserved business-records objection.
Careplus Med. Supply, Inc. v Travelers Indem. Co. (2009 NY Slip Op 51386(U)) Appellate Term, Second Department, June 29, 2009Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie showing because its medical biller's affidavit did not establish that the annexed documents were admissible under CPLR 4518, affirming the denial on that ground rather than the IME defense.
Al Correa, Neurologist, P.C. v Progressive Northeastern Ins. Co. (2009 NY Slip Op 51356(U)) Appellate Term, Second Department, June 25, 2009Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed to make a prima facie showing on the remaining claim because its billing manager's affidavit did not establish that the annexed documents were admissible under CPLR 4518.
Amaze Med. Supply, Inc. v Travelers Prop. Cas. (2009 NY Slip Op 51357(U)) Appellate Term, Second Department, June 25, 2009Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie showing because its biller's affidavit did not establish that the annexed documents were admissible under CPLR 4518.
Life Chiropractic, P.C. v Farm Family Cas. Ins. Co. (2009 NY Slip Op 52822(U)) Appellate Term, Second Department, June 18, 2009Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed to make a prima facie showing because its billing manager's affidavit did not establish that the annexed claim documents were admissible as business records under CPLR 4518.
A.B. Med. Servs., PLLC v American Tr. Ins. Co. (2009 NY Slip Op 51261(U)) Appellate Term, Second Department, June 18, 2009Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the providers failed their prima facie case because their billing manager's affidavit did not establish that the annexed documents were admissible as business records under CPLR 4518.
Post Traumatic Med. Care, P.C. v Travelers Home & Mar. Ins. Co. (2009 NY Slip Op 51149(U)) Appellate Term, Second Department, June 8, 2009Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider's motion properly denied because its billing manager's affidavit did not show personal knowledge of the provider's practices sufficient to lay a business-records foundation for the annexed documents.
Bath Med. Supply, Inc. v Country Wide Ins. Co. (2009 NY Slip Op 51145(U)) Appellate Term, Second Department, June 8, 2009Claimant's proof held to make out its prima facie case (also decides)Held the provider made its prima facie case because its billing manager personally mailed the claims and her affidavit established the claim forms as admissible business records.
Careplus Med. Supply, Inc. v Utica Mut. Ins. Co. (2009 NY Slip Op 51132(U)) Appellate Term, Second Department, June 2, 2009Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie showing because its president and biller's affidavit did not establish that the annexed documents were admissible under CPLR 4518.
RLC Med., P.C. v Allstate Ins. Co. (2009 NY Slip Op 51131(U)) Appellate Term, Second Department, June 2, 2009Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie case because the billing manager's affidavit did not establish that the annexed claim documents were admissible as business records under CPLR 4518.
A.B. Med. Servs., PLLC v Country-Wide Ins. Co. (2009 NY Slip Op 51130(U)) Appellate Term, Second Department, June 2, 2009Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the providers failed their prima facie case because the medical biller's affidavit did not establish that the annexed documents were admissible as business records under CPLR 4518.
Inwood Hill Med., P.C. v Utica Mut. Ins. Co. (2009 NY Slip Op 51129(U)) Appellate Term, Second Department, June 2, 2009Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the providers failed their prima facie showing because their medical biller's affidavit did not establish that the annexed documents were admissible under CPLR 4518.
A.B. Med. Servs., PLLC v Motor Veh. Acc. Indem. Corp. (2009 NY Slip Op 51025(U)) Appellate Term, Second Department, May 22, 2009Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the providers' summary judgment motion properly denied because their billing manager's supporting affidavit did not comply with CPLR 4518.
Star Med. Supply v Farmington Cas. Co. (2009 NY Slip Op 50971(U)) Appellate Term, Second Department, May 14, 2009Insufficient: claimant did not prove the claim was submitted (mailed to and received by the insurer)Held the provider failed its prima facie case because its affidavit did not establish submission of the claim form, and the annexed denial concerned a different claim date and amount, so it was no admission of receipt.
St. Vincent Med. Care, P.C. v Country-Wide Ins. Co. (2009 NY Slip Op 29508) Appellate Term, Second Department, May 8, 2009Claimant's proof held to make out its prima facie case (also decides)Held the provider established its prima facie case because the insurer's denial forms and its claims representative's concession of receipt cured any gap in the mailing proof, and the provider's affidavit made the claim forms admissible.
Metropolitan Med. Supplies, LLC v Eveready Ins. Co. (2009 NY Slip Op 50586(U)) Appellate Term, Second Department, April 3, 2009Claimant's proof held to make out its prima facie case (also decides)Held the provider made its prima facie case: CPLR 4518 foundation shown, the insurer's conceded receipt cured any mailing gap, and proof of the provider's costs was not required.
DJS Med. Supplies, Inc. v Travelers Prop. Cas. Ins. Co. (2009 NY Slip Op 50584(U)) Appellate Term, Second Department, April 1, 2009Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider's motion properly denied because its officer's affidavit did not show personal knowledge of the provider's practices sufficient to lay a business-records foundation for the annexed documents.
A.B. Med. Servs., PLLC v Country-Wide Ins. Co. (2009 NY Slip Op 50583(U)) Appellate Term, Second Department, April 1, 2009Claimant's proof held to make out its prima facie caseHeld the providers made their prima facie case by proving submission of claim forms and overdue payment, the billing manager's affidavit making the claim forms admissible, reversing the finding of no prima facie case.
RLC Med., P.C. v Allstate Prop. & Cas. Ins. Co. (2009 NY Slip Op 52691(U)) Appellate Term, Second Department, March 19, 2009Claimant's proof held to make out its prima facie case (also decides)Held the providers made their prima facie case by proving submission of claim forms and overdue payment, with the billing manager's affidavit making the claim forms admissible.
Amaze Med. Supply, Inc. v Utica Mut. Ins. Co. (2009 NY Slip Op 52690(U)) Appellate Term, Second Department, March 19, 2009Claimant's proof held to make out its prima facie case (also decides)Held, contrary to the lower court, that the provider's affidavit laid a business-records foundation for the claim forms and established submission and overdue payment.
Audobon Physical Med & Rehab, P.C. v GEICO Ins. Co. (2009 NY Slip Op 50456(U)) Appellate Term, Second Department, March 16, 2009Claimant's proof held to make out its prima facie case (also decides)Held the provider established its prima facie case, its officer's affidavit laying a CPLR 4518 foundation making the claim forms admissible, so the burden shifted to the insurer.
Daras v GEICO Ins. Co. (2009 NY Slip Op 50438(U)) Appellate Term, Second Department, March 10, 2009Claimant's proof held to make out its prima facie caseHeld the provider made its prima facie case because the insurer's denial forms and claims representative conceded receipt, curing any mailing gap, and the billing manager's affidavit made the claim forms admissible.
Velen Med. Supply, Inc. v Country-Wide Ins. Co. (2009 NY Slip Op 50343(U)) Appellate Term, Second Department, February 27, 2009Insufficient: claim forms not shown admissible as business records / merits of claim not provedReversed summary judgment for the provider because its billing manager's affidavit did not show personal knowledge of the provider's practices sufficient to lay a business-records foundation for the annexed documents.
A.B. Med. Servs., PLLC v New York Cent. Mut. Fire Ins. Co. (2009 NY Slip Op 50331(U)) Appellate Term, Second Department, February 24, 2009Claimant's proof held to make out its prima facie case (also decides)Held the billing manager's affidavit made the claim forms admissible and established the providers' prima facie entitlement to summary judgment.
Great Wall Acupuncture, P.C. v New York Cent. Mut. Fire Ins. Co. (2009 NY Slip Op 50294(U)) Appellate Term, Second Department, February 20, 2009Claimant's proof held to make out its prima facie case (also decides)Held the provider made its prima facie showing because its billing manager laid a business-records foundation and the insurer's denial forms and examiner's affidavit conceded receipt of the claims.
Infinity Health Prods., Ltd. v Country-Wide Ins. Co. (2009 NY Slip Op 50239(U)) Appellate Term, Second Department, February 13, 2009Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie case because its billing manager's affidavit did not show personal knowledge of the provider's practices and procedures sufficient to lay a business-records foundation for the annexed documents.
Great Wall Acupuncture, P.C. v New York Central Mutual Insurance Company (2009 NY Slip Op 50224(U)) Appellate Term, Second Department, February 10, 2009Claimant's proof held to make out its prima facie caseRejected the insurer's challenge, holding the billing manager's affidavit laid a business-records foundation and any gap in proof of mailing was cured by the insurer's denials and examiner's affidavit conceding receipt.
Gashinskaya v State Farm Mut. Auto. Ins. Co. (2009 NY Slip Op 51283(U)) Appellate Term, Second Department, January 26, 2009Claimant's proof held to make out its prima facie caseRejected the insurer's argument that the provider had to allege that the denials were untimely, holding that proof of submission of the claim and overdue payment suffices.
Lopes v Liberty Mut. Ins. Co. (2009 NY Slip Op 51279(U)) Appellate Term, Second Department, January 26, 2009Claimant's proof held to make out its prima facie case (also decides)On a CPLR 3211 motion, held the insurer's denial forms showed receipt and nonpayment of two unassigned providers' claims, so those claims survived, while claims without proof of submission were dismissed; the plaintiff need not prove she paid providers.
Union Physician Healthcare, P.C. v Utica Mut. Ins. Co. (2009 NY Slip Op 50039(U)) Appellate Term, Second Department, January 9, 2009Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie case because its officer's affidavit did not show personal knowledge of the provider's practices and procedures sufficient to admit the annexed documents as business records.
D.A.V. Chiropractic, P.C. v GEICO Indem. Co. (2008 NY Slip Op 52304(U)) Appellate Term, Second Department, November 7, 2008Claimant's proof held to make out its prima facie case (also decides)Held the billing manager's affidavit sufficed to make the claim forms admissible, establishing the providers' prima facie entitlement to summary judgment.
Avenue N Med., P.C. v Travelers Prop. Cas. Ins. Co. (2008 NY Slip Op 52174(U)) Appellate Term, Second Department, October 31, 2008Claimant's proof held to make out its prima facie case (also decides)Rejecting the lower court's reasoning, held the provider made its prima facie case because the insurer's denial forms and conceded receipt cured any gap in mailing proof and the provider's own affidavit laid a CPLR 4518 foundation.
Focus Radiology, P.C. v Utica Mut. Ins. Co. (2008 NY Slip Op 52050(U)) Appellate Term, Second Department, October 9, 2008Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie case because its employee's affidavit neither referred to the annexed documents nor asserted they were the provider's business records under CPLR 4518 (a).
Infinity Health Prods., Ltd. v New York Cent. Mut. Fire Ins. Co. (2008 NY Slip Op 51870(U)) Appellate Term, Second Department, September 10, 2008Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie case because its billing manager's affidavit did not show personal knowledge of its practices sufficient to lay a business-records foundation for the annexed documents.
Infinity Health Prods., Ltd. v Zurich Ins. Co. (2008 NY Slip Op 51869(U)) Appellate Term, Second Department, September 10, 2008Insufficient: claimant did not prove the claim was submitted (mailed to and received by the insurer)Held the provider failed to prove submission of claim forms for the accident sued on because its affidavit and complaint referred to one accident date while the annexed claim forms and denials referred to another.
Amaze Med. Supply, Inc. v Allstate Ins. Co. (2008 NY Slip Op 51866(U)) Appellate Term, Second Department, September 10, 2008Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie case because its officer and billing manager's affidavit did not show personal knowledge of the provider's practices sufficient to admit the annexed documents as business records.
Align for Health Chiropractic, P.C. v New York Cent. Mut. Fire Ins. Co. (2008 NY Slip Op 51862(U)) Appellate Term, Second Department, September 3, 2008Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie case because its officer's conclusory affidavit did not show personal knowledge of its practices to lay a business-records foundation for the annexed documents.
Midisland Med., PLLC v Allstate Ins. Co. (2008 NY Slip Op 51861(U)) Appellate Term, Second Department, September 3, 2008Claimant's proof held to make out its prima facie case (also decides)Held the provider established its prima facie case by proof that it submitted the claim forms and that payment was overdue, shifting the burden to the insurer.
A.B. Med. Servs., PLLC v Utica Mut. Ins. Co. (2008 NY Slip Op 51859(U)) Appellate Term, Second Department, September 2, 2008Claimant's proof held to make out its prima facie case (also decides)Held, contrary to the lower court's business-records ruling, that the providers' affidavits established submission of the claim forms and overdue payment.
Delta Diagnostic Radiology, P.C. v Unitrin Advantage Ins. Co. (2008 NY Slip Op 51854(U)) Appellate Term, Second Department, September 2, 2008Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie case because its officer's affidavit did not show personal knowledge of the provider's practices and procedures sufficient to admit the annexed documents as business records.
A.T. Med., P.C. v American Tr. Ins. Co. (2008 NY Slip Op 51853(U)) Appellate Term, Second Department, September 2, 2008Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie case because its officer's affidavit and post office ledger did not prove mailing and the affidavit laid no business-records foundation for the annexed documents.
Crossbridge Diagnostic Radiology, P.C. v Progressive Ins. Co. (2008 NY Slip Op 51761(U)) Appellate Term, Second Department, August 19, 2008Claimant's proof held to make out its prima facie caseHeld the provider made its prima facie showing because any deficiency in its proof of mailing the claim forms was cured by the insurer's denial forms and representative's affidavit conceding receipt.
Midisland Med., PLLC v Allstate Ins. Co. (2008 NY Slip Op 51760(U)) Appellate Term, Second Department, August 19, 2008Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie case because the treating doctor's affirmation neither laid a business-records foundation for the claim forms nor sufficiently set forth the pertinent facts of the claims, and the insurer did not waive the objection.
NYC East-West Acupuncture, P.c. v Maryland Cas. Co. (2008 NY Slip Op 51762(U)) Appellate Term, Second Department, August 19, 2008Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie showing because its affiants did not show personal knowledge of the provider's office practices so as to lay a business-records foundation for the annexed claim forms.
Horton Med., P.C. v New York Cent. Mut. Fire Ins. Co. (2008 NY Slip Op 51682(U)) Appellate Term, Second Department, July 30, 2008Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie case because its billing manager's conclusory affirmation did not show personal knowledge of office practices to lay a business-records foundation for the claim forms.
Boro Med. Supplies, Inc. v Country Wide Ins. Co. (2008 NY Slip Op 52698(U)) Appellate Term, Second Department, July 25, 2008Claimant's proof held to make out its prima facie case (also decides)Held the provider established its prima facie case by proof that it submitted the claim form and that payment was overdue, shifting the burden to the insurer.
Mani Med., P.C. v Eveready Ins. Co. (2008 NY Slip Op 52697(U)) Appellate Term, Second Department, July 25, 2008Claimant's proof held to make out its prima facie case (also decides)Rejected the insurer's argument that the provider failed to prove a valid assignment, holding any such burden satisfied where the claim forms said the signature was on file and the insurer did not timely seek verification.
Quality Health Prods., Inc. v Auto One Ins. Co. (2008 NY Slip Op 51530(U)) Appellate Term, Second Department, July 10, 2008Claimant's proof held to make out its prima facie case (also decides)Held the provider established its prima facie case by proof of submitting the claim and that payment was overdue, shifting the burden to the insurer.
Infinity Health Prods., Ltd. v Eveready Ins. Co. (2008 NY Slip Op 28271) Appellate Term, Second Department, July 10, 2008Claimant's proof held to make out its prima facie caseRejected the insurer's argument that the supplier had to prove its costs, holding a provider makes its prima facie case by proof of a submitted claim form and overdue payment, fee schedule excess being only a defense.
Liberty Orthopedics, PLLC v Mvaic (2008 NY Slip Op 51533(U)) Appellate Term, Second Department, July 10, 2008Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed to make a prima facie showing because its officer's affidavit did not establish personal knowledge of its practices and procedures to lay a business-records foundation for the annexed documents.
Freeport Med., P.C. v Utica Natl. Ins. Co. of Tex. (2008 NY Slip Op 51448(U)) Appellate Term, Second Department, July 8, 2008Claimant's proof held to make out its prima facie caseHeld the biller's affidavit showed sufficient personal knowledge of the provider's practices to lay a business-records foundation, so the provider made its prima facie showing.
Health Plus Med., P.C. v American Mfrs. Mut. Ins. Co. (2008 NY Slip Op 51444(U)) Appellate Term, Second Department, July 8, 2008Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie case because the affidavit of its counsel's employee did not show personal knowledge of the provider's practices to lay a business-records foundation for the annexed documents.
Alur Med. Supply, Inc. v Country-Wide Ins. Co. (2008 NY Slip Op 51234(U)) Appellate Term, Second Department, June 12, 2008Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie case because its billing manager's affidavit did not show personal knowledge of the provider's practices sufficient to lay a business-records foundation for the annexed documents.
Vista Surgical Supplies, Inc. v American Protection Ins. Co. (2008 NY Slip Op 51229(U)) Appellate Term, Second Department, June 12, 2008Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie case because its corporate officer's affidavit did not show personal knowledge of the provider's practices sufficient to lay a business-records foundation for the annexed documents.
Infinity Health Prods. v Amex Assur. Co. (2008 NY Slip Op 51233(U)) Appellate Term, Second Department, June 12, 2008Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie showing because its billing manager's affidavit did not establish personal knowledge of the provider's practices and procedures to lay a business-records foundation for the annexed documents.
Struhl v Alea N. Am. Ins. Co. (2008 NY Slip Op 51113(U)) Appellate Term, Second Department, May 27, 2008Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie case because counsel's affirmation could not lay a foundation showing the claim form was admissible under the business records exception.
First Aid Occupational Therapy, PLLC v State Farm Fire & Cas. Co. (2008 NY Slip Op 51099(U)) Appellate Term, Second Department, May 27, 2008Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie showing because its employee's affidavit gave no basis for her conclusory claim of personal knowledge of the provider's practices, so the annexed documents were not admissible as business records.
Rockaway Med. & Diagnostic, P.C. v Utica Mut. Ins. Co. (2008 NY Slip Op 51033(U)) Appellate Term, Second Department, April 30, 2008Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie case because its supervisor's affidavit did not show personal knowledge of its practices to lay a business-records foundation, and the claim forms were not annexed.
Med-Tech Prod., Inc. v Liberty Mut. Ins. Co. (2008 NY Slip Op 51469(U)) Appellate Term, Second Department, April 29, 2008Claimant's proof held to make out its prima facie case (also decides)Held the provider's deficient proof of mailing was cured by the insurer's acknowledgment of receipt in its claims affidavit and denial form, so the prima facie burden was met and shifted to the insurer.
Vinings Spinal Diagnostics v Progressive Cas. Ins. Co. (2008 NY Slip Op 51468(U)) Appellate Term, Second Department, April 29, 2008Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie case because its owner's affidavit was too unspecific to show personal knowledge of the provider's practices sufficient to admit the annexed documents as business records.
Boris Kleyman, P.C. v Kemper Ins. Co. (2008 NY Slip Op 50877(U)) Appellate Term, Second Department, April 24, 2008Claimant's proof held to make out its prima facie case (also decides)Rejected the insurer's contention and held the provider established prima facie entitlement by proof of submission of the statutory claim form and that payment was overdue.
Executive MRI Imaging, P.C. v State Farm Ins. Co. (2008 NY Slip Op 50902(U)) Appellate Term, Second Department, April 21, 2008Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie case because its corporate officer's affidavit did not show personal knowledge of the provider's practices sufficient to admit the annexed documents as business records.
Orthotic Surgical & Med. Supply, Inc. v GEICO Ins. Co. (2008 NY Slip Op 50869(U)) Appellate Term, Second Department, April 14, 2008Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie burden because the affidavit of its former attorney's employee showed no personal knowledge of the provider's practices and procedures to lay a business-records foundation for the annexed documents.
First Aid Occupational Therapy, PLLC v New York Cent. Mut. Fire Ins. Co. (2008 NY Slip Op 50863(U)) Appellate Term, Second Department, April 8, 2008Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie burden because its billing manager's conclusory affirmation did not show personal knowledge of office practices to admit the claim forms as business records; storage under a retention policy was not enough.
R.J. Professional Acupuncturist, P.C. v Travelers Prop. Cas. Ins. Co. (2008 NY Slip Op 50541(U)) Appellate Term, Second Department, March 13, 2008Claimant's proof held to make out its prima facie caseHeld the arbitrator's ruling that the provider failed its prima facie case for not submitting additional evidence substantiating its bills was contrary to settled law, since submission of a complete claim and overdue payment suffice.
Metropolitan Radiological Imaging, P.C. v Country-Wide Ins. Co. (2008 NY Slip Op 50539(U)) Appellate Term, Second Department, March 13, 2008Claimant's proof held to make out its prima facie caseHeld the arbitrator's ruling that the provider failed its prima facie showing for lack of additional proof of medical necessity was contrary to settled law, since proof of a complete claim and overdue payment suffices.
Delta Diagnostic Radiology, P.C. v Progressive Cas. Ins. Co. (2008 NY Slip Op 50535(U)) Appellate Term, Second Department, March 12, 2008Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie case because its officer's conclusory affidavit did not show personal knowledge of the provider's practices sufficient to lay a business-records foundation for the annexed documents.
Vista Surgical Supplies, Inc. v Utica Mut. Ins. Co. (2008 NY Slip Op 50524(U)) Appellate Term, Second Department, March 10, 2008Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie burden because its corporate officer's affidavit did not show personal knowledge of the provider's practices and procedures to lay a business-records foundation for the annexed documents.
Fortune Med., P.C. v New York Cent. Mut. Fire Ins. (2008 NY Slip Op 50522(U)) Appellate Term, Second Department, March 10, 2008Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie burden because its corporate officer's affidavit did not show personal knowledge of the provider's practices and procedures to lay a business-records foundation for the annexed documents.
Mani Med., P.C. v NY Cent. Mut. Ins. Co. (2008 NY Slip Op 50508(U)) Appellate Term, Second Department, March 5, 2008Claimant's proof held to make out its prima facie case (also decides)Held the provider established its prima facie case by proof that it submitted the claim forms and payment was overdue, shifting the burden to the insurer.
Colonia Med., P.C. v New York Cent. Mut. Fire Ins. Co. (2008 NY Slip Op 50352(U)) Appellate Term, Second Department, February 26, 2008Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie burden because its corporate officer's conclusory affidavit did not show personal knowledge of the provider's practices to admit the claim forms as business records.
Nagle Med. Plaza, P.C. v Allstate Ins. Co. (2008 NY Slip Op 50349(U)) Appellate Term, Second Department, February 26, 2008Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie case because its president's affidavit did not show personal knowledge of its practices and procedures sufficient to lay a business-records foundation for the annexed documents.
Bath Med. Supply, Inc. v New York Cent. Mut. Fire Ins. Co. (2008 NY Slip Op 50347(U)) Appellate Term, Second Department, February 26, 2008Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider's officer affidavit did not show personal knowledge of the provider's practices sufficient to lay a business-records foundation for the annexed documents, so no prima facie case was made.
Be Well Med. Supply, Inc. v New York Cent. Mut. Fire Ins. Co. (2008 NY Slip Op 50346(U)) Appellate Term, Second Department, February 21, 2008Claimant's proof held to make out its prima facie case (also decides)Rejected the insurer's argument that the provider had to prove the supplies were furnished under a prescription, since submission of the claim form and overdue payment suffice.
Infinity Health Prods., Ltd. v Progressive Ins. Co. (2008 NY Slip Op 50345(U)) Appellate Term, Second Department, February 21, 2008Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie case because its billing manager's affidavit did not show personal knowledge of its practices to lay a business-records foundation for the annexed documents.
Quentin Med. Servs., P.C. v Geico Gen. Ins. Co. (2008 NY Slip Op 50294(U)) Appellate Term, Second Department, February 8, 2008Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie burden because its employee's affidavit did not show personal knowledge of the provider's practices and procedures to lay a business-records foundation for the annexed documents.
Delta Diagnostic Radiology, P.C. v Progressive Cas. Ins. Co. (2008 NY Slip Op 50293(U)) Appellate Term, Second Department, February 8, 2008Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie case because its corporate officer's affidavit did not show personal knowledge of its practices to lay a business-records foundation for the annexed documents.
Bedford Park Med. Practice, P.C. v New York Cent. Mut. Fire Ins. Co. (2008 NY Slip Op 50289(U)) Appellate Term, Second Department, February 8, 2008Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie burden on its cross motion because its corporate officer's conclusory affidavit did not show personal knowledge of the provider's practices to admit the annexed documents as business records.
Delta Diagnostic Radiology, P.C. v Progressive Cas. Ins. Co. (2008 NY Slip Op 50087(U)) Appellate Term, Second Department, January 4, 2008Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie burden because its officer's conclusory affidavit did not show personal knowledge of the provider's practices to lay a business-records foundation for the annexed documents.
Delta Diagnostic Radiology, P.C. v American Tr. Ins. Co. (2007 NY Slip Op 52455(U)) Appellate Term, Second Department, December 27, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie showing because its officer's conclusory affidavit did not show personal knowledge of its practices and procedures to lay a business-records foundation for the annexed documents.
Delta Diagnostic Radiology, P.C. v Progressive Cas. Ins. Co. (2007 NY Slip Op 52453(U)) Appellate Term, Second Department, December 27, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie case because its officer's conclusory affidavit did not show personal knowledge of its practices to lay a business-records foundation for the annexed documents.
Gentle Care Acupuncture, P.C. v Allstate Ins. Co. (2007 NY Slip Op 52334(U)) Appellate Term, Second Department, December 7, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie case because its employee's conclusory affidavit did not establish personal knowledge of its practices needed to admit the annexed documents as business records.
Impulse Chiropractic, P.C. v Countrywide Ins. (2007 NY Slip Op 52293(U)) Appellate Term, Second Department, November 21, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie case because its officer's affidavit did not show personal knowledge of its practices and procedures sufficient to admit the annexed documents as business records.
V.S. Med. Servs., P.C. v Farm Family Ins. (2007 NY Slip Op 52287(U)) Appellate Term, Second Department, November 21, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie case, so summary judgment in its favor was reversed, because its officer's affidavit did not lay a business-records foundation for the annexed documents.
Walter Karpinski Acupuncture, P.C. v Progressive Cas. Ins. Co. (2007 NY Slip Op 52280(U)) Appellate Term, Second Department, November 20, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie case because its officer's conclusory affidavit did not show personal knowledge of its practices to lay a foundation for admitting the annexed documents as business records.
Struhl v Countrywide Ins. Co. (2007 NY Slip Op 52071(U)) Appellate Term, Second Department, October 23, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the physician-claimant failed his prima facie case, reversing summary judgment, because his affirmation, based on review of records, did not establish personal knowledge of office practices to admit the claim forms as business records.
Allstate Social Work & Psychological Servs., P.L.L.C. v Utica Mut. Ins. Co. (2007 NY Slip Op 52042(U)) Appellate Term, Second Department, October 19, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider's officer's affidavit failed to show personal knowledge of the provider's practices and procedures needed to lay a business-records foundation for the annexed documents, so no prima facie case was made.
JSI Expert Servs., Inc. v Travelers Ins. Co. (2007 NY Slip Op 51974(U)) Appellate Term, Second Department, October 3, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie case because its employee's conclusory affidavit that the documents were true copies of what was sent did not lay a business-records foundation.
Lexington Acupuncture, P.C. v MVAIC (2007 NY Slip Op 51973(U)) Appellate Term, Second Department, October 2, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedReversed summary judgment for the claimant against MVAIC because its employee's affidavit did not show personal knowledge of the claimant's practices sufficient to lay a business-records foundation for the annexed documents.
Great Wall Acupuncture, P.C. v Travelers Prop. Cas. (2007 NY Slip Op 51969(U)) Appellate Term, Second Department, October 1, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the claimant failed its prima facie case because its employee's conclusory affidavit did not show personal knowledge of the claimant's practices sufficient to lay a business-records foundation for its bills.
AVA Acupuncture, P.C. v GEICO Gen. Ins. Co. (2007 NY Slip Op 27371) Appellate Term, Second Department, September 14, 2007Claimant's proof held to make out its prima facie case (also decides)Rejected the insurer's argument that the acupuncture provider had to show its fees were within prevailing local fees, holding the prima facie case requires only proof of submission of the claim and that payment is overdue.
Astoria Quality Med. Supply v Allstate Ins. Co. (2007 NY Slip Op 51977(U)) Appellate Term, Second Department, September 4, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie case because its employee's affidavit did not establish personal knowledge of its practices and procedures to lay a business-records foundation for the annexed documents.
Delta Diagnostic Radiology, P.C. v Chubb Group of Ins. (2007 NY Slip Op 27345) Appellate Term, Second Department, August 20, 2007Claimant's proof held to make out its prima facie case (also decides)Rejected the insurer's argument that the claims were not overdue because timely denied, holding a claim is overdue if unpaid within 30 days notwithstanding a timely denial.
V.S. Med. Servs., P.C. v Allstate Ins. Co. (2007 NY Slip Op 51615(U)) Appellate Term, Second Department, August 16, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie case because its officer's conclusory affidavit did not show personal knowledge of its practices needed to admit the annexed documents as business records.
N.Y.Q. Acupuncture, P.C. v American Tr. Ins. Co. (2007 NY Slip Op 51614(U)) Appellate Term, Second Department, August 16, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie case because its officer's conclusory affidavit did not establish personal knowledge of its practices to lay a foundation for admitting the annexed documents as business records.
Andrew Carothers, M.D., P.C. v New York Cent. Mut. Fire Ins. Co. (2007 NY Slip Op 51613(U)) Appellate Term, Second Department, August 16, 2007Claimant's proof held to make out its prima facie case (also decides)Held the provider established its prima facie case by proof that it submitted the claims and that payment was overdue.
A.M. Med. Servs., P.C. v Deerbrook Ins. Co. (2007 NY Slip Op 51610(U)) Appellate Term, Second Department, August 16, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie case because its officer's conclusory affidavit did not show personal knowledge of its practices so as to admit the annexed documents as business records.
Great Wall Acupuncture v Liberty Mut. Ins. Co. (2007 NY Slip Op 51609(U)) Appellate Term, Second Department, August 16, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie case, reversing summary judgment for it, because its officer's affidavit did not lay a business-records foundation for the annexed documents.
Vista Surgical Supplies, Inc. v Nationwide Mut. Ins. Co. (2007 NY Slip Op 51608(U)) Appellate Term, Second Department, August 16, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie case because its officer's affidavit did not establish personal knowledge of its practices to lay a foundation for admitting the annexed documents as business records.
Bath Med. Supply, Inc. v Allstate Ins. Co. (2007 NY Slip Op 51602(U)) Appellate Term, Second Department, August 16, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie case because its officer's affidavit did not show personal knowledge of its practices and procedures to lay a business-records foundation for the annexed documents.
Boai Zhong Yi Acupuncture Servs., P.C. v Allstate Ins. Co. (2007 NY Slip Op 51601(U)) Appellate Term, Second Department, August 16, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie case because its officer's conclusory affidavit did not establish personal knowledge of its practices needed to admit the annexed documents as business records.
Lexington Acupuncture, P.C. v MVAIC (2007 NY Slip Op 51604(U)) Appellate Term, Second Department, August 16, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie showing because its employee's conclusory affidavit did not show personal knowledge of its practices and procedures to lay a business-records foundation for the annexed documents.
Delta Diagnostic Radiology, P.C. v General Assur. Co. (2007 NY Slip Op 51616(U)) Appellate Term, Second Department, August 16, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedAffirmed denial of the claimant's motion on the ground that its officer's affidavit did not show personal knowledge of the claimant's practices sufficient to lay a business-records foundation for the annexed documents.
Union Physician Health Care, P.C. v American Mfrs. Mut. Ins. Co. (2007 NY Slip Op 51505(U)) Appellate Term, Second Department, July 24, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie case because its officer's affidavit did not show personal knowledge of its practices so as to lay a business-records foundation for the annexed documents.
Mega Supply & Billing, Inc. v Allstate Indemnity Co. (2007 NY Slip Op 51515(U)) Appellate Term, Second Department, July 23, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedReversed summary judgment for the claimant because its employee's conclusory affidavit did not show personal knowledge of the claimant's practices sufficient to make the claim forms admissible as business records.
Delta Diagnostic Radiology, P.C. v Progressive Cas. Ins. Co. (2007 NY Slip Op 51487(U)) Appellate Term, Second Department, July 12, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie case because its officer's conclusory affidavit did not establish personal knowledge of its business practices to admit the annexed documents as business records.
Bronxborough Med., P.C. v Travelers Ins. Co. (2007 NY Slip Op 51485(U)) Appellate Term, Second Department, July 12, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie case because its officer's conclusory affidavit did not show personal knowledge of its practices to lay a foundation for admitting the annexed documents as business records.
A Khodadadi Radiology, P.C. v NY Cent. Mut. Fire Ins. Co. (2007 NY Slip Op 51342(U)) Appellate Term, Second Department, July 3, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie showing because its owner's affidavit did not establish personal knowledge of its practices and procedures to lay a business-records foundation for the annexed documents.
Psychological Practice, P.C. v NY Cent. Mut. Fire Ins. Co. (2007 NY Slip Op 51304(U)) Appellate Term, Second Department, June 29, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie case because its owner's conclusory affidavit did not establish personal knowledge of its practices needed to admit the annexed documents as business records.
East Acupuncture, P.C. v Electric Ins. Co. (2007 NY Slip Op 51281(U)) Appellate Term, Second Department, June 25, 2007Insufficient: claimant did not prove the claim was submitted (mailed to and received by the insurer)Held the provider's proof of mailing insufficient for one assignor's claims and for unacknowledged claims, while the insurer's denial forms conceding receipt cured the deficiency for four assignors' claims.
VA Acutherapy Acupuncture, P.C. v State Farm Ins. Co. (2007 NY Slip Op 51217(U)) Appellate Term, Second Department, June 15, 2007Claimant's proof held to make out its prima facie case (also decides)Held the insurer's denial form annexed to the provider's papers established submission and receipt, and rejected the argument that a denial issued within 10 days defeated the overdue element; the motion failed on the insurer's defenses instead.
Triboro Chiropractic & Acupuncture, PLLC v New York Cent. Mut. Fire Ins. Co. (2007 NY Slip Op 51175(U)) Appellate Term, Second Department, June 8, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider's principal doctor lacked personal knowledge to lay a business-records foundation for the documents relied on, so no prima facie case was made.
Art of Healing Medicine, P.C. v Travelers Home & Mar. Ins. Co. (2007 NY Slip Op 51161(U)) Appellate Term, Second Department, June 4, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the providers failed their prima facie case because their billing manager's affidavit did not show personal knowledge of their practices to lay a business-records foundation for the annexed documents.
Capri Med., P.C. v Progressive Cas. Ins. Co. (2007 NY Slip Op 51158(U)) Appellate Term, Second Department, June 1, 2007Insufficient: claimant did not prove the claim was submitted (mailed to and received by the insurer)Held the provider's motion properly denied because its officer's affidavit had multiple defects such that it could not be determined to be properly sworn, so it did not establish entitlement to judgment.
Delta Diagnostic Radiology, P.C. v Country-Wide Ins. Co. (2007 NY Slip Op 51157(U)) Appellate Term, Second Department, June 1, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie case because its officer's conclusory affidavit did not establish personal knowledge of its practices to admit the annexed documents as business records.
IVB Med. Supply, Inc. v Allstate Ins. Co. (2007 NY Slip Op 51081(U)) Appellate Term, Second Department, May 25, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie showing because its corporate officer's affidavit did not show personal knowledge of the provider's practices and procedures to lay a business-records foundation for the annexed documents.
V.S. Med. Servs., P.C. v New York Cent. Mut. Ins. (2007 NY Slip Op 51080(U)) Appellate Term, Second Department, May 25, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie showing because its corporate officer's affidavit did not establish personal knowledge of the provider's practices and procedures to lay a business-records foundation for the annexed documents.
Vista Surgical Supplies, Inc. v New York Cent. Mut. Fire Ins. Co. (2007 NY Slip Op 50939(U)) Appellate Term, Second Department, May 7, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie showing because its corporate officer's affidavit did not show personal knowledge of the provider's practices and procedures to lay a business-records foundation for the annexed documents.
IVB Med. Supply, Inc. v State Farm Mut. Ins. Co. (2007 NY Slip Op 50890(U)) Appellate Term, Second Department, April 27, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie case because its officer's conclusory affidavit did not show personal knowledge of the provider's practices sufficient to lay a business-records foundation for the annexed documents.
Med-Tech Prod., Inc. v Liberty Mut. Ins. Co. (2007 NY Slip Op 50876(U)) Appellate Term, Second Department, April 26, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie showing because its officer's conclusory affidavit did not establish personal knowledge of the provider's practices and procedures to admit the annexed documents as business records.
First Help Acupuncture, P.C. v General Assur. Co. (2007 NY Slip Op 50859(U)) Appellate Term, Second Department, April 19, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the claimant failed its prima facie case because its employee's conclusory affidavit did not show personal knowledge of the claimant's practices sufficient to lay a business-records foundation for the annexed documents.
Preferred Med. Imaging, P.C. v Countrywide Ins. Co. (2007 NY Slip Op 50693(U)) Appellate Term, Second Department, April 3, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie case because its employee's conclusory affidavit did not show personal knowledge of the provider's practices sufficient to lay a business-records foundation for the claim forms.
S.P. Med. Ctr. v Trumbull Ins. Co. (2007 NY Slip Op 50692(U)) Appellate Term, Second Department, April 3, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedReversed summary judgment for the provider because its corporate officer's affidavit did not show personal knowledge of the provider's practices and procedures to lay a business-records foundation for the annexed documents.
Vista Surgical Supplies, Inc. v Progressive Cas. (2007 NY Slip Op 50695(U)) Appellate Term, Second Department, April 3, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the claimant failed its prima facie case because its officer's conclusory affidavit did not show personal knowledge of the claimant's practices sufficient to lay a business-records foundation for the annexed documents.
Vista Surgical Supplies, Inc. v GEICO Ins. Co. (2007 NY Slip Op 50688(U)) Appellate Term, Second Department, April 2, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie showing because its officer's conclusory affidavit did not establish personal knowledge of the provider's practices and procedures to admit the annexed documents as business records.
Alfa Med. Supplies, Inc. v Liberty Mut. Ins. Co. (2007 NY Slip Op 50686(U)) Appellate Term, Second Department, April 2, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie showing because its employee's affidavit did not establish personal knowledge of the provider's business practices to lay a foundation for admitting the annexed documents as business records.
Preferred Med. Imaging, P.C. v Hudson Ins. Co. (2007 NY Slip Op 50685(U)) Appellate Term, Second Department, April 2, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie case because its employee's conclusory affidavit did not show personal knowledge of the provider's practices sufficient to lay a business-records foundation for the claim forms.
Colonia Med., P.C. v Allstate Ins. Co. (2007 NY Slip Op 50679(U)) Appellate Term, Second Department, March 28, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie showing because its corporate officer's conclusory affidavit did not establish personal knowledge of the provider's practices to lay a business-records foundation for the annexed documents.
Delta Diagnostic Radiology, P.C. v Statewide Ins. Co. (2007 NY Slip Op 50677(U)) Appellate Term, Second Department, March 28, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie showing because its corporate officer's conclusory affidavit did not establish personal knowledge of the provider's practices to admit the annexed documents as business records.
Great Wall Acupuncture v Liberty Mut. Ins. Co. (2007 NY Slip Op 50676(U)) Appellate Term, Second Department, March 28, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie showing because its employee's conclusory affidavit did not establish personal knowledge of the provider's practices to lay a business-records foundation for the annexed documents.
Global Med. Equip., Inc v Allstate Ins. Co. (2007 NY Slip Op 50675(U)) Appellate Term, Second Department, March 28, 2007Claimant's proof held to make out its prima facie caseUpheld summary judgment for the provider, rejecting the insurer's argument that the provider had to prove the insurer's denial was untimely as part of its prima facie case, which required only a submitted claim form and overdue payment.
A.M. Med. Servs., P.C. v Progressive Cas. Ins. Co. (2007 NY Slip Op 50671(U)) Appellate Term, Second Department, March 28, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie showing because its corporate officer's conclusory affidavit did not establish personal knowledge of the provider's practices to admit the annexed documents as business records.
Midwood Med. Equip. Supply, Inc. v NY Cent. Mut. Fire Ins. Co. (2007 NY Slip Op 50670(U)) Appellate Term, Second Department, March 28, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedReversed summary judgment for the provider because its corporate officer's conclusory affidavit did not establish personal knowledge of the provider's practices to lay a business-records foundation for the annexed documents.
Delta Diagnostic Radiology, P.C. v Liberty Mut. Ins. Co. (2007 NY Slip Op 50666(U)) Appellate Term, Second Department, March 28, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie showing because its corporate officer's conclusory affidavit did not establish personal knowledge of the provider's practices to admit the annexed documents as business records.
Downtown Acupuncture, P.C. v Geico Gen. Ins. Co. (2007 NY Slip Op 50660(U)) Appellate Term, Second Department, March 28, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie showing because its president's affidavit did not establish personal knowledge of the provider's practices and procedures to lay a business-records foundation for the annexed documents.
W.H.O. Acupuncture, P.C. v Allstate Ins. Co. (2007 NY Slip Op 50615(U)) Appellate Term, Second Department, March 26, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie showing because its corporate officer's conclusory affidavit did not establish personal knowledge of the provider's practices to lay a business-records foundation for the annexed documents.
Capri Med., P.C. v Allstate Ins. Co. (2007 NY Slip Op 50611(U)) Appellate Term, Second Department, March 26, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedReversed summary judgment for the provider because its corporate officer's conclusory affidavit did not establish personal knowledge of the provider's practices to admit the annexed documents as business records.
Fair Price Med. Supply Corp. v Allstate Ins. Co. (2007 NY Slip Op 50608(U)) Appellate Term, Second Department, March 26, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie showing because its corporate officer's conclusory affidavit did not establish personal knowledge of the provider's practices to lay a business-records foundation for the annexed documents.
Vista Surgical Supplies, Inc. v Nationwide Mut. Ins. Co. (2007 NY Slip Op 50605(U)) Appellate Term, Second Department, March 26, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedReversed summary judgment for the provider, reaching the insurer's argument first raised on appeal, because the officer's affidavit did not establish personal knowledge of the provider's practices to lay a business-records foundation.
Delta Diagnostic Radiology, P.C. v Allstate Ins. Co. (2007 NY Slip Op 50604(U)) Appellate Term, Second Department, March 26, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie showing because its officer's conclusory affidavit did not establish personal knowledge of the provider's practices to admit the annexed documents as business records.
City Wide Social Work & Psychological Servs., PLLC v GEICO Gen. Ins. Co. (2007 NY Slip Op 50603(U)) Appellate Term, Second Department, March 26, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie showing because its employee's conclusory affidavits did not establish personal knowledge of the provider's business practices to lay a business-records foundation for the annexed documents.
Dan Med., P.C. v New York Cent. Mut. Ins. Co. (2007 NY Slip Op 50602(U)) Appellate Term, Second Department, March 26, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie showing because its corporate officer's affidavit did not show personal knowledge of the provider's practices and procedures to lay a business-records foundation for the annexed documents.
All Mental Care Medicine, P.C. v Travelers Indem. Co. (2007 NY Slip Op 50607(U)) Appellate Term, Second Department, March 26, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the claimant failed its prima facie case because its officer's conclusory affidavit did not show personal knowledge of the claimant's practices sufficient to lay a business-records foundation for the annexed documents.
Vista Surgical Supplies, Inc. v General Assur. Co. (2007 NY Slip Op 50613(U)) Appellate Term, Second Department, March 26, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the claimant failed its prima facie case because its officer's conclusory affidavit did not show personal knowledge of the claimant's practices sufficient to lay a business-records foundation under CPLR 4518 for the annexed documents.
Great Wall Acupuncture v American Tr. Ins. Co. (2007 NY Slip Op 50538(U)) Appellate Term, Second Department, March 19, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie showing because its employee's affidavit, conclusorily calling the documents business records, did not show personal knowledge of the provider's practices to lay a business-records foundation.
Capri Med., P.C. v New York Cent. Mut. Ins. Co. (2007 NY Slip Op 50536(U)) Appellate Term, Second Department, March 19, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed to show prima facie that it submitted its claim forms because its officer's affidavit did not establish personal knowledge of the provider's practices to lay a business-records foundation for the annexed documents.
All Mental Care Medicine, P.C. v Travelers Indem. Co. (2007 NY Slip Op 50537(U)) Appellate Term, Second Department, March 19, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the claimant failed its prima facie case because its officer's affidavit did not show personal knowledge of the claimant's practices sufficient to lay a business-records foundation for the annexed documents.
Vista Surgical Supplies, Inc. v Allstate Ins. Co. (2007 NY Slip Op 50502(U)) Appellate Term, Second Department, March 15, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie showing because its corporate officer's conclusory affidavit did not show personal knowledge of the provider's practices to lay a business-records foundation for the annexed documents.
SZ Med., P.C. v Trumbull Ins. Co. (2007 NY Slip Op 50499(U)) Appellate Term, Second Department, March 15, 2007Claimant's proof held to make out its prima facie case (also decides)Held the providers established prima facie entitlement by proof that they submitted claims stating the fact and amount of loss and that payment was overdue, shifting the burden to the insurer.
Fortune Med., P.C. v Nationwide Mut. Ins. Co. (2007 NY Slip Op 50497(U)) Appellate Term, Second Department, March 12, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider's cross motion properly denied because its officer's conclusory affidavit did not show personal knowledge of the provider's practices to lay a business-records foundation for the annexed documents.
Bedford Park Med. Practice, P.C. v Progressive Cas. Ins. Co. (2007 NY Slip Op 50494(U)) Appellate Term, Second Department, March 8, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie showing because counsel's affirmation showed no personal knowledge and laid no business-records foundation for the annexed documents, and an officer's affidavit served only in reply could not cure the defect.
A.M. Med. Servs., P.C. v Liberty Mut. Ins. Co. (2007 NY Slip Op 50492(U)) Appellate Term, Second Department, March 8, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider's cross motion properly denied because its officer's conclusory affidavit did not show personal knowledge of the provider's practices to lay a business-records foundation for the annexed documents.
Delta Diagnostic Radiology, P.C. v Encompass Prop. & Cas. Co. (2007 NY Slip Op 50493(U)) Appellate Term, Second Department, March 8, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the claimant failed its prima facie case because its officer's conclusory affidavit did not show personal knowledge of the claimant's practices sufficient to lay a business-records foundation for the annexed documents.
V.S. Med. Servs., P.C. v Allstate Ins. Co. (2007 NY Slip Op 50400(U)) Appellate Term, Second Department, March 5, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedReversed summary judgment for the provider, holding its officer's affidavit did not show personal knowledge of the provider's practices to lay a business-records foundation, so submission of the claim forms was not established.
Fortune Med., P.C. v Kemper Ins. Co. (2007 NY Slip Op 50388(U)) Appellate Term, Second Department, March 2, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie showing because its officer's conclusory affidavit did not show personal knowledge of the provider's practices to lay a business-records foundation for the annexed documents.
Bedford Park Med. Practice, P.C. v New York Cent. Mut. Fire Ins. Co. (2007 NY Slip Op 50378(U)) Appellate Term, Second Department, February 27, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedReversed summary judgment for the provider because its officer's affidavit did not show personal knowledge of the provider's practices to lay a business-records foundation for the annexed documents.
Mega Supply & Billing, Inc. v Clarendon Natl. Ins. Co. (2007 NY Slip Op 50377(U)) Appellate Term, Second Department, February 27, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie showing because its corporate officer's conclusory affidavit did not show personal knowledge of the provider's practices to lay a business-records foundation for the annexed documents.
Fortune Med., P.C. v Nationwide Mut. Ins. Co. (2007 NY Slip Op 50376(U)) Appellate Term, Second Department, February 27, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie showing because its officer's affidavit did not show personal knowledge of the provider's practices to lay a business-records foundation for the annexed documents.
Fair Price Med. Supply Corp. v Clarendon Natl. Ins. Co. (2007 NY Slip Op 50375(U)) Appellate Term, Second Department, February 27, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie showing because its corporate officer's conclusory affidavit did not show personal knowledge of the provider's practices to lay a business-records foundation for the annexed documents.
Fair Price Med. Supply Corp. v Clarendon Natl. Ins. Co. (2007 NY Slip Op 50374(U)) Appellate Term, Second Department, February 27, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie showing because its corporate officer's conclusory affidavit did not show personal knowledge of the provider's practices to lay a business-records foundation for the annexed documents.
V.S. Med. Servs., P.C. v One Beacon Ins. (2007 NY Slip Op 50369(U)) Appellate Term, Second Department, February 27, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the officer's conclusory affidavit did not show personal knowledge of the provider's practices to lay a business-records foundation for the annexed documents, so no prima facie case was made.
Vista Surgical Supplies, Inc. v GEICO Ins. Co. (2007 NY Slip Op 50367(U)) Appellate Term, Second Department, February 26, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie showing because its corporate officer's conclusory affidavit did not show personal knowledge of the provider's practices to lay a business-records foundation for the annexed documents.
Grigory v State Wide Ins. Co. (2007 NY Slip Op 50366(U)) Appellate Term, Second Department, February 26, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie showing because the affidavit of an employee or billing-company employee did not show personal knowledge of the provider's practices to lay a business-records foundation.
First Help Acupuncture, P.C. v Lumbermens Mut. Ins. Co. (2007 NY Slip Op 50365(U)) Appellate Term, Second Department, February 26, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie showing because its employee's affidavit did not show personal knowledge of the provider's practices to lay a business-records foundation for the annexed documents.
Great Wall Acupuncture v New York Cent. Mut. Fire Ins. Co. (2007 NY Slip Op 50364(U)) Appellate Term, Second Department, February 26, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie showing because its employee's affidavit did not show personal knowledge of the provider's practices to lay a business-records foundation for the annexed documents.
Fair Price Med. Supply Corp. v New York Cent. Mut. Fire Ins. Co. (2007 NY Slip Op 50357(U)) Appellate Term, Second Department, February 16, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed to make a prima facie showing because its officer's conclusory affidavit did not show personal knowledge of its practices to lay a business-records foundation for the annexed documents.
Delta Diagnostic Radiology, P.C. v Allstate Ins. Co. (2007 NY Slip Op 50246(U)) Appellate Term, Second Department, February 7, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie showing because its corporate officer's affidavit did not show personal knowledge of the provider's practices to lay a business-records foundation for the annexed documents.
Vista Surgical Supplies, Inc. v Progressive Cas. Ins. Co. (2007 NY Slip Op 50245(U)) Appellate Term, Second Department, February 7, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedAgreed the provider's moving papers were insufficient to make a prima facie showing, relying on the business-records foundation rule.
Fortune Med., P.C. v Allstate Ins. Co. (2007 NY Slip Op 50243(U)) Appellate Term, Second Department, February 7, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider's affidavit laid no business-records foundation for the claim forms and that the insurer's denial acknowledging receipt did not concede the forms' admissibility or the facts in them.
Delta Diagnostic Radiology, P.C. v American Tr. Ins. Co. (2007 NY Slip Op 50238(U)) Appellate Term, Second Department, February 6, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie showing because its corporate officer's conclusory affidavit did not show personal knowledge of the provider's practices to lay a business-records foundation for the annexed documents.
Fair Price Med. Supply Corp. v Nationwide Mut. Ins. Co. (2007 NY Slip Op 50237(U)) Appellate Term, Second Department, February 6, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie showing because its corporate officer's conclusory affidavit did not show personal knowledge of the provider's practices sufficient to lay a business-records foundation for the annexed documents.
Infinity Chiropractic, P.C. v New York Cent. Mut. Ins. Co. (2007 NY Slip Op 50262(U)) Appellate Term, Second Department, February 1, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie showing because its corporate officer's affidavit did not show personal knowledge of the provider's practices to lay a business-records foundation for the annexed documents.
DJS Med. Supplies, Inc. v Progressive Cas. Ins. Co. (2007 NY Slip Op 50261(U)) Appellate Term, Second Department, February 1, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie showing because its officer's conclusory affidavit did not show personal knowledge of the provider's practices to lay a business-records foundation for the annexed documents.
Delta Diagnostic Radiology, P.C. v Mercury Cas. Co. (2007 NY Slip Op 50264(U)) Appellate Term, Second Department, February 1, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the claimant failed its prima facie case because its officer's conclusory affidavit did not show personal knowledge of the claimant's practices sufficient to lay a business-records foundation for the annexed documents.
Fair Price Med. Supply Corp. v Progressive Cas. Ins. Co. (2007 NY Slip Op 50168(U)) Appellate Term, Second Department, January 31, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie showing because its corporate officer's conclusory affidavit did not establish personal knowledge of the provider's practices to lay a business-records foundation for the annexed documents.
All Mental Care Medicine, P.C. v Travelers Indem. Co. (2007 NY Slip Op 50166(U)) Appellate Term, Second Department, January 31, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the claimant failed its prima facie case because its officer's affidavit did not show personal knowledge of the claimant's practices sufficient to lay a business-records foundation for the annexed documents.
Fair Price Med. Supply Corp. v Tri-State Consumer Ins. Co. (2007 NY Slip Op 50152(U)) Appellate Term, Second Department, January 26, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie showing because its corporate officer's affidavit did not establish personal knowledge of the provider's practices to lay a business-records foundation for the annexed documents.
Bath Med. Supply, Inc. v Deerbrook Ins. Co. (2007 NY Slip Op 50179(U)) Appellate Term, Second Department, January 12, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed to show it submitted its claim forms because its officer's affidavit did not establish personal knowledge of the provider's practices to lay a business-records foundation for the annexed documents.
Mega Supply & Billing, Inc. v Progressive Cas. Ins. Co. (2007 NY Slip Op 50023(U)) Appellate Term, Second Department, January 3, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie showing because its corporate officer's conclusory affidavit did not establish personal knowledge of the provider's practices to lay a business-records foundation for the annexed documents.
Olympic Chiropractic, P.C. v American Tr. Ins. Co. (2007 NY Slip Op 50011(U)) Appellate Term, Second Department, January 2, 2007Claimant's proof held to make out its prima facie case (also decides)Held the provider made its prima facie case by proof of submitted claims and overdue payment, the insurer's admissions of receipt curing any defects in the mailing proof.
Fair Price Med. Supply Corp. v GEICO (2007 NY Slip Op 50012(U)) Appellate Term, Second Department, January 2, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the claimant failed its prima facie case because its officer's conclusory affidavit did not show personal knowledge of the claimant's practices sufficient to lay a business-records foundation for the annexed documents.
Mid Atl. Med. P.C. v GEICO (2007 NY Slip Op 50014(U)) Appellate Term, Second Department, January 2, 2007Claimant's proof held to make out its prima facie case (also decides)Held the provider's deficient proof of mailing its claim form was cured by the insurer's acknowledgment of receipt in its affidavit and denial form, shifting the burden to the insurer.
Vista Surgical Supplies Inc. v Allstate Ins. Co. (2006 NY Slip Op 52520(U)) Appellate Term, Second Department, December 28, 2006Insufficient: claimant did not prove the claim was submitted (mailed to and received by the insurer)Held the provider failed to establish its prima facie case because its officer's affidavit and the annexed proof did not show the claim was mailed under the certified mail number, and counsel lacked personal knowledge.
Boai Zhong Yi Acupuncture Servs., P.C. v Travelers Ins. Co. (2006 NY Slip Op 52516(U)) Appellate Term, Second Department, December 28, 2006Insufficient: claimant did not prove the claim was submitted (mailed to and received by the insurer)Held the provider failed its prima facie burden because neither its officer's affidavit with the mailing proof nor counsel's affirmation established that the claim was submitted to the insurer.
Magnezit Med. Care, P.C. v New York Cent. Mut. Fire Ins. Co. (2006 NY Slip Op 52515(U)) Appellate Term, Second Department, December 27, 2006Insufficient: claimant did not prove the claim was submitted (mailed to and received by the insurer)Held the providers failed to establish submission of the claim forms because the principal's affidavit did not describe office mailing practices, and the insurer's denials and letters did not reliably identify the claims.
North Acupuncture, P.C. v State Farm Ins. Co. (2006 NY Slip Op 52523(U)) Appellate Term, Second Department, December 18, 2006Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie burden because counsel's affirmation laid no business-records foundation for the claim form, and the insurer's denial showed only receipt, not the form's admissibility or facts.
Mega Supply & Billing, Inc. v New York Cent. Mut. Fire Ins. Co. (2006 NY Slip Op 52504(U)) Appellate Term, Second Department, December 15, 2006Insufficient: claimant did not prove the claim was submitted (mailed to and received by the insurer)Held the provider failed its prima facie burden because it did not prove mailing of the claim, and the insurer's denial form did not cure this because it did not state the amount or tie to the claim.
Vista Surgical Supplies, Inc. v Travelers Ins. Co. (2006 NY Slip Op 52502(U)) Appellate Term, Second Department, December 15, 2006Claimant's proof held to make out its prima facie case (also decides)Held the provider established its prima facie case, the insurer's denial forms showing the receipt dates adequately establishing that the claims were sent and received.
Starrett Med. L.C.P.C. v GEICO Cas. Ins. Co. (2006 NY Slip Op 52493(U)) Appellate Term, Second Department, December 13, 2006Claimant's proof held to make out its prima facie caseHeld the provider's failure to prove mailing of the claim forms was cured by the insurer's denial forms, which established that the claims were sent and received.
Vista Surgical Supplies, Inc. v American Tr. Ins. Co. (2006 NY Slip Op 52470(U)) Appellate Term, Second Department, December 12, 2006Insufficient: claimant did not prove the claim was submitted (mailed to and received by the insurer)Held the provider's moving papers did not establish that the claim form was ever submitted to the insurer, and a verification request first offered in reply was inadmissible and not properly before the court.
Impulse Chiropractic P.C. v Travelers Ins. Co. (2006 NY Slip Op 52469(U)) Appellate Term, Second Department, December 12, 2006Insufficient: claimant did not prove the claim was submitted (mailed to and received by the insurer)Held the provider failed its prima facie burden because its officer's affidavit and counsel's affirmation did not establish that the claims were mailed, and the insurer's delay letters did not identify the claims.
V.S. Med. Servs., P.C. v New York Cent. Mut. Fire Ins. Co. (2006 NY Slip Op 52553(U)) Appellate Term, Second Department, December 11, 2006Insufficient for another reason (eligibility, timely submission, own papers defeat the claim)Held the provider did not establish prima facie entitlement because three claim forms showed independent-contractor treating providers and two left the business-relationship box as 'N/A', leaving triable issues about its right to direct payment.
Vitality Chiropractic, P.C. v Kemper Ins. Co. (2006 NY Slip Op 26536) Appellate Term, Second Department, December 11, 2006Claimant's proof held to make out its prima facie case (also decides)Held the provider established its prima facie case by proof of submitted claims and overdue payment, and rejected the insurer's contentions that the showing was deficient.
Impulse Chiropractic, P.C. v Travelers Ins. Co. (2006 NY Slip Op 52371(U)) Appellate Term, Second Department, December 8, 2006Insufficient: claimant did not prove the claim was submitted (mailed to and received by the insurer)Held the provider failed to show submission of the claim form because its officer's affidavit was inadequate and the insurer's acknowledgment letter did not state the amount of the claim received.
Delta Diagnostic Radiology, P.C. v State Farm Mut. Auto. Ins. Co. (2006 NY Slip Op 52370(U)) Appellate Term, Second Department, December 8, 2006Claimant's proof held to make out its prima facie case (also decides)Held the provider established submission of its claim through the insurer's annexed denial form acknowledging receipt, but its cross motion failed because the insurer raised a triable issue.
Oleg Barshay, D.C., P.C. v State Farm Ins. Co. (2006 NY Slip Op 26496) Appellate Term, Second Department, December 8, 2006Claimant's proof held to make out its prima facie caseHeld that, although the provider's moving papers did not prove submission of the claim, the court could search the record and the insurer's own denial form annexed to its opposition supplied that element, establishing the prima facie case.
PDG Psychological P.C. v Eveready Ins. Co. (2006 NY Slip Op 52305(U)) Appellate Term, Second Department, December 1, 2006Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie showing because its corporate officer did not show sufficient personal knowledge of its office practices to lay a business-records foundation for the annexed claim forms.
Mega Supply & Billing Inc. v Auto One Ins. Co. (2006 NY Slip Op 52304(U)) Appellate Term, Second Department, December 1, 2006Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie showing because its corporate officer's conclusory affidavit did not establish personal knowledge of the provider's practices to lay a business-records foundation for the annexed documents.
Delta Diagnostic Radiology, P.C. v Liberty Mut. Ins. Co. (2006 NY Slip Op 52303(U)) Appellate Term, Second Department, December 1, 2006Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie case because its corporate officer's affidavit did not show he could lay a business-records foundation for the documents annexed to the motion.
Dan Med., P.C. v New York Cent. Mut. Fire Ins. Co. (2006 NY Slip Op 26483) Appellate Term, Second Department, December 1, 2006Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie case because its corporate officer's conclusory affidavit did not show personal knowledge of its office practices to lay a business-records foundation, and the insurer's denials or admitted receipt did not concede the claim forms' facts.
Boai Zhong Yi Acupuncture Servs. P.C. v Progressive Cas. Ins. Co. (2006 NY Slip Op 26485) Appellate Term, Second Department, November 28, 2006Claimant's proof held to make out its prima facie case (also decides)Held the provider established its prima facie case, relying on the insurer's timely denial forms conceding receipt of the four claims.
Forrest Chen Acupuncture Servs., P.C. v Nationwide Mut. Ins. Co. (2006 NY Slip Op 52270(U)) Appellate Term, Second Department, November 17, 2006Insufficient: claimant did not prove the claim was submitted (mailed to and received by the insurer)Held the provider did not establish its prima facie case because it failed to prove mailing of its claims, so the burden never shifted to the insurer.
Dilon Med. Supply Corp. v State Farm Mut. Auto. Ins. Co. (2006 NY Slip Op 52266(U)) Appellate Term, Second Department, November 17, 2006Claimant's proof held to make out its prima facie case (also decides)Held the provider made its prima facie case because the insurer's annexed denial form, whose contents matched the claim forms, showed the claims were sent and received, which shifted the burden to the insurer.
AVA Acupuncture, P.C. v New York Cent. Mut. Fire Ins. Co. (2006 NY Slip Op 52256(U)) Appellate Term, Second Department, November 15, 2006Claimant's proof held to make out its prima facie caseHeld the provider established its prima facie case for four claims because it annexed the insurer's denial forms corresponding to them, which showed the claims were sent and received.
Executive MRI Imaging, P.C. v New York Cent. Mut. Fire Ins. Co. (2006 NY Slip Op 52250(U)) Appellate Term, Second Department, November 13, 2006Claimant's proof held to make out its prima facie case (also decides)Held the provider established its prima facie case by proof it submitted claims and payment was overdue, any mailing deficiency being cured by the insurer's acknowledgment of receipt on its denial form.
AB Med. Servs., PLLC v Lancer Ins. Co. (2006 NY Slip Op 52241(U)) Appellate Term, Second Department, November 2, 2006Insufficient: claimant did not prove the claim was submitted (mailed to and received by the insurer)Held the provider failed its prima facie showing because it did not annex to its motion papers the claim forms being sued upon.
New Century Chiropractic, P.C. v State Farm Mut. Ins. Co. (2006 NY Slip Op 52236(U)) Appellate Term, Second Department, November 2, 2006Claimant's proof held to make out its prima facie case (also decides)Held the provider established its prima facie case because, although its moving papers did not prove mailing, the insurer's denial form showed the claims were sent and received and payment was overdue.
Post Traumatic Med. Care P.C. v Travelers Home & Mar. Ins. Co. (2006 NY Slip Op 52222(U)) Appellate Term, Second Department, October 27, 2006Insufficient: claimant did not prove the claim was submitted (mailed to and received by the insurer)Held no prima facie case because the billing manager's affidavit did not state when the claim was mailed or describe office mailing practice, and the certified-mail card was not tied to the claim.
Bell Air Med. Supply LLC v State Farm Ins. Claim Off. (2006 NY Slip Op 52218(U)) Appellate Term, Second Department, October 27, 2006Insufficient: claimant did not prove the claim was submitted (mailed to and received by the insurer) (also decides)Held the provider failed to prove mailing of one claim, while the insurer's denial form acknowledging receipt established a prima facie case on the other claim.
SpineAmericare Med., P.C. v State Farm Mut. Auto. Ins. Co. (2006 NY Slip Op 52035(U)) Appellate Term, Second Department, October 5, 2006Claimant's proof held to make out its prima facie caseHeld the provider made its prima facie showing for 10 of 12 claims because the insurer's letters established receipt, despite its officer's deficient mailing affidavit; the other two claims went to further proceedings.
Delta Diagnostic Radiology, P.C. v Allstate Ins. Co. (2006 NY Slip Op 52034(U)) Appellate Term, Second Department, October 5, 2006Claimant's proof held to make out its prima facie caseHeld the provider established its prima facie case because the insurer's explanation of benefits form, giving the date the claim was received, showed submission and receipt.
Midborough Acupuncture, P.C. v New York Cent. Mut. Fire Ins. Co. (2006 NY Slip Op 51879(U)) Appellate Term, Second Department, October 2, 2006Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie case because counsel's affirmation lacked personal knowledge and laid no business-records foundation for the claim forms, and the insurer's denials established receipt but not the forms' admissibility or contents.
Delta Diagnostic Radiology, P.C. v Country-Wide Ins. Co. (2006 NY Slip Op 51877(U)) Appellate Term, Second Department, October 2, 2006Claimant's proof held to make out its prima facie case (also decides)Held the provider's affirmation and affidavit did not show submission, but the insurer's denial forms acknowledging receipt ordinarily cured that deficiency.
Triboro Chiropractic & Acupuncture P.L.L.C v Allstate Ins. Co. (2006 NY Slip Op 51740(U)) Appellate Term, Second Department, September 14, 2006Claimant's proof held to make out its prima facie case (also decides)Held the provider established prima facie entitlement to summary judgment for the claims at issue.
Prestige Med. & Surgical Supply, Inc. v Clarendon Natl. Ins. Co. (2006 NY Slip Op 51672(U)) Appellate Term, Second Department, August 18, 2006Claimant's proof held to make out its prima facie caseHeld the provider established its prima facie case because, although its own mailing proof was insufficient, the insurer's denial forms and adjusters' affidavits acknowledged receipt of the claims.
A.M. Med. Servs., P.C. v New York Cent. Mut. Ins. (2006 NY Slip Op 51662(U)) Appellate Term, Second Department, August 15, 2006Claimant's proof held to make out its prima facie case (also decides)Held the provider made its prima facie case because the insurer admitted receiving the five claim forms at issue.
IVB Med. Supply, Inc. v New York Cent. Mut. Fire Ins. Co. (2006 NY Slip Op 51660(U)) Appellate Term, Second Department, August 14, 2006Insufficient: claimant did not prove the claim was submitted (mailed to and received by the insurer)Held the provider failed its prima facie burden because its officer's affidavit, post office ledger and counsel's affirmation did not prove mailing, and the denial form named a different claim amount.
Delta Diagnostic Radiology, P.C. v GEICO Ins. Co. (2006 NY Slip Op 51557(U)) Appellate Term, Second Department, July 26, 2006Claimant's proof held to make out its prima facie case (also decides)Held, contrary to the lower court, that the provider's affidavit sufficed to admit its claim forms, mailing receipts and denials showing receipt, so it established its prima facie case.
Vista Surgical Supplies, Inc. v Nationwide Mut. Ins. Co. (2006 NY Slip Op 51556(U)) Appellate Term, Second Department, July 26, 2006Insufficient: claimant did not prove the claim was submitted (mailed to and received by the insurer)Held the provider failed its prima facie burden because its officer's affidavit and certified mail proof did not show the claims were mailed, and the denial form left the receipt-date fields blank.
Midborough Acupuncture P.C. v State Farm Ins. Co. (2006 NY Slip Op 26360) Appellate Term, Second Department, July 26, 2006Claimant's proof held to make out its prima facie case (also decides)Held the provider established its prima facie case by proof that it submitted claims setting forth the fact and amount of loss and that payment was overdue.
A.B. Med. Servs. PLLC v Peerless Ins. Co. (2006 NY Slip Op 26318) Appellate Term, Second Department, July 26, 2006Claimant's proof held to make out its prima facie caseHeld the providers made their prima facie case by proof of submitted claims and overdue payment and did not have to establish the validity of the assignments, though one provider's mailing receipts did not prove three claims.
Accessible & Advance Med. P.C. v Allstate Ins. Co. (2006 NY Slip Op 51599(U)) Appellate Term, Second Department, July 19, 2006Claimant's proof held to make out its prima facie case (also decides)Held the provider made its prima facie case because, although its affidavit did not prove mailing of the claim forms, the insurer's denial forms established that the claims were sent and received.
Delta Diagnostic Radiology, P.C. v American Mfrs. Mut. Ins. Co. (2006 NY Slip Op 51439(U)) Appellate Term, Second Department, July 18, 2006Claimant's proof held to make out its prima facie case (also decides)Held the provider's affidavit sufficed to put the claim forms before the court and the denial forms acknowledging receipt cured the mailing gap, shifting the burden to the insurer.
Fair Price Med. Supply Corp. v Liberty Mut. Ins. Co. (2006 NY Slip Op 51438(U)) Appellate Term, Second Department, July 18, 2006Claimant's proof held to make out its prima facie caseHeld the gap in the provider's proof of submitting the claim was cured by the insurer's denial form stating the date the claim was received, so the provider made its prima facie case.
Magnezit Med. Care, P.C. v New York Cent. Mut. Fire Ins. Co. (2006 NY Slip Op 51434(U)) Appellate Term, Second Department, July 18, 2006Claimant's proof held to make out its prima facie case (also decides)Held the providers made their prima facie showing because, although their papers did not prove mailing, the insurer's claims examiner affidavit and denial forms acknowledging receipt established the claims were sent and received.
Fair Price Med. Supply Corp. v ELRAC Inc. (2006 NY Slip Op 51437(U)) Appellate Term, Second Department, July 18, 2006Claimant's proof held to make out its prima facie case (also decides)Held the provider made its prima facie case because the insurer's denial form acknowledging receipt cured the provider's insufficient mailing affidavit, shifting the burden to the insurer.
PDG Psychological P.C. v Progressive Cas. Ins. Co. (2006 NY Slip Op 51432(U)) Appellate Term, Second Department, July 17, 2006Insufficient: claimant did not prove the claim was submitted (mailed to and received by the insurer)Held the provider proved one claim through the insurer's denial showing receipt, but not two others, because its officer neither stated he mailed them nor described a mailing practice and certified receipts were not tied to them.
SZ Med. P.C. v Clarendon Natl. Ins. Co. (2006 NY Slip Op 51428(U)) Appellate Term, Second Department, July 17, 2006Claimant's proof held to make out its prima facie case (also decides)Held the record established the provider's prima facie showing that it submitted the claim and that payment was overdue.
Benson Med., P.C. v Progressive Northeastern Ins. Co. (2006 NY Slip Op 51427(U)) Appellate Term, Second Department, July 17, 2006Claimant's proof held to make out its prima facie case (also decides)Held the provider established its prima facie case by proving submission of claims setting forth the fact and amount of loss and that payment was overdue, and that proper claim forms establish medical necessity prima facie.
A.M. Med. Servs., P.C. v Allstate Ins. Co. (2006 NY Slip Op 51426(U)) Appellate Term, Second Department, July 17, 2006Claimant's proof held to make out its prima facie case (also decides)Held that although the provider's affidavit did not establish mailing, the insurer's denial forms showed the claims were sent and received, curing the deficiency in the provider's prima facie showing.
A.M. Med. Servs., P.C. v Nationwide Mut. Ins. Co. (2006 NY Slip Op 51425(U)) Appellate Term, Second Department, July 14, 2006Claimant's proof held to make out its prima facie case (also decides)Held the provider established prima facie entitlement by proof that it submitted the claims and that payment was overdue, the pre-2002 EUO request not tolling the 30-day period.
Ocean Diagnostic Imaging P.C. v New York Cent. Mut. Fire Ins. Co. (2006 NY Slip Op 51424(U)) Appellate Term, Second Department, July 14, 2006Claimant's proof held to make out its prima facie case (also decides)Held the provider established prima facie entitlement by proof that it submitted the claim forms and that payment was overdue because the insurer did not pay or deny within 30 days.
Amaze Med. Supply Inc. v Allstate Ins. Co. (2006 NY Slip Op 51412(U)) Appellate Term, Second Department, July 12, 2006Claimant's proof held to make out its prima facie case (also decides)Held the supplier made its prima facie showing by proving it submitted claims stating the fact and amount of loss and that payment was overdue, though the motion failed on the insurer's defense.
Fair Price Med. Supply Corp. v ELRAC Inc. (2006 NY Slip Op 51417(U)) Appellate Term, Second Department, July 12, 2006Insufficient: claimant did not prove the claim was submitted (mailed to and received by the insurer) (also decides)Held the provider's affidavit failed to show mailing; the defect was cured for one claim by the insurer's denial acknowledging receipt, but the other claim failed for lack of proof of submission.
Bronxborough Med., P.C. v New Hampshire Ins. Co. (2006 NY Slip Op 51354(U)) Appellate Term, Second Department, July 7, 2006Claimant's proof held to make out its prima facie caseHeld the provider made its prima facie case because the insurer's concession and its denial form noting the receipt date established submission and receipt, and alleged defects in the claim form and supporting affidavit were waived.
Psychology & Massage Therapy Assoc., PLLC v Progressive Cas. Ins. Co. (2006 NYSlipOp 51351(U)) Appellate Term, Second Department, July 6, 2006Claimant's proof held to make out its prima facie case (also decides)Held the provider established its prima facie case by proving it submitted a claim stating the fact and amount of the loss and that payment was overdue.
Psychological Practice, P.C. v Kemper Auto & Home Ins. Co. (2006 NY Slip Op 51289(U)) Appellate Term, Second Department, July 3, 2006Claimant's proof held to make out its prima facie case (also decides)Held the provider established its prima facie case by proof that it submitted the claim and that payment was overdue, shifting the burden to the insurer.
M.G.M. Psychiatry Care P.C. v Utica Mut. Ins. Co. (2006 NY Slip Op 51286(U)) Appellate Term, Second Department, July 3, 2006Claimant's proof held to make out its prima facie caseHeld the provider made out its prima facie case because the insurer's denial of claim forms, annexed to the moving papers, cured defects in its proof of submission by showing the claims were sent and received.
Fair Price Med. Supply Corp. v ELRAC Inc. (2006 NY Slip Op 26269) Appellate Term, Second Department, July 3, 2006Claimant's proof held to make out its prima facie case (also decides)Held the provider established its prima facie case because the insurer's acknowledgment of receipt on its denial form cured the provider's insufficient mailing affidavit, shifting the burden to the insurer.
Vista Surgical Supplies, Inc. v Liberty Mut. Ins. Co. (2006 NY Slip Op 26276) Appellate Term, Second Department, June 30, 2006Insufficient: claimant did not prove the claim was submitted (mailed to and received by the insurer)Held the provider failed its prima facie case because its officer referred to proof of mailing that was not annexed, the insurer admitted no receipt, and the unsigned stipulation was unenforceable.
Contemporary Acupuncture P.C. v Travelers Ins. Co. (2006 NY Slip Op 51278(U)) Appellate Term, Second Department, June 29, 2006Insufficient: claimant did not prove the claim was submitted (mailed to and received by the insurer)Held the provider failed its prima facie case because counsel's affirmation and an officer's affidavit merely noting proof of mailing in the file did not establish submission, and an unrelated denial form did not show receipt.
A.B. Med. Servs. PLLC v New York Cent. Mut. Fire Ins. Co. (2006 NY Slip Op 51347(U)) Appellate Term, Second Department, June 22, 2006Claimant's proof held to make out its prima facie case (also decides)Held the providers made their prima facie showing by proof that they submitted claims stating the fact and amount of the losses and that payment was overdue, shifting the burden to the insurer.
Vista Surgical Supplies, Inc. v State Farm Mut. Ins. Co. (2006 NY Slip Op 51189(U)) Appellate Term, Second Department, June 15, 2006Claimant's proof held to make out its prima facie caseHeld the provider made its prima facie case because the insurer's denial forms cured its deficient mailing affidavit by showing receipt, except a $110 item not covered by the prescription.
Lexington Acupuncture, P.C. v State Farm Ins. Co. (2006 NY Slip Op 26251) Appellate Term, Second Department, June 7, 2006Claimant's proof held to make out its prima facie case (also decides)Held the provider's affidavit sufficiently established mailing of the claims and that payment was overdue, rejecting the insurer's challenge to its prima facie showing.
Amaze Med. Supply Inc. v New York Cent. Mut. Fire Ins. Co. (2006 NY Slip Op 51051(U)) Appellate Term, Second Department, June 5, 2006Claimant's proof held to make out its prima facie case (also decides)Held the supplier made its prima facie showing by proof that it submitted claims setting forth the fact and amounts of loss and that payment was overdue, shifting the burden to the insurer.
Vista Surgical Supplies, Inc. v Metropolitan Prop. & Cas. Ins. Co. (2006 NY Slip Op 51047(U)) Appellate Term, Second Department, June 2, 2006Claimant's proof held to make out its prima facie case (also decides)Held the provider established its prima facie case because the insurer's claims adjuster acknowledged receipt of both claims, curing the provider's insufficient proof of mailing.
First Help Acupuncture P.C. v State Farm Ins. Co. (2006 NY Slip Op 51043(U)) Appellate Term, Second Department, May 30, 2006Claimant's proof held to make out its prima facie case (also decides)Held that although the provider's papers did not establish submission of the claim forms, the insurer's acknowledgment of receipt in its denial forms cured the deficiency.
Delta Diagnostic Radiology, P.C. v State Farm Mut. Ins. Co. (2006 NY Slip Op 51345(U)) Appellate Term, Second Department, May 25, 2006Claimant's proof held to make out its prima facie case (also decides)Held the provider established its prima facie entitlement by proof that it submitted the claim stating the fact and amount of the loss and that payment was overdue.
Dilon Med. Supply Corp. v State Farm Mut. Ins. Co. (2006 NY Slip Op 51344(U)) Appellate Term, Second Department, May 25, 2006Claimant's proof held to make out its prima facie caseHeld the provider made its prima facie case because, although its moving papers did not prove mailing of the claim form, the insurer's denial form and employee affidavit acknowledged receipt and the denial was untimely.
Ultra Diagnostics Imaging v Empire Ins. Co. (2006 NY Slip Op 51337(U)) Appellate Term, Second Department, May 24, 2006Claimant's proof held to make out its prima facie caseHeld the provider established its prima facie case by proof that it submitted the claim setting forth the fact and amount of loss and that payment was overdue; with no opposition, summary judgment was granted.
Vista Surgical Supplies, Inc. v Statewide Ins. Co. (2006 NY Slip Op 51118(U)) Appellate Term, Second Department, May 24, 2006Insufficient: claimant did not prove the claim was submitted (mailed to and received by the insurer)Held the provider failed its prima facie case because its officer lacked personal knowledge of mailing, certified-mail receipts were not tied to the claims, and the insurer's verification letters did not show receipt.
A.M. Med. Servs., P.C. v Progressive Cas. Ins. Co. (2006 NY Slip Op 51036(U)) Appellate Term, Second Department, May 19, 2006Claimant's proof held to make out its prima facie case (also decides)Held the provider established prima facie entitlement by showing it submitted the statutory claim form stating the fact and amount of loss and that payment was overdue.
A.B. Med. Servs. PLLC v State Farm Mut. Auto. Ins. Co. (2006 NY Slip Op 51033(U)) Appellate Term, Second Department, May 19, 2006Claimant's proof held to make out its prima facie case (also decides)Held the providers established their prima facie entitlement by proof that they submitted claims stating the fact and amount of the loss and that payment was overdue.
Vista Surgical Supplies, Inc. v General Assur. Co. (2006 NY Slip Op 51034(U)) Appellate Term, Second Department, May 19, 2006Claimant's proof held to make out its prima facie case (also decides)Held the supplier made its prima facie case by proving submission of claims and overdue payment, rejecting the argument that it had to authenticate the assignment.
Amaze Med. Supply Inc. v Allstate Ins. Co. (2006 NY Slip Op 50909(U)) Appellate Term, Second Department, May 17, 2006Claimant's proof held to make out its prima facie case (also decides)Held the provider established prima facie entitlement by proving submission of a claim setting forth the fact and amount of the loss and that payment was overdue.
Dilon Med. Supply Corp. v Progressive Cas. Ins. Co. (2006 NY Slip Op 50908(U)) Appellate Term, Second Department, May 17, 2006Claimant's proof held to make out its prima facie caseHeld the provider made its prima facie case on both claims through its officer's account of its certified-mail billing practice and signed, date-stamped post office ledgers naming the insurer.
SZ Med. P.C. v Country-Wide Ins. Co. (2006 NY Slip Op 26194) Appellate Term, Second Department, May 17, 2006Claimant's proof held to make out its prima facie case (also decides)Held the three providers established their prima facie case by proof that they submitted claims and that payment was overdue, shifting the burden to the insurer.
Amaze Med. Supply Inc. v General Assur. Co. (2006 NY Slip Op 50910(U)) Appellate Term, Second Department, May 17, 2006Claimant's proof held to make out its prima facie case (also decides)Held the provider made its prima facie showing by proving submission of claims stating the fact and amount of loss and that payment was overdue, though its motion failed on the insurer's triable issue.
A.B. Med. Servs. PLLC v Allstate Ins. Co. (2006 NY Slip Op 50746(U)) Appellate Term, Second Department, April 27, 2006Insufficient: claimant did not prove the claim was submitted (mailed to and received by the insurer)Held the billing manager's affidavit insufficient because it did not specify for which of the three plaintiff providers he worked, so the providers' submission of the claims was not established.
AT Med. P.C. v Utica Mut. Ins. Co. (2006 NY Slip Op 50739(U)) Appellate Term, Second Department, April 14, 2006Claimant's proof held to make out its prima facie case (also decides)Held deficiencies in the provider's proof of submitting the claims were cured by the insurer's denial forms, which established the claims were sent and received, so the prima facie case was made.
Staten Is. Chiropractic Assoc., P.C. v Long Is. Ins. Co. (2006 NY Slip Op 50588(U)) Appellate Term, Second Department, April 7, 2006Insufficient: claimant did not prove the claim was submitted (mailed to and received by the insurer)Held the provider failed its prima facie case because its bare statement that claims were timely submitted in the ordinary course did not prove mailing, and a blanket denial form admitted receipt of no specific claim.
A.B. Med. Servs. PLLC v Utica Mut. Ins. Co. (2006 NY Slip Op 51334(U)) Appellate Term, Second Department, April 6, 2006Claimant's proof held to make out its prima facie case (also decides)Held the providers established their prima facie case by proof that they submitted statutory claim forms stating the fact and amounts of the losses and that payment was overdue.
Rigid Med. of Flatbush, P.C. v New York Cent. Mut. Fire Ins. Co. (2006 NY Slip Op 50582(U)) Appellate Term, Second Department, April 6, 2006Claimant's proof held to make out its prima facie case (also decides)Held the provider established its prima facie case by proof of submission of the claim form and overdue payment, noting the insurer's own denial form showed a denial more than 30 days after receipt.
A.B. Med. Servs. PLLC v Prudential Prop. & Cas. Ins. Co. (2006 NY Slip Op 50504(U)) Appellate Term, Second Department, March 27, 2006Claimant's proof held to make out its prima facie case (also decides)Held the providers established prima facie entitlement by proof that they submitted statutory claim forms setting forth the fact and amount of loss and that payment was overdue, rejecting index-number and assignment objections.
Delta Diagnostic Radiology, P.C. v Progressive Cas. Ins. Co (2006 NYSlipOp 50491(U)) Appellate Term, Second Department, March 27, 2006Claimant's proof held to make out its prima facie case (also decides)Held the provider established its prima facie case through the insurer's denial acknowledging receipt and need not prove mailing of the assignment form, since its NF-3 stated an assignment was attached.
Ocean Diagnostic Imaging, P.C. v Nationwide Mut. Ins. Co. (2006 NY Slip Op 50477(U)) Appellate Term, Second Department, March 27, 2006Claimant's proof held to make out its prima facie case (also decides)Held the provider made its prima facie showing by proving it submitted the claims stating the fact and amount of loss and that payment was overdue, shifting the burden to the insurer.
A.B. Med. Servs. PLLC v Allstate Ins. Co. (2006 NY Slip Op 50474(U)) Appellate Term, Second Department, March 27, 2006Claimant's proof held to make out its prima facie case (also decides)Held the providers made their prima facie case by proof that they submitted the statutory claim forms setting forth the fact and amount of the loss and that payment was overdue.
Magnezit Med. Care, P.C. v New York Cent. Mut. Fire Ins. Co. (2006 NY Slip Op 50473(U)) Appellate Term, Second Department, March 27, 2006Insufficient: claimant did not prove the claim was submitted (mailed to and received by the insurer)Held the providers failed their prima facie case because the principal's bare averment of mailing described no office practice, and unexplained discrepancies made the insurer's denial forms inadequate to show receipt.
Radiology Today P.C. v Allstate Ins. Co. (2006 NY Slip Op 50472(U)) Appellate Term, Second Department, March 27, 2006Claimant's proof held to make out its prima facie case (also decides)Held the provider established its prima facie case by showing it submitted a completed proof of claim and payment was overdue, shifting the burden to the insurer.
A.B. Med. Servs. PLLC v GEICO Cas. Ins. Co. (2006 NY Slip Op 26133) Appellate Term, Second Department, March 27, 2006Claimant's proof held to make out its prima facie case (also decides)Held the provider established its prima facie case for the two claims it actually sought, but not for an additional amount it had not requested.
A.B. Med. Servs. PLLC v Commercial Mut. Ins. Co. (2006 NY Slip Op 26118) Appellate Term, Second Department, March 27, 2006Claimant's proof held to make out its prima facie case (also decides)Held the providers established prima facie entitlement by proof that they submitted the claims stating the fact and amount of the losses and that payment was overdue; the motion still failed on the insurer's fraud defense.
Star Med. Servs., P.C. v Allstate Ins. Co. (2006 NYSlipOp 50344(U)) Appellate Term, Second Department, March 7, 2006Claimant's proof held to make out its prima facie case (also decides)Held the provider made its prima facie showing by proving it submitted claims stating the fact and amount of loss and that payment was overdue.
All County Open MRI & Diagn. Radiology P.C. v Travelers Ins. Co. (2006 NY Slip Op 50318(U)) Appellate Term, Second Department, March 3, 2006Claimant's proof held to make out its prima facie caseHeld the provider made its prima facie case by proof of submitting the claim and overdue payment, and was not required to submit a physician's affidavit proving medical necessity.
Fair Price Med. Supply Corp. v ELRAC Inc. (2006 NY Slip Op 50862(U)) Appellate Term, Second Department, March 2, 2006Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the insurer's dated admission of receipt cured the proof gap for one claim, but for two claims its undated acknowledgment of receipt left the supplier unable to show payment was overdue.
Magnezit Med. Care, P.C. v Allstate Ins. Co. (2006 NY Slip Op 50293(U)) Appellate Term, Second Department, February 28, 2006Insufficient: claimant did not prove the claim was submitted (mailed to and received by the insurer)Held the providers failed their prima facie case on the first cause of action because the principal described no office mailing practice and her bare averment of mailing dates showed no personal knowledge.
Fair Price Med. Supply Corp. v ELRAC Inc. (2006 NY Slip Op 50858(U)) Appellate Term, Second Department, February 28, 2006Claimant's proof held to make out its prima facie case (also decides)Held the gap in the supplier's proof of submission was cured by the insurer's denial form admitting receipt of the claim, and its investigation letters did not toll the 30-day period.
Fair Price Med. Supply Corp. v ELRAC Inc. (2006 NY Slip Op 50859(U)) Appellate Term, Second Department, February 28, 2006Claimant's proof held to make out its prima facie case (also decides)Held the gap in the provider's proof of submission was cured by the insurer's denial form admitting receipt of the claim, so the provider's prima facie showing was made.
Fair Price Med. Supply Corp. v ELRAC Inc. (2006 NY Slip Op 50861(U)) Appellate Term, Second Department, February 28, 2006Insufficient: claimant did not prove the claim was submitted (mailed to and received by the insurer) (also decides)Held two claims established through the insurer's denial forms acknowledging receipt, but two others not shown submitted because the officer merely said mailing proofs were in his possession and counsel lacked personal knowledge.
Patil v Countrywide Ins. Co. (2006 NY Slip Op 50306(U)) Appellate Term, Second Department, February 27, 2006Insufficient: claimant did not prove the claim was submitted (mailed to and received by the insurer)Held the provider failed its prima facie case because the claim forms were offered only through an attorney's affirmation lacking personal knowledge and the provider's affidavit did not refer to them.
Amaze Med. Supply Inc. v General Assur. Co. (2006 NY Slip Op 50307(U)) Appellate Term, Second Department, February 27, 2006Claimant's proof held to make out its prima facie case (also decides)Held the provider made its prima facie case by proof that it submitted claims stating the fact and amount of loss and that payment was overdue; the motion was nonetheless denied on the insurer's opposition.
A.B. Med. Servs. PLLC v Utica Mut. Ins. Co. (2006 NY Slip Op 26068) Appellate Term, Second Department, February 17, 2006Claimant's proof held to make out its prima facie case (also decides)Held the providers made their prima facie showing by proving submission of claims stating the fact and amount of loss and that payment was overdue; summary judgment was still denied because discovery was outstanding.
PDG Psychological P.C. v Utica Mut. Ins. Co. (2006 NY Slip Op 50246(U)) Appellate Term, Second Department, February 14, 2006Claimant's proof held to make out its prima facie caseRejected the insurer's challenge, holding the provider made its prima facie case because it could rely on the insurer's own denial forms to establish the dates of receipt of the claims.
Star Med. Servs., P.C. v Allstate Ins. Co. (2006 NY Slip Op 50245(U)) Appellate Term, Second Department, February 14, 2006Claimant's proof held to make out its prima facie case (also decides)Held the provider made its prima facie showing by proving it submitted claims stating the fact and amounts of loss and that payment was overdue.
Vista Surgical Supplies, Inc. v Allstate Ins. Co. (2006 NY Slip Op 51332(U)) Appellate Term, Second Department, February 6, 2006Insufficient: claimant did not prove the claim was submitted (mailed to and received by the insurer)Held the provider failed its prima facie case because counsel lacked personal knowledge and the officer neither stated he mailed the claim nor described a standard office mailing practice.
Modern Psychiatric Servs. P.C. v Progressive Ins. Co. (2006 NY Slip Op 50143(U)) Appellate Term, Second Department, February 3, 2006Claimant's proof held to make out its prima facie case (also decides)Held the provider established prima facie entitlement by proof that it submitted the statutory claim form stating the fact and amount of loss and that payment was overdue.
Ocean Diagnostic Imaging P.C. v Allstate Ins. Co. (2006 NY Slip Op 50140(U)) Appellate Term, Second Department, February 3, 2006Claimant's proof held to make out its prima facie caseHeld the provider established its prima facie case by proof that it submitted claims stating the fact and amount of the losses and that payment was overdue, contrary to the lower court.
Delta Diagnostic Radiology, P.C. v GEICO Ins. Co. (2006 NY Slip Op 50137(U)) Appellate Term, Second Department, February 2, 2006Claimant's proof held to make out its prima facie case (also decides)Held the provider established its prima facie case by proof of submitting its claim and that payment was overdue, shifting the burden to the insurer.
Star Med. Servs. P.C. v Allstate Ins. Co. (2006 NY Slip Op 50129(U)) Appellate Term, Second Department, February 1, 2006Claimant's proof held to make out its prima facie case (also decides)Held the provider made its prima facie case by proof that it submitted claims stating the fact and amount of loss and that payment was overdue; the affirmance rested mainly on rejecting the insurer's defenses.
Jeffrey I. Rubin, Phd Psyc. Svcs., P.C. v Utica Mut. Ins. Co. (2005 NY Slip Op 52206(U)) Appellate Term, Second Department, December 30, 2005Claimant's proof held to make out its prima facie case (also decides)Held the provider established its prima facie entitlement by proof that it submitted claims stating the fact and amount of loss and that payment was overdue, before the insurer raised a triable coverage issue.
Gribenko v Allstate Ins. Co. (2005 NYSlipOp 52201(U)) Appellate Term, Second Department, December 30, 2005Insufficient: claimant did not prove the claim was submitted (mailed to and received by the insurer)Held the providers failed to make a prima facie showing because their affidavits did not establish a standard office mailing practice or the affiants' knowledge of compliance, so submission of the claim forms was not proved.
Ocean Diagnostic Imaging P.C. v AIU Ins. Co. (2005 NY Slip Op 52200(U)) Appellate Term, Second Department, December 30, 2005Claimant's proof held to make out its prima facie case (also decides)Held the provider established its prima facie entitlement by proof that it submitted claims stating the fact and amount of loss and that payment was overdue.
Millennium Med. Instruments Inc. v NYC Tr. Auth. (2005 NY Slip Op 52205(U)) Appellate Term, Second Department, December 30, 2005Claimant's proof held to make out its prima facie case (also decides)Held the supplier made its prima facie showing by proof that it submitted a claim setting forth the fact and amount of loss and that payment was overdue.
Careplus Med. Supply Inc. v State-Wide Ins. Co. (2005 NY Slip Op 25545) Appellate Term, Second Department, December 15, 2005Claimant's proof held to make out its prima facie caseHeld the provider made its prima facie case because the insurer's own denial form, submitted by both sides without objection, established that the claims were sent and received and showed the denial was untimely.
Air Plus Surgical Supply, Inc. v Progressive Ins. Co. (2005 NY Slip Op 52088(U)) Appellate Term, Second Department, December 12, 2005Claimant's proof held to make out its prima facie case (also decides)Held the supplier established its prima facie case by showing it submitted completed proofs of claim and that payment was overdue, shifting the burden to the insurer.
A.B. Med. Servs. PLLC v Liberty Mut. Ins. Co. (2005 NY Slip Op 51902(U)) Appellate Term, Second Department, November 21, 2005Claimant's proof held to make out its prima facie case (also decides)Held the provider established prima facie entitlement to partial summary judgment by proof that it submitted claims setting forth the fact and amount of loss and that payment was overdue.
Amaze Med. Supply Inc. v Lumbermens Mut. Cas. Co. (2005 NY Slip Op 51898(U)) Appellate Term, Second Department, November 21, 2005Claimant's proof held to make out its prima facie case (also decides)Held the supplier made its prima facie showing by proof that it submitted claims setting forth the fact and amounts of loss and that payment was overdue, shifting the burden to the insurer.
A.B. Med. Servs. PLLC v American Tr. Ins. Co. (2005 NY Slip Op 51893(U)) Appellate Term, Second Department, November 4, 2005Claimant's proof held to make out its prima facie caseHeld the provider established its prima facie case by proof that it submitted claims setting forth the fact and amounts of loss and that payment was overdue, and granted partial summary judgment.
A.B. Med. Servs. PLLC v Encompass Ins. (2005 NY Slip Op 51892(U)) Appellate Term, Second Department, November 4, 2005Claimant's proof held to make out its prima facie case (also decides)Held three providers established prima facie entitlement by proof that they submitted claims stating the fact and amount of loss and that payment was overdue, with untimely denials precluding most defenses.
Ocean Diagnostic Imaging, P.C. v Utica Mut. Ins. Co. (2005 NY Slip Op 51747(U)) Appellate Term, Second Department, October 21, 2005Claimant's proof held to make out its prima facie case (also decides)Held the provider made its prima facie case by proof that it submitted a statutory claim form setting forth the fact and amount of the loss and that payment was overdue.
D.A.V. Chiropractic P.C. v GEICO Ins. (2005 NY Slip Op 51746(U)) Appellate Term, Second Department, October 21, 2005Claimant's proof held to make out its prima facie case (also decides)Held the provider established a prima facie case by proof that it submitted claims stating the fact and amount of loss and that payment was overdue.
Ocean Diagnostic Imaging, P.C. v Utica Mut. Ins. Co. (2005 NYSlipOp 51745(U)) Appellate Term, Second Department, October 21, 2005Claimant's proof held to make out its prima facie case (also decides)Held the provider established its prima facie case by proof that it submitted a statutory claim form setting forth the fact and amount of the loss and that payment was overdue, shifting the burden to the insurer.
A.B. Med. Servs. PLLC v Utica Mut. Ins. Co. (2005 NY Slip Op 25456) Appellate Term, Second Department, October 21, 2005Claimant's proof held to make out its prima facie case (also decides)Held the providers established prima facie entitlement by proof that they submitted statutory claim forms stating the fact and amount of loss and that payment was overdue.
Corona Med. Imaging, P.C. v State Farm Ins. Cos. (2005 NY Slip Op 51685(U)) Appellate Term, Second Department, October 20, 2005Claimant's proof held to make out its prima facie case (also decides)Held the provider established its prima facie entitlement by proof that it submitted a claim stating the fact and amount of loss and that payment was overdue.
Careplus Med. Medical Supply Inc. v Allstate Ins. Co. (2005 NY Slip Op 51598(U)) Appellate Term, Second Department, September 30, 2005Claimant's proof held to make out its prima facie case (also decides)Held the provider established prima facie entitlement on the two assignors' claims by proof that it submitted claims stating the fact and amount of loss and that payment was overdue.
Careplus Med. Supply Inc. v Allstate Ins. Co. (2005 NYSlipOp 51526(U)) Appellate Term, Second Department, September 20, 2005Claimant's proof held to make out its prima facie case (also decides)Held the supplier established its prima facie case through claim forms showing the fact and amount of loss and overdue payment, rejecting arguments that coverage was unproven and that its billing manager lacked personal knowledge of delivery.
Careplus Med. Supply Inc. v Allstate Ins. Co. (2005 NYSlipOp 51525(U)) Appellate Term, Second Department, September 20, 2005Claimant's proof held to make out its prima facie caseHeld the supplier established prima facie entitlement by proof of claim forms and overdue payment, its claim forms prima facie showing coverage and its billing manager's affidavit laying a sufficient business-records foundation for delivery.
Ultra Diagnostics Imaging v Liberty Mut. Ins. Co. (2005 NY Slip Op 25402) Appellate Term, Second Department, September 20, 2005Claimant's proof held to make out its prima facie caseHeld the provider established its prima facie case because the insurer's own denial forms, showing the dates the claims were received, adequately proved submission and receipt, and payment was overdue.
Careplus Med. Supply, Inc v Allstate Indem. Co. (2005 NY Slip Op 51527(U)) Appellate Term, Second Department, September 20, 2005Claimant's proof held to make out its prima facie case (also decides)Held the supplier established its prima facie case through claim forms showing the fact and amount of loss and overdue payment, rejecting arguments that coverage was unproven and that its billing manager lacked personal knowledge of delivery.
A.B. Med. Servs. PLLC v American Tr. Ins. Co. (2005 NYSlipOp 51316(U)) Appellate Term, Second Department, August 17, 2005Claimant's proof held to make out its prima facie caseHeld, contrary to the lower court, that the providers made their prima facie case because the insurer's denial forms showing the dates the claims were received established that the claims were sent and received.
Amaze Med. Supply Inc. v State Farm Mut. Auto. Ins. Co. (2005 NYSlipOp 51315(U)) Appellate Term, Second Department, August 17, 2005Claimant's proof held to make out its prima facie case (also decides)Held the provider established its prima facie case by proof that it submitted a claim setting forth the fact and amount of the loss and that payment was overdue.
S&M Supply Inc. v Progressive Ins. Co. (2005 NYSlipOp 51312(U)) Appellate Term, Second Department, August 17, 2005Claimant's proof held to make out its prima facie case (also decides)Held the supplier established its prima facie case by proof that it submitted the claims setting forth the fact and amount of the loss and that payment was overdue.
Amaze Med. Supply Inc. v Hereford Ins. Co. (2005 NYSlipOp 51331(U)) Appellate Term, Second Department, August 11, 2005Claimant's proof held to make out its prima facie case (also decides)Held the supplier established a prima facie case by proof that it submitted claims stating the fact and amount of loss and that payment was overdue.
Fair Price Med. Supply Corp. v Travelers Indem. Co. (2005 NY Slip Op 25343) Appellate Term, Second Department, August 11, 2005Claimant's proof held to make out its prima facie case (also decides)Held the provider made a prima facie showing because its papers established the insurer received the claims and payment was overdue.
A.B. Med. Servs. PLLC v Travelers Prop. Cas. Corp. (2005 NY Slip Op 51330(U)) Appellate Term, Second Department, August 11, 2005Claimant's proof held to make out its prima facie case (also decides)Held the providers established their prima facie case by proof that they submitted claims setting forth the fact and amounts of loss and that payment was overdue.
A.B. Med. Servs. PLLC v Allstate Ins. Co. (2005 NYSlipOp 51270(U)) Appellate Term, Second Department, July 28, 2005Claimant's proof held to make out its prima facie case (also decides)Held the providers established their prima facie case by showing they submitted claims setting forth the fact and amount of loss and that payment was overdue, shifting the burden to the insurer.
Ocean Diagnostic Imaging P.C. v Allstate Ins. Co. (2005 NYSlipOp 51181(U)) Appellate Term, Second Department, July 21, 2005Claimant's proof held to make out its prima facie case (also decides)Held the claimant made out its prima facie case by proof of the claim and the amount of the loss, so with interest and fees fixed by statute there was no basis for an assessment of damages.
A.B. Med. Servs. PLLC v USAA Gen. Indem. Co. (2005 NY Slip Op 25297) Appellate Term, Second Department, July 21, 2005Claimant's proof held to make out its prima facie case (also decides)Held the providers established prima facie entitlement by proof of submitted claims and overdue payment, with receipt shown by the insurer's denial forms and proper proof of mailing.
Ocean Diagnostic Imaging P.C. v General Assur. Co. (2005 NY Slip Op 51155(U)) Appellate Term, Second Department, July 21, 2005Claimant's proof held to make out its prima facie caseHeld the claimant made out its prima facie case by proof of the claim and the amount of the loss, so summary judgment should have been granted outright without an assessment of damages, interest and fees being statutory.
Ocean Diagnostic Imaging P.C. v New York Cent. Mut. Fire Ins. Co. (2005 NY Slip Op 51772(U)) Appellate Term, Second Department, July 7, 2005Claimant's proof held to make out its prima facie case (also decides)Held the provider established its prima facie case by proof that it submitted claims setting forth the losses and that payment was overdue.
Ocean Diagnostic Imaging P.C. v Utica Mut. Ins. Co. (2005 NYSlipOp 51080(U)) Appellate Term, Second Department, July 7, 2005Claimant's proof held to make out its prima facie case (also decides)Held the provider established its prima facie entitlement by proof that it submitted a claim stating the fact and amount of loss and that payment was overdue, shifting the burden to the insurer.
A.B. Med. Servs. PLLC v GMAC Ins. (2005 NYSlipOp 51079(U)) Appellate Term, Second Department, July 7, 2005Claimant's proof held to make out its prima facie case (also decides)Held the providers established prima facie entitlement by proof that they submitted claims stating the fact and amount of loss and that payment was overdue.
Medwide Med. Supply Inc. v Country-Wide Ins. Co. (2005 NYSlipOp 51078(U)) Appellate Term, Second Department, July 7, 2005Claimant's proof held to make out its prima facie case (also decides)Held the supplier established its prima facie case by proof of submitting statutory claim forms and overdue payment, and that an officer and billing manager's affidavit was a proper vehicle to show submission.
Rockaway Blvd. Med. P.C. v Progressive Ins. (2005 NY Slip Op 25278) Appellate Term, Second Department, July 7, 2005Claimant's proof held to make out its prima facie caseHeld the omission of the billing-treating provider relationship from generic claim forms did not defeat the provider's prima facie showing, since the insurer waived claim-form objections by not seeking verification or timely denying.
S & M Supply Inc. v State-Wide Ins. Co. (2005 NYSlipOp 51046(U)) Appellate Term, Second Department, July 6, 2005Claimant's proof held to make out its prima facie caseHeld the supplier's proof that it submitted the functional equivalent of claim forms and that payment was overdue sufficient; the billing manager's affidavit was proper and needed no personal knowledge that the equipment was furnished.
Ocean Diagnostic Imaging P.C. v Travelers Prop. Cas. Corp. (2005 NY Slip Op 51047(U)) Appellate Term, Second Department, July 6, 2005Claimant's proof held to make out its prima facie case (also decides)Held the provider established its prima facie case on three of four assignors' claims, with certificates of mailing and return receipts proving mailing of two, but not on the fourth claim, which lacked proof of mailing.
Summit Psychological, P.C. v General Assur. Co. (2005 NY Slip Op 25263) Appellate Term, Second Department, June 28, 2005Claimant's proof held to make out its prima facie case (also decides)Held the provider established its prima facie case and rejected the insurer's challenge based on the unauthenticated assignment, since no rule requires authentication and, even if it did, the insurer's failure to seek verification or deny on that ground waived it.
Shtarkman v Allstate Ins. Co. (2005 NYSlipOp 51028(U)) Appellate Term, Second Department, June 27, 2005Claimant's proof held to make out its prima facie case (also decides)Held the provider made its prima facie case with admissible proof that the claim was mailed and uncontroverted proof that it was not paid or denied within 30 days.
Ocean Diagnostic Imaging P.C. v Eagle Ins. Co. (2005 NYSlipOp 51027(U)) Appellate Term, Second Department, June 27, 2005Claimant's proof held to make out its prima facie case (also decides)Held the provider established its prima facie entitlement by proof that it submitted a claim stating the fact and amount of loss and that payment was overdue, shifting the burden to the insurer.
A.B. Med. Servs. PLLC v American Tr. Ins. Co. (2005 NYSlipOp 50959(U)) Appellate Term, Second Department, June 9, 2005Claimant's proof held to make out its prima facie case (also decides)Held the providers established prima facie entitlement by proof that they submitted claim forms stating the fact and amount of loss and that payment was overdue, shifting the burden to the insurer.
Careplus Med. Supply Inc. v Kemper Auto & Home Ins. Co. (2005 NYSlipOp 50958(U)) Appellate Term, Second Department, June 9, 2005Claimant's proof held to make out its prima facie case (also decides)Held the provider established its prima facie entitlement by proof that it submitted claims stating the fact and amount of loss and that payment was overdue.
Amaze Med. Supply Inc. v General Assur. Co. (2005 NY Slip Op 50960(U)) Appellate Term, Second Department, June 9, 2005Claimant's proof held to make out its prima facie case (also decides)Held the provider established its prima facie case by proof that it submitted claims setting forth the fact and amount of the loss and that payment was overdue.
Ocean Diagnostic Imaging P.C. v GMAC Ins. F/k/a Integon Ins. (2005 NYSlipOp 50865(U)) Appellate Term, Second Department, June 3, 2005Claimant's proof held to make out its prima facie case (also decides)Held the provider established its prima facie case by proof that it submitted a claim and that payment was overdue, though the motion failed because the insurer raised a triable issue on timely notice of the accident.
Struhl v Progressive Cas. Ins. Co. (2005 NYSlipOp 50864(U)) Appellate Term, Second Department, June 3, 2005Claimant's proof held to make out its prima facie case (also decides)Held the provider established its prima facie case by proving submission of the functional equivalent of a claim form setting forth the loss with sufficient particulars, and that payment was overdue.
GPM Chiropractic, P.C. v State Farm Mut. Ins. Co (2005 NYSlipOp 50861(U)) Appellate Term, Second Department, June 3, 2005Claimant's proof held to make out its prima facie case (also decides)Held the provider established its prima facie entitlement by proof that it submitted a claim stating the fact and amount of loss and that payment was overdue, shifting the burden to the insurer.
R.M. Med. P.C. v Lumbermens Mut. Cas. Co. (2005 NY Slip Op 50859(U)) Appellate Term, Second Department, June 3, 2005Insufficient: claimant did not prove the claim was submitted (mailed to and received by the insurer)Held the billing manager's affidavit insufficient to show properly completed claim forms were provided to the insurer because it did not identify which of the two plaintiffs he worked for.
Triboro Chiropractic & Acupuncture P.L.L.C. v New York Cent. Mut. Fire Ins. Co. (2005 NYSlipOp 50856(U)) Appellate Term, Second Department, June 1, 2005Claimant's proof held to make out its prima facie case (also decides)Held the provider established prima facie entitlement by proof it submitted claims and payment was overdue, leading to partial summary judgment on the untimely denied claims.
A.B. Med. Servs. PLLC v State-Wide Ins. Co. (2005 NYSlipOp 50785(U)) Appellate Term, Second Department, May 23, 2005Claimant's proof held to make out its prima facie case (also decides)Held the providers established prima facie entitlement by proof that they submitted claims stating the fact and amount of loss and that payment was overdue, and that pleading their claims in one cause of action was no bar.
Ocean Diagnostic Imaging P.C. v Travelers Prop. Cas. Corp. (2005 NY Slip Op 50790(U)) Appellate Term, Second Department, May 23, 2005Claimant's proof held to make out its prima facie case (also decides)Held the provider made its prima facie showing by proof that it submitted claims setting forth the fact and amount of loss and that payment was overdue, shifting the burden to the insurer.
S & M Supply Inc. v State Farm Mut. Auto. Ins. Co. (2005 NYSlipOp 50747(U)) Appellate Term, Second Department, May 19, 2005Claimant's proof held to make out its prima facie case (also decides)Held the supplier made its prima facie showing by proving it submitted a claim stating the fact and amount of loss and that payment was overdue.
Gpm Chiropractic, P.C. v State Farm Mut. Ins. Co. (2005 NYSlipOp 50744(U)) Appellate Term, Second Department, May 19, 2005Claimant's proof held to make out its prima facie case (also decides)Held the provider made its prima facie showing by proving it submitted a claim stating the fact and amount of loss and that payment was overdue.
Ocean Diagnostic Imaging P.C. v Lumbermens Mut. Cas. Co. (2005 NY Slip Op 50743(U)) Appellate Term, Second Department, May 19, 2005Claimant's proof held to make out its prima facie case (also decides)Held the provider established its prima facie case by proof that it submitted claim forms setting forth the losses and that payment was overdue.
A.B. Med. Servs. PLLC v GEICO Cas. Ins. Co. (2005 NYSlipOp 50650(U)) Appellate Term, Second Department, April 29, 2005Claimant's proof held to make out its prima facie case (also decides)Held the provider established a prima facie case by proof that it submitted completed claim forms and that payment was overdue.
Careplus Med. Supply Inc. v Travelers Home & Mar. Ins. Co. (2005 NYSlipOp 50648(U)) Appellate Term, Second Department, April 29, 2005Claimant's proof held to make out its prima facie caseHeld the supplier made its prima facie case by its officer and billing manager's affidavit showing submission of the functional equivalent of claim forms stating the fact and amount of loss and that payment was overdue.
Ocean Diagnostic Imaging P.C. v Commerce Ins. Co. (2005 NYSlipOp 50642(U)) Appellate Term, Second Department, April 29, 2005Claimant's proof held to make out its prima facie case (also decides)Held the provider established prima facie entitlement by proof that it submitted claims and payment was overdue, the insurer conceding receipt and its failure to pay or deny within 30 days.
Ocean Diagnostic Imaging P.C. v Travelers Indem. Co. (2005 NY Slip Op 50644(U)) Appellate Term, Second Department, April 29, 2005Claimant's proof held to make out its prima facie case (also decides)Held the provider made its prima facie showing by proof that it submitted a claim setting forth the fact and amount of loss and that payment was overdue, shifting the burden to the insurer.
Ocean Diagnostic Imaging P.C. v Utica Mut. Ins. Co. (2005 NYSlipOp 50611(U)) Appellate Term, Second Department, April 22, 2005Claimant's proof held to make out its prima facie case (also decides)Held the provider made its prima facie showing by proof that it submitted a claim setting forth the fact and amount of loss and that payment was overdue, shifting the burden to the insurer.
D.A.V. Chiropractic P.C. v American Tr. Ins. Co. (2005 NYSlipOp 50609(U)) Appellate Term, Second Department, April 22, 2005Claimant's proof held to make out its prima facie case (also decides)Held the provider established prima facie entitlement by proof that it submitted claims setting forth the fact and amount of loss and that payment was overdue, though the motion was denied on a triable issue.
South Queens Imaging P.C. v Nationwide Mut. Ins. Co. (2005 NYSlipOp 50608(U)) Appellate Term, Second Department, April 22, 2005Claimant's proof held to make out its prima facie case (also decides)Held the provider established a prima facie case by proof that it submitted claim forms stating the fact and amount of loss and that payment was overdue.
Ocean Diagnostic Imaging P.C. v New York Cent. Mut. Fire Ins. Co. (2005 NYSlipOp 50607(U)) Appellate Term, Second Department, April 22, 2005Claimant's proof held to make out its prima facie case (also decides)Held the provider established its prima facie case by proof that it submitted a claim setting forth the fact and amount of loss and that payment was overdue.
Ocean Diagnostic Imaging P.C. v New York Cent. Mut. Fire Ins. Co. (2005 NYSlipOp 50606(U)) Appellate Term, Second Department, April 22, 2005Claimant's proof held to make out its prima facie case (also decides)Held the provider established its prima facie case by proof that it submitted a claim setting forth the fact and amount of loss and that payment was overdue.
A.B. Med. Servs. PLLC v GMAC Ins. (2005 NYSlipOp 50602(U)) Appellate Term, Second Department, April 22, 2005Claimant's proof held to make out its prima facie case (also decides)Held the three health care providers established their prima facie case by proof that they submitted claims setting forth the fact and amount of loss and that payment was overdue.
S&M Supply Inc. v Allstate Ins. Co. (2005 NYSlipOp 50543(U)) Appellate Term, Second Department, April 13, 2005Insufficient: claimant did not prove the claim was submitted (mailed to and received by the insurer)Held the supplier's motion properly denied because its supporting affidavit did not establish that the affiant had the requisite personal knowledge, leaving it without probative value.
A.B. Med. Servs. PLLC v Electric Ins. Co. (2005 NYSlipOp 50542(U)) Appellate Term, Second Department, April 13, 2005Claimant's proof held to make out its prima facie caseHeld the providers established their prima facie case by proof of submitting claims stating the fact and amount of loss and that payment was overdue, except one $100 claim whose proof of mailing bore a post date earlier than the bill.
Ocean Diagnostic Imaging P.C. v State Farm Mut. Auto. Ins. Co. (2005 NYSlipOp 50535(U)) Appellate Term, Second Department, April 13, 2005Claimant's proof held to make out its prima facie case (also decides)Held the provider established its prima facie case by proof that it submitted a claim setting forth the fact and amount of loss and that payment was overdue.
Capio Med., P.C. v Progressive Cas. Ins. Co. (2005 NYSlipOp 50526(U)) Appellate Term, Second Department, April 13, 2005Claimant's proof held to make out its prima facie caseRejected the insurer's challenge and held the provider established its prima facie case, since the insurer's denial forms stating the dates the claims were received showed the claims were sent and received and payment was overdue.
Ocean Diagnostic Imaging P.C. v New York Cent. Mut. Fire Ins. Co. (2005 NYSlipOp 50525(U)) Appellate Term, Second Department, April 13, 2005Claimant's proof held to make out its prima facie case (also decides)Held the provider established its prima facie case by proof that it submitted claims setting forth the fact and amount of loss and that payment was overdue.
A.B. Med. Servs. PLLC v Liberty Mut. Ins. Co. (2005 NYSlipOp 50453(U)) Appellate Term, Second Department, March 31, 2005Claimant's proof held to make out its prima facie case (also decides)Held the provider established a prima facie case by proof that it submitted the claims stating the fact and amount of loss and that payment was overdue.
King's Med. Supply Inc. v Allstate Ins. Co. (2005 NYSlipOp 50451(U)) Appellate Term, Second Department, March 31, 2005Claimant's proof held to make out its prima facie case (also decides)Held the supplier established its prima facie case by proof that it submitted claim forms setting forth the fact and amount of loss and that payment was overdue.
King's Med. Supply Inc. v Kemper Auto & Home Ins. Co. (2005 NYSlipOp 50450(U)) Appellate Term, Second Department, March 31, 2005Claimant's proof held to make out its prima facie case (also decides)Held the provider established its prima facie case by proof that it submitted claim forms setting forth the losses and that payment was overdue.
A.B. Med. Servs. PLLC v State Farm Mut. Auto. Ins. Co. (2005 NYSlipOp 50432(U)) Appellate Term, Second Department, March 31, 2005Insufficient: claimant did not prove the claim was submitted (mailed to and received by the insurer)Held the providers failed to establish their prima facie case because they did not append the claim forms to their motion papers.
Careplus Med. Supply Inc. v General Assur. Co. (2005 NY Slip Op 50429(U)) Appellate Term, Second Department, March 31, 2005Claimant's proof held to make out its prima facie case (also decides)Held the provider established its prima facie case by proof that it submitted the claims setting forth the fact and amount of the loss and that payment was overdue.
Ocean Diagnostic Imaging P.C. v General Assur. Co. (2005 NY Slip Op 50435(U)) Appellate Term, Second Department, March 31, 2005Claimant's proof held to make out its prima facie case (also decides)Held, reversing, that the provider established its prima facie case by proof that it submitted claim forms setting forth the fact and amount of the loss and that payment was overdue.
Amaze Med. Supply Inc. v Travelers Prop. Cas. Corp. (2005 NY Slip Op 50452(U)) Appellate Term, Second Department, March 31, 2005Claimant's proof held to make out its prima facie case (also decides)Held the supplier established its prima facie case by proof that it submitted a claim setting forth the fact and amount of loss and that payment was overdue.
SZ Med., P.C. v Lancer Ins. Co. (2005 NY Slip Op 25112) Appellate Term, Second Department, March 22, 2005Insufficient: claimant did not prove the claim was submitted (mailed to and received by the insurer)Held the providers failed their prima facie showing because the billing manager's affidavit did not say which of the three plaintiffs she worked for, so it could not establish that properly completed forms were provided.
A.B. Med. Servs. PLLC v Country-Wide Ins. Co. (2005 NY Slip Op 50255(U)) Appellate Term, Second Department, March 2, 2005Claimant's proof held to make out its prima facie caseHeld the providers established prima facie entitlement on 55 of 58 claims by showing submission of claims stating the fact and amount of loss and that payment was overdue; three claims failed for lack of proof of verification compliance.
Contemp. Med. Diag. & Treatment, P.C. v Government Employees Ins. Co. (2005 NY Slip Op 50254(U)) Appellate Term, Second Department, March 2, 2005Claimant's proof held to make out its prima facie case (also decides)Held the provider established its prima facie case by proof that it submitted the statutory claim forms setting forth the fact and amount of loss and that payment was overdue, shifting the burden to the insurer.
Fair Price Med. Supply Corp. v General Assur. Co. (2005 NY Slip Op 50256(U)) Appellate Term, Second Department, March 2, 2005Claimant's proof held to make out its prima facie case (also decides)Held the provider established its prima facie case by proof that it submitted a claim setting forth the fact and amount of the loss and that payment was overdue.
Ocean Diagnostic Imaging P.C. v State Farm Mut. Auto. Ins. Co. (2005 NY Slip Op 25336) Appellate Term, Second Department, March 1, 2005Claimant's proof held to make out its prima facie case (also decides)Held the provider established its prima facie case by proof that the statutory billing forms were received and payment was overdue.
Amaze Med. Supply Inc. v GEICO Ins. (2005 NYSlipOp 51053(U)) Appellate Term, Second Department, February 17, 2005Claimant's proof held to make out its prima facie case (also decides)Held the supplier established a prima facie case by proof that it submitted a claim stating the fact and amount of loss and that payment was overdue.
Ocean Diagnostic Imaging P.C. v State Farm Mut. Auto. Ins. Co. (2005 NYSlipOp 50454(U)) Appellate Term, Second Department, February 17, 2005Claimant's proof held to make out its prima facie case (also decides)Held the provider established its prima facie case by proof that it submitted a claim setting forth the fact and amount of loss and that payment was overdue.
Ocean Diagnostic Imaging P.C. v Allstate Ins. Co. (2005 NY Slip Op 50189(U)) Appellate Term, Second Department, February 17, 2005Claimant's proof held to make out its prima facie case (also decides)Held the provider established its prima facie case by proof that it submitted a claim form setting forth the fact and amount of loss and that payment was overdue.
Ocean Diagnostic Imaging P.C. v AIU Ins. Co. (2005 NY Slip Op 50188(U)) Appellate Term, Second Department, February 17, 2005Claimant's proof held to make out its prima facie case (also decides)Held the provider established its prima facie case by proof that it submitted a claim setting forth the fact and amount of loss and that payment was overdue.
A.B. Med. Servs. PLLC v New York Cent. Mut. Fire Ins. Co. (2005 NY Slip Op 50115(U)) Appellate Term, Second Department, February 2, 2005Claimant's proof held to make out its prima facie caseHeld the moving papers made out a prima facie case by showing statutory claim forms were submitted and payment was overdue, and with no opposition considered, summary judgment should have been granted.
SZ Med. P.C. v State-Wide Ins. Co. (2005 NY Slip Op 50103(U)) Appellate Term, Second Department, February 2, 2005Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the providers failed to show payment was overdue because the affidavit did not say when the claims were submitted and the insurer's acknowledgment letters did not identify which claims were received.
A.B. Med. Servs. PLLC v Motor Veh. Acc. Indem. Corp. (2005 NY Slip Op 50088(U)) Appellate Term, Second Department, February 1, 2005Claimant's proof held to make out its prima facie caseHeld the providers established their prima facie case by proof that they submitted claims stating the fact and amount of loss and that payment was overdue.
Ocean Diagnostic Imaging, Inc. v Utica Mut. Ins. Co. (2005 NY Slip Op 50081(U)) Appellate Term, Second Department, January 27, 2005Claimant's proof held to make out its prima facie case (also decides)Held the provider established its prima facie case by evidentiary proof that it mailed and the insurer received the claim forms and that the claims were not paid or denied within 30 days.
Amaze Med. Supply Inc. v Lumbermens Mut. Cas. Co. (2005 NY Slip Op 50084(U)) Appellate Term, Second Department, January 27, 2005Claimant's proof held to make out its prima facie case (also decides)Held the supplier established its prima facie case by proof that it submitted the claims setting forth the fact and amount of loss and that payment was overdue.
A.B. Med. Servs. PLLC v Prudential Prop. & Cas. Ins. Co. (2005 NY Slip Op 25032) Appellate Term, Second Department, January 20, 2005Claimant's proof held to make out its prima facie case (also decides)Held the providers established their prima facie case by proof of submitting the claim forms and that payment was overdue, with the insurer's delay letters establishing submission and receipt of some bills.
King's Med. Supply Inc. v New York Cent. Mut. Fire Ins. Co. (2004 NY Slip Op 51685(U)) Appellate Term, Second Department, December 22, 2004Claimant's proof held to make out its prima facie case (also decides)Held the provider established prima facie entitlement by proof that it submitted claim forms setting forth the fact and amount of the loss and that payment was overdue.
S&M Supply Inc. v Peerless Ins. Co. (2004 NY Slip Op 51683(U)) Appellate Term, Second Department, December 22, 2004Claimant's proof held to make out its prima facie caseHeld the provider established its prima facie case on the untimely denied claim by a complete proof of claim showing the fact and amount of loss and overdue payment.
A.B. Med. Servs. PLLC v USAA Cas. Ins. Co. (2004 NY Slip Op 51682(U)) Appellate Term, Second Department, December 22, 2004Claimant's proof held to make out its prima facie caseHeld the provider established its prima facie case on three claims by showing it submitted properly completed claim forms, including one whose mailing the billing manager proved despite the insurer's denial of receipt.
Ocean Diagnostic Imaging P.C. v Eagle Ins. Co. (2004 NY Slip Op 51640(U)) Appellate Term, Second Department, December 15, 2004Claimant's proof held to make out its prima facie case (also decides)Held the provider established its prima facie case by proof that it submitted a claim form setting forth the fact and amount of loss and that payment was overdue.
A.B. Med. Servs. PLLC v State Farm Mut. Auto. Ins. Co. (2004 NY Slip Op 51639(U)) Appellate Term, Second Department, December 15, 2004Claimant's proof held to make out its prima facie case (also decides)Held the providers made their prima facie showing by proof that they submitted claims setting forth the fact and amount of loss and that payment was overdue, shifting the burden to the insurer.
Amaze Medical Supply Inc. v Allstate Ins. Co. (2004 NY Slip Op 51636(U)) Appellate Term, Second Department, December 15, 2004Claimant's proof held to make out its prima facie case (also decides)Held the supplier established a prima facie case by submitting complete proofs of claim stating the fact and amount of loss and showing payment was overdue.
Amaze Med. Supply Inc. v AIU Ins. Co. (2004 NY Slip Op 51629(U)) Appellate Term, Second Department, December 15, 2004Claimant's proof held to make out its prima facie case (also decides)Held the supplier made its prima facie showing by proof that it submitted a claim setting forth the fact and amount of loss and that payment was overdue, shifting the burden to the insurer.
A.B. Med. Servs. PLLC v State Farm Mut. Auto. Ins. Co. (2004 NY Slip Op 51627(U)) Appellate Term, Second Department, December 14, 2004Claimant's proof held to make out its prima facie case (also decides)Held the providers made their prima facie showing by proof that they submitted a claim setting forth the fact and amount of loss and that payment was overdue.
Ocean Diagnostic Imaging, P.C. v State Farm Mut. Auto. Ins. Co. (2004 NY Slip Op 51624(U)) Appellate Term, Second Department, December 14, 2004Claimant's proof held to make out its prima facie case (also decides)Held the provider made its prima facie showing by proof that it submitted a claim setting forth the fact and amount of loss and that payment was overdue.
A.B. Med. Servs. PLLC v Nationwide Mut. Ins. Co. (2004 NY Slip Op 24506) Appellate Term, Second Department, December 10, 2004Insufficient: claimant did not prove the claim was submitted (mailed to and received by the insurer)Held the affidavit of the self-described billing manager 'of plaintiff' insufficient to establish that the plaintiffs provided the insurer with properly completed claim forms, so their summary judgment motion was properly denied.
Ocean Diagnostic Imaging, P.C. v Lancer Ins. Co. (2004 NY Slip Op 24501) Appellate Term, Second Department, December 8, 2004Claimant's proof held to make out its prima facie case (also decides)Held the provider made its prima facie showing by proof that the claim forms were mailed and received and that the insurer did not pay or deny within 30 days.
Star Med. Servs. P.C. v Eagle Ins. Co. (2004 NY Slip Op 24482) Appellate Term, Second Department, December 1, 2004Claimant's proof held to make out its prima facie case (also decides)Held the provider made out its prima facie case by proof that it submitted the statutory claim form stating the fact and amount of the loss and that payment was overdue.
A.B. Med. Servs. PLLC v State Farm Mut. Auto. Ins. Co. (2004 NY Slip Op 51432(U)) Appellate Term, Second Department, November 19, 2004Claimant's proof held to make out its prima facie case (also decides)Held the providers made their prima facie showing by proof that they submitted the statutory claim form setting forth the fact and amount of loss, with the insurer having failed to pay or deny within 30 days.
S & M Supply Inc. v State Farm Mut. Auto. Ins. Co. (2004 NY Slip Op 51429(U)) Appellate Term, Second Department, November 19, 2004Claimant's proof held to make out its prima facie case (also decides)Held the supplier made its prima facie showing by proof that it submitted the statutory claim form setting forth the fact and amount of loss, with the insurer having failed to pay or deny within 30 days.
Ocean Diagnostic Imaging P.C. v State Farm Mut. Auto. Ins. Co. (2004 NY Slip Op 51251(U)) Appellate Term, Second Department, October 20, 2004Claimant's proof held to make out its prima facie case (also decides)Held the provider made its prima facie showing by evidence of submission of a complete proof of claim, its receipt, and the insurer's failure to pay or deny within 30 days.
A.B. Med. Servs. PLLC v State Farm Mut. Auto. Ins. Co. (2004 NY Slip Op 51104(U)) Appellate Term, Second Department, September 29, 2004Claimant's proof held to make out its prima facie case (also decides)Held the providers established their prima facie case by evidentiary proof that the claim forms were mailed and that the insurer failed to pay or deny within 30 days.
King's Med. Supply, Inc. v Hereford Ins. Co. (2004 NY Slip Op 24343) Appellate Term, Second Department, September 20, 2004Claimant's proof held to make out its prima facie case (also decides)Held the provider established its prima facie case by showing it submitted a properly completed claim form, its billing manager not needing personal knowledge that the supplies were furnished, but the insurer raised a triable issue on timely denial.
Ocean Diagnostic Imaging P.C. v State Farm Mut. Auto. Ins. Co. (2004 NY Slip Op 51032(U)) Appellate Term, Second Department, September 17, 2004Claimant's proof held to make out its prima facie case (also decides)Held the billing manager's affidavit need not show personal knowledge that services were rendered; it laid an adequate business-records foundation, and the provider established its prima facie case by submitting a properly completed claim.
A.B. Med. Servs. PLLC v State Farm Mut. Auto. Ins. Co. (2004 NY Slip Op 51031(U)) Appellate Term, Second Department, September 17, 2004Insufficient: claimant did not prove the claim was submitted (mailed to and received by the insurer)Held the providers' affidavit insufficient to show properly completed claim forms were provided because the affiant did not say which of three plaintiffs she worked for, and one provider showed no assignment.
Ocean Diagnostic Imaging P.C. v State Farm Mut. Auto. Ins. Co. (2004 NY Slip Op 24342) Appellate Term, Second Department, September 17, 2004Claimant's proof held to make out its prima facie case (also decides)Held the provider made its prima facie showing by submitting a complete proof of claim and the amount of the loss, the insurer having failed to deny within 30 days.
Amaze Med. Supply Inc. v Allstate Ins. Co. (2004 NY Slip Op 50833(U)) Appellate Term, Second Department, July 21, 2004Claimant's proof held to make out its prima facie case (also decides)Held the supplier established a prima facie case by submitting a properly completed claim, shifting the burden to the insurer to raise a triable issue.
A.B. Med. Servs. PLLC v Travelers Prop. Cas. Corp. (2004 NY Slip Op 50779(U)) Appellate Term, Second Department, July 8, 2004Insufficient: claimant did not prove the claim was submitted (mailed to and received by the insurer)Held the billing manager's affidavit insufficient to show properly completed claim forms were provided to the insurer because it did not say which of the two plaintiffs she worked for.
S & M Supply Inc. v State Farm Mut. Auto. Ins. Co. (2004 NY Slip Op 50693(U)) Appellate Term, Second Department, June 30, 2004Claimant's proof held to make out its prima facie case (also decides)Held the provider established prima facie entitlement to summary judgment by submitting a proper proof of claim, shifting the burden to the insurer.
A.B. Med. Servs. Pllc v Lumbermens Mut. Cas. Co. (2004 NY Slip Op 50692(U)) Appellate Term, Second Department, June 30, 2004Insufficient: claimant did not prove the claim was submitted (mailed to and received by the insurer)Held the providers failed their prima facie case because the billing manager's affidavit did not say which of the four plaintiffs he worked for, so it did not establish that properly completed claim forms were provided.
Melbourne Med., P.C. v Utica Mut. Ins. Co. (2004 NY Slip Op 24221) Appellate Term, Second Department, June 7, 2004Claimant's proof held to make out its prima facie case (also decides)Held the provider established its prima facie case by proof that it submitted properly executed statutory claim forms, the insurer conceding it did not pay or deny within 30 days.
A.B. Med. Servs., Pllc v N. Y. Cent. Mut. Fire Ins. Co. (2004 NY Slip Op 50550(U)) Appellate Term, Second Department, May 26, 2004Claimant's proof held to make out its prima facie case (also decides)Held the providers established their prima facie case by showing submission of complete proofs of claim, the insurer's denials stating the dates of receipt sufficing to show the claims were sent.
A.B. Med. Servs. v N. Y. Cent. Mut. Fire Ins. Co. (2004 NY Slip Op 50507(U)) Appellate Term, Second Department, May 26, 2004Claimant's proof held to make out its prima facie case (also decides)Held the providers established their prima facie case by showing submission of complete proofs of claim, the insurer's denials stating the dates of receipt sufficing to show the claims were sent.
Park Neurological Servs. P.C. v GEICO Ins. (2004 NY Slip Op 24210) Appellate Term, Second Department, May 26, 2004Claimant's proof held to make out its prima facie caseHeld the billing manager's imprecisely worded affidavit established the prima facie case, since a properly completed claim form suffices and the affiant needed no personal medical knowledge of medical necessity.
A.B. Med. Servs. PLLC v Lumbermens Mut. Cas. Co. (2004 NY Slip Op 24194) Appellate Term, Second Department, May 26, 2004Claimant's proof held to make out its prima facie case (also decides)Held the provider established its prima facie case by showing it submitted complete proofs of claim, shifting the burden to the insurer.
A.B. Med. Servs. v Am. Tr. Ins. Co. (2004 NY Slip Op 50515(U)) Appellate Term, Second Department, May 25, 2004Insufficient: claimant did not prove the claim was submitted (mailed to and received by the insurer)Held the billing manager's affidavit insufficient to show properly completed claim forms were provided because it did not indicate for which of two plaintiffs with different addresses she acted.
A.B. Med. Servs. v Travelers Prop. Cas. Corp. (2004 NY Slip Op 50517(U)) Appellate Term, Second Department, May 25, 2004Insufficient: claimant did not prove the claim was submitted (mailed to and received by the insurer)Held the billing manager's affidavit insufficient to show properly completed claim forms were provided because it did not specify for which of the several plaintiffs the affiant worked.
Amaze Med. Supply Inc. v Allstate Ins. Co. (2004 NY Slip Op 50447(U)) Appellate Term, Second Department, May 20, 2004Claimant's proof held to make out its prima facie caseHeld the provider made out its prima facie case with a date-stamped post office ledger and its president's affidavit that the bills were mailed, so the insurer had to raise a triable issue.
A.B. Med. Servs. v Country-Wide Ins. Co. (2004 NY Slip Op 50535(U)) Appellate Term, Second Department, May 14, 2004Insufficient: claimant did not prove the claim was submitted (mailed to and received by the insurer)Held the billing manager's affidavit insufficient to show properly completed claim forms were provided because it did not say which of the several plaintiffs she worked for.
A.B. Med. Servs. v Allstate Ins. Co. (2004 NY Slip Op 50373(U)) Appellate Term, Second Department, April 27, 2004Insufficient: claimant did not prove the claim was submitted (mailed to and received by the insurer)Held the billing manager's affidavit insufficient to establish that properly completed claim forms were provided because it did not identify which of three plaintiffs she represented.
Adam'S Med. Supplies v Windsor Group Ins. Co. (2004 NY Slip Op 50310(U)) Appellate Term, Second Department, April 14, 2004Claimant's proof held to make out its prima facie caseHeld the provider established prima facie entitlement on most of its claims by showing complete proofs of claim not paid or denied within 30 days, but not for an item its records did not mention.
Damadian Mri In Garden City v Windsor Group Ins. (2004 NY Slip Op 50266(U)) Appellate Term, Second Department, April 9, 2004Insufficient for another reason (eligibility, timely submission, own papers defeat the claim)Held the provider failed its prima facie burden because the assignment named only 'Damadian MRI,' leaving a question whether the plaintiff was the entity to which benefits were assigned.
Damadian Mri In Garden City v Windsor Group Ins. (2004 NY Slip Op 50262(U)) Appellate Term, Second Department, April 9, 2004Insufficient for another reason (eligibility, timely submission, own papers defeat the claim)Held the provider failed its prima facie burden because the assignment named only 'Damadian MRI,' raising a question whether the plaintiff was the assignee entity.
Amaze Med. Supply v Allstate Ins. Co. (2004 NY Slip Op 24119) Appellate Term, Second Department, April 9, 2004Insufficient for another reason (eligibility, timely submission, own papers defeat the claim)Held the supplier's own submissions showed two items were never prescribed, negating its prima facie case for that $400 portion, so summary judgment was limited to the remaining amount.
Amaze Med. Supply v Allstate Ins. Co. (2004 NY Slip Op 50211(U)) Appellate Term, Second Department, March 26, 2004Claimant's proof held to make out its prima facie caseHeld the supplier established prima facie entitlement by showing it submitted complete proofs of claim that the insurer neither paid nor denied within 30 days, so summary judgment was granted.
A.B. Med. Servs. PLLC v State Farm Mut. Auto. Ins. Co. (2004 NY Slip Op 50902(U)) Appellate Term, Second Department, March 17, 2004Insufficient: claimant did not prove the claim was submitted (mailed to and received by the insurer)Held the providers failed their prima facie case because the billing manager's affidavit did not identify which of the three plaintiffs she represented, so it could not establish that complete claim forms were provided.
A.B. Med. Servs. PLCC v State Farm Mut. Auto. Ins. Co. (2004 NY Slip Op 24181) Appellate Term, Second Department, March 17, 2004Claimant's proof held to make out its prima facie case (also decides)Held the provider established its prima facie case for most claims by submitting completed statutory forms, but not for claims where the affiant failed to say which named plaintiff she represented.
A.B. Med. Servs. PLLC v State Farm Mut. Auto. Ins. Co. (2004 NY Slip Op 50903(U)) Appellate Term, Second Department, March 12, 2004Insufficient: claimant did not prove the claim was submitted (mailed to and received by the insurer)Held the providers failed their prima facie case because the billing manager's affidavit did not identify which of the four plaintiffs she represented, so it could not establish that claim forms were provided.
Amaze Med. Supply v Colonial Penn Ins. Co. (2004 NY Slip Op 50471(U)) Appellate Term, Second Department, March 3, 2004Claimant's proof held to make out its prima facie caseHeld the provider's cross motion established a prima facie case because its affidavit set out facts within the affiant's personal knowledge and was not defective merely for including two case citations.
Amaze Med. Supply v Eagle Ins. Co. (2004 NY Slip Op 50389(U)) Appellate Term, Second Department, February 26, 2004Insufficient for another reason (eligibility, timely submission, own papers defeat the claim)Held that, although proof of a properly submitted claim generally suffices, the supplier's own added prescription and delivery receipt, which did not match the billed equipment or assignor, raised a triable issue defeating summary judgment.
A.B. Med. Servs. v State Farm Mut. Auto. Ins. Co. (2004 NY Slip Op 50387(U)) Appellate Term, Second Department, February 10, 2004Claimant's proof held to make out its prima facie caseHeld the providers made their prima facie case on most of the claim by proof of completed claim forms without proof of medical necessity, but not on several bills lacking any mailing allegation or proof of receipt.
Amstel Chiropractic v Omni Indem. Co. (2004 NY Slip Op 50088(U)) Appellate Term, Second Department, January 27, 2004Claimant's proof held to make out its prima facie case (also decides)Held the providers established prima facie entitlement by showing they submitted complete proofs of claim that the insurer neither paid nor denied within the statutory period.
Damadian Mri In Garden City v Liberty Mut. Ins. Co. (2003 NY Slip Op 51702(U)) Appellate Term, Second Department, December 24, 2003Claimant's proof held to make out its prima facie caseHeld, for the reasons stated in a companion decision, that the provider's proof of its claim as submitted to the insurer sufficed to establish its prima facie case on summary judgment.
Amaze Med. Supply v Eagle Ins. Co. (2003 NY Slip Op 51701(U)) Leading case Appellate Term, Second Department, December 24, 2003Claimant's proof held to make out its prima facie caseHeld a properly completed claim form makes out the provider's prima facie case, so it need not separately prove medical necessity by admissible proof, especially where the insurer is precluded.
Damadian Mri In Elmhurst v Liberty Mut. Ins. Co. (2003 NY Slip Op 51700(U)) Appellate Term, Second Department, December 24, 2003Claimant's proof held to make out its prima facie caseHeld the provider's properly completed claim form established its prima facie case, rejecting the insurer's argument that the provider had to prove medical necessity by admissible proof.
A.B. Med. Servs. v Eagle Ins. Co. (2003 NY Slip Op 23978) Appellate Term, Second Department, December 24, 2003Claimant's proof held to make out its prima facie case (also decides)Held the providers made their prima facie showing by proof they submitted completed claim forms, except for one $170 claim whose proof was omitted from the motion papers.
A.B. Med. Servs. v GEICO Ins. (2003 NY Slip Op 23949) Appellate Term, Second Department, December 9, 2003Claimant's proof held to make out its prima facie caseRejected the insurer's argument that the providers had to prove medical necessity to make their prima facie case, and granted them summary judgment on all four claims.
A.B. Med. Servs. PLLC Royalton Chiropractic P.C. v Lumbermens Mut. Cas. Co. (2003 NY Slip Op 51392(U)) Appellate Term, Second Department, October 21, 2003Claimant's proof held to make out its prima facie caseHeld the provider entitled to summary judgment on all bills: some were never paid or denied, an EUO request did not toll the time for others, and a mailing affidavit with postmarked receipt proved submission of two disputed bills.
A.B. Med. Servs. PLLC Royalton Chiropractic P.C. v Lumbermens Mut. Cas. Co. (2003 NY Slip Op 51393(U)) Appellate Term, Second Department, October 21, 2003Claimant's proof held to make out its prima facie caseHeld the provider entitled to summary judgment on two bills the insurer denied receiving because the billing manager swore she mailed the claim forms on a stated date and attached a postmarked receipt.

Trial courts in the First Department (16 decisions)

Van Loon DME USA, Inc v Maya Assur. Co. (2025 NY Slip Op 50102(U)) Civil Court of the City of New York, Bronx County, January 10, 2025Claimant's proof held to make out its prima facie caseHeld the provider made its prima facie showing because its mailing-department affidavit raised a presumption the bills were mailed and the insurer's improper late-submission denial left payment overdue.
Kim v State Farm Ins. Co. (2024 NY Slip Op 51364(U)) Civil Court of the City of New York, New York County, June 10, 2024Insufficient: claimant did not prove the claim was submitted (mailed to and received by the insurer)Held the provider's cross motion failed because it was not supported by an affidavit of someone with personal knowledge of the facts constituting its claim.
Balance Art Acupuncture P.C. v MVAIC (2022 NY Slip Op 22061) Civil Court of the City of New York, New York County, February 9, 2022Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Denied the provider's cross motion because it failed to establish that the insurer's denials were without merit as a matter of law, the insurer having properly paid under the chiropractic fee schedule.
Sabodash v Hereford Ins. Co. (2021 NY Slip Op 51099(U)) Civil Court of the City of New York, Bronx County, November 19, 2021Claimant's proof held to make out its prima facie caseHeld the provider made its prima facie case without its own evidence because the insurer's denial forms showed the claim was timely received and denied, and the rejected coverage defense left payment overdue.
Restorative Chiropractic Solutions, PC v State Farm Mut. Auto. Ins. Co. (2021 NY Slip Op 50209(U)) Civil Court of the City of New York, New York County, March 12, 2021Insufficient: claimant did not prove the claim was overdue (not paid or timely denied) (also decides)Held that, although the claims were timely submitted, the provider could not establish the claims were overdue because the insurer proved timely partial payment and denials after tolling verification requests.
Harvey Family Chiro PT & Acup, PLLC v Ameriprise Ins. Co. (2020 NY Slip Op 20136) Civil Court of the City of New York, Bronx County, June 15, 2020Insufficient: claimant did not prove the claim was submitted (mailed to and received by the insurer)Denied the provider's cross motion because it submitted no biller's documentation that the bill was generated and mailed, did not state when it was mailed, and attached no proof of mailing.
HKP Physical Therapy, P.C. v Government Empls. Ins. Co. (2019 NY Slip Op 29381) Civil Court of the City of New York, New York County, December 2, 2019Claimant's proof held to make out its prima facie case (also decides)On searching the record in two actions, held the provider showed the fact and amount of loss and that payment was overdue, entitling it to judgment once the insurer's verification toll lapsed for lack of a timely follow-up.
Ocean Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co. (2009 NY Slip Op 50565(U)) Civil Court, New York County, April 2, 2009Claimant's proof held to make out its prima facie case (also decides)Held the provider established its prima facie case through its owner's affidavit and exhibits showing claims submitted and payment overdue, with any affidavit deficiencies cured by the insurer's denials acknowledging receipt.

Show all 16 decisions

Lenox Hill Radiology MIA, P.C. v American Tr. Ins. Co. (2008 NY Slip Op 28053) Civil Court of the City of New York, New York County, February 20, 2008Claimant's proof held to make out its prima facie case (also decides)Held the claimant made its prima facie case because the insurer's own examiner affidavit established receipt of the bill and that it was neither paid nor denied within 30 days.
Devonshire Surgical Facility v AIU Ins. Co. (2007 NY Slip Op 51034(U)) Civil Court of the City of New York, New York County, May 21, 2007Claimant's proof held to make out its prima facie case (also decides)Held the office manager's affidavit sufficient because she personally mailed the claims, knew the providers' billing practices so as to lay a business-records foundation, and stated the claims were neither paid nor timely denied.
Jeff Mollins, D.C v GEICO (2007 NY Slip Op 50467(U)) Civil Court of the City of New York, New York County, March 2, 2007Claimant's proof held to make out its prima facie caseHeld the provider made its prima facie case on three bills through claim forms and the insurer's denials acknowledging receipt, but not on a fourth bill whose payment status the record left unclear.
Devonshire Surgical Facility v GEICO (2006 NY Slip Op 52450(U)) Civil Court of the City of New York, New York County, December 1, 2006Claimant's proof held to make out its prima facie case (also decides)Held the providers made their prima facie case because an employee swore she personally mailed the claim forms, a certified-mail receipt showed receipt, and the claims were not timely paid or denied.
Chiropractic Neurodiagnostics, P.C. v Travelers Indem. Co. (2006 NY Slip Op 26049) Civil Court, New York County, February 8, 2006Claimant's proof held to make out its prima facie caseRejected the insurer's argument that the claimant failed its prima facie case by submitting a defective assignment form, holding that a valid assignment is not part of the claimant's burden and that the technical defects were waived.
T&G Med. Supplies, Inc. v State Farm Mut. Auto. Ins. Co. (2005 NY Slip Op 50636(U)) Civil Court of the City of New York, New York County, February 4, 2005Insufficient for another reason (eligibility, timely submission, own papers defeat the claim)Held the provider failed its prima facie case because the assignment did not name the assignee, accident date or assignment date and its own papers showed the assignor never received the supplies.
Healing Hands Chiropractic, P.C. v Nationwide Assur. Co. (2004 NY Slip Op 24472) Civil Court of the City of New York, New York County, December 1, 2004Claimant's proof held to make out its prima facie case (also decides)Held the provider established its prima facie case by submitting the assignment, the claim form, an affidavit of a person with knowledge of the claim and proof of mailing the claim.
Inwood Hill Med. v Allstate Ins. Co. (2004 NY Slip Op 50565(U)) Civil Court of the City of New York, New York County, June 18, 2004Claimant's proof held to make out its prima facie case (also decides)Held the providers made their prima facie case with executed assignments and completed claim forms that the insurer received but did not pay or deny within 30 days; they did not have to prove medical necessity.

Trial courts in the Second Department (115 decisions)

Syed Asim Maqsood Med. PC v MVAIC (2026 NY Slip Op 51401(U)) Civil Court of the City of New York, Kings County, August 18, 2026Claimant's proof held to make out its prima facie case (also decides)Found that the provider established its prima facie case on six bills, leaving medical necessity for trial.
Maxim Orthopaedics PLLC v MVAIC (2026 NY Slip Op 51282(U)) Civil Court of the City of New York, Richmond County, July 2, 2026Claimant's proof held to make out its prima facie caseHeld the claimant made its prima facie showing for the three allegedly unreceived bills through proof that the billing forms were mailed and received and payment was overdue, which the insurer failed to rebut.
CuraHealth Specialty Pharm. Corp v State Farm Ins. Co. (2026 NY Slip Op 50852(U)) Civil Court of the City of New York, Queens County, June 1, 2026Insufficient: claimant did not prove the claim was submitted (mailed to and received by the insurer) (also decides)Held the provider's cross motion failed to make a prima facie case because it rested only on counsel's affirmation, made without personal knowledge of the facts.
Queens Radiology Imaging v GEICO (2025 NY Slip Op 51823(U)) Civil Court of the City of New York, Queens County, September 21, 2025Insufficient: claimant did not prove the claim was submitted (mailed to and received by the insurer) (also decides)Held the provider's cross motion deficient because it submitted no affidavit from someone with personal knowledge that the bills were timely submitted and overdue, though the cross motion was denied mainly as moot.
Avamed Supply Inc v GEICO (2024 NY Slip Op 50688(U)) Civil Court of the City of New York, Richmond County, June 10, 2024Claimant's proof held to make out its prima facie case (also decides)Held the provider made out its prima facie case because the insurer's own motion exhibits showed it received the bill, and its improper denial left payment overdue.
Renelique v Foremost Signature Ins. Co. (2023 NY Slip Op 51226(U)) Civil Court of the City of New York, Queens County, November 20, 2023Claimant's proof held to make out its prima facie case (also decides)Held under CPLR 3212 (g) that the provider's affidavit and bills, with no denial of receipt by the insurer, established mailing, receipt and overdue payment, though summary judgment was denied because the ineligibility defense remained.
Jiang Acupuncture PC v State Farm Ins. Co. (2023 NY Slip Op 50961(U)) Civil Court of the City of New York, Queens County, September 11, 2023Claimant's proof held to make out its prima facie case (also decides)Held the insurer's denial forms acknowledging receipt were prima facie evidence that the claims were received and overdue, though the provider's cross-motion was denied because the ineligibility defense and outstanding verification raised factual issues.
Sloan v Nationwide Mut. Ins. Co. (2022 NY Slip Op 50997(U)) Civil Court of the City of New York, Queens County, October 13, 2022Claimant's proof held to make out its prima facie caseHeld the provider established its prima facie case because the insurer's denial forms showed receipt and nonpayment and the denial was untimely, issued more than 30 days after the second EUO nonappearance.

Show all 115 decisions

Top Choice Pharm. Corp. v Merchants Mut. Ins. Co. (2022 NY Slip Op 50867(U)) Civil Court of the City of New York, Queens County, September 14, 2022Claimant's proof held to make out its prima facie caseHeld the provider entitled to judgment because the insurer's denial form established receipt and nonpayment and its timely medical-necessity denial was without merit, the supporting peer opinion being conclusory.
Life Equip., Inc v Mid-Century Ins Co (2022 NY Slip Op 50877(U)) Civil Court of the City of New York, Kings County, August 9, 2022Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider not entitled to judgment because its showing rested only on nonpayment within 30 days while the insurer proved timely denials, and it did not show the denials conclusory, vague or meritless, though mailing and nonpayment were found established.
Advanced Recovery Equip. & Supplies v Travelers Ins. Co. (2022 NY Slip Op 50690(U)) Civil Court of the City of New York, Queens County, July 21, 2022Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed its prima facie burden because the denial forms it relied on, while proving receipt, showed partial payment and timely denial of the rest.
New York Med. & Diagnostic Ctr. v GEICO Ins. Co. (2021 NY Slip Op 51138(U)) Civil Court of the City of New York, Queens County, December 2, 2021Insufficient for another reason (eligibility, timely submission, own papers defeat the claim)Held the provider failed its prima facie burden because its own office manager admitted the bills were submitted after the 45-day deadline without adequate justification, and it offered no proof of fee schedule compliance.
Advanced Recovery E. & S. v MVAIC (2021 NY Slip Op 51035(U)) Civil Court of the City of New York, Queens County, November 1, 2021Claimant's proof held to make out its prima facie case (also decides)Held the provider met its initial burden of showing it timely submitted the claims and that MVAIC failed to timely pay or deny them, though the lack-of-coverage defense required denial of its cross motion.
Jiang Acupuncture, P.C. v New York Cent. Mut. Fire Ins. Co. (2021 NY Slip Op 50945(U)) District Court of Suffolk County, Fourth District, September 23, 2021Insufficient: claimant did not prove the claim was submitted (mailed to and received by the insurer)Held the provider failed its prima facie case because it relied on the insurer's denial forms without submitting its claim forms with a billing manager's affidavit of personal knowledge of their issuance.
Custom Rx Pharm. v Country Wide Ins. Co. (2021 NY Slip Op 50860(U)) Civil Court of the City of New York, Queens County, September 15, 2021Insufficient: claimant did not prove the claim was submitted (mailed to and received by the insurer)Held the claimant's cross motion failed because its biller's affidavit, based only on review of business records, lacked personal knowledge of submission and was hearsay; the insurer's denial form also showed a denial twelve days after receipt.
MSB Physical Therapy, P.C. v Nationwide Ins. (2021 NY Slip Op 50750(U)) Civil Court of the City of New York, Kings County, July 13, 2021Claimant's proof held to make out its prima facie case (also decides)Held the provider made its prima facie case for five bills because the insurer's own denial forms admitted receipt and showed nonpayment within 30 days, the denials being untimely; the other three bills were timely denied.
Medalliance Med. Health Servs. v Travelers Prop. Cas. Ins. Co. (2021 NY Slip Op 50737(U)) District Court of Suffolk County, Fourth District, June 30, 2021Claimant's proof held to make out its prima facie case (also decides)Held the provider established its prima facie case, by proof that the claim forms were mailed to and received by the insurer and payment was overdue, warranting summary judgment for the non-moving provider.
New York Core Chiropractic, P.C. v Ameriprise Ins. Co. (2021 NY Slip Op 50599(U)) Civil Court of the City of New York, Queens County, June 24, 2021Claimant's proof held to make out its prima facie case (also decides)Held the insurer's denial forms acknowledging receipt of the claims were prima facie evidence of receipt and overdue payment, though the cross-motion failed because of the proven EUO no-show defense.
Apazidis, M.D., P.C. v State Farm Mut. Auto. Ins. Co. (2021 NY Slip Op 50498(U)) Civil Court of the City of New York, Queens County, May 26, 2021Claimant's proof held to make out its prima facie case (also decides)Held the insurer's denial forms acknowledging receipt months earlier were prima facie evidence that the claims were received and overdue, but denied the cross-motion because the ineligibility defense and outstanding verification raised factual issues.
Parisien v Travelers Ins. Co. (2021 NY Slip Op 50396(U)) Civil Court of the City of New York, Kings County, April 30, 2021Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held that the insurer's denial forms cured any defect in the provider's proof of mailing the bills, but denied the provider's cross motion because the record showed the bills were timely denied.
Sayyed DC, P.C. v Ameriprise Ins. Co. (2021 NY Slip Op 50311(U)) Civil Court of the City of New York, Queens County, April 13, 2021Claimant's proof held to make out its prima facie caseHeld that although the provider submitted no evidence, the insurer's denial of claim forms were prima facie proof of receipt, and with the untimely denials the provider was entitled to judgment on two bills.
Barakat P.T., P.C. v Progressive Ins. Co. (2021 NY Slip Op 50342(U)) Civil Court of the City of New York, Kings County, April 9, 2021Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider not entitled to summary judgment because the record showed the insurer timely denied the bill on the deductible ground, although the denial's admission of receipt cured any gap in mailing proof.
Longevity Med. Supply, Inc. v Progressive Ins. Co. (2020 NY Slip Op 20137) Civil Court of the City of New York, Kings County, June 17, 2020Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider's showing that bills went unpaid did not entitle it to judgment on three claims because the insurer proved timely denials and the provider did not show them conclusory, vague or without merit.
New Chiropractic Care, P.C. v Nationwide Ins. Co. of N.Y. (2020 NY Slip Op 50652(U)) Civil Court of the City of New York, Kings County, June 1, 2020Claimant's proof held to make out its prima facie caseHeld the billing representative's affidavit insufficient to prove mailing for lack of knowledge of the billing company's practices, but found the defect cured by the insurer's denial forms admitting receipt, and granted judgment on two bills whose denials were untimely or unproved.
Montvale Surgical Ctr., LLC. v State Farm Mut. Auto. Ins. Co. (2020 NY Slip Op 50106(U)) District Court of Suffolk County, Third District, January 20, 2020Insufficient for another reason (eligibility, timely submission, own papers defeat the claim) (also decides)Held the claimant failed to make a prima facie case because its own assignment of benefits form referred to a different accident date than the accident in suit.
Krasner Chiropractic, P.C. v IDS Prop. & Cas. Ins. Co. (2019 NY Slip Op 29382) Civil Court of the City of New York, Richmond County, November 12, 2019Claimant's proof held to make out its prima facie case (also decides)Held over the insurer's objection that the provider demonstrated its prima facie case, granting partial summary judgment on that point and leaving only the staged-accident coverage question for trial.
Dassa Orthopedic Med. Servs. PC v Amica Mut. Ins. Co. (2019 NY Slip Op 51664(U)) Civil Court of the City of New York, Kings County, October 22, 2019Claimant's proof held to make out its prima facie case (also decides)Held the provider proved timely submission of the bills and that they were overdue with no denial issued, granting partial CPLR 3212(g) relief, but left medical necessity for trial if New Jersey law applies.
Island Life Chiropractic Pain Care PLLC v Amica Mut. Ins. Co. (2019 NY Slip Op 51589(U)) Civil Court of the City of New York, Kings County, May 17, 2019Claimant's proof held to make out its prima facie case (also decides)Granted the provider a CPLR 3212 (g) finding that the bills were mailed to and received by the insurer, while denying summary judgment because of a factual issue about the provider's corporate status.
Parisien v Omni Indem. Co. (2019 NY Slip Op 50523(U)) Civil Court of the City of New York, Kings County, April 9, 2019Claimant's proof held to make out its prima facie case (also decides)Granted the claimant's cross motion only to the extent of finding it showed timely mailing of the statutory billing forms and that payment was overdue, leaving the policy rescission issue for trial.
Longevity Med. Supply, Inc. v MVAIC (2019 NY Slip Op 50965(U)) Civil Court of the City of New York, Kings County, March 11, 2019Insufficient: claimant did not prove the claim was submitted (mailed to and received by the insurer)Held the provider's cross motion failed because it submitted no admissible proof that the claim forms were mailed and did not show the claims were not timely denied or that the denial was conclusory or meritless.
Pavlova v Allstate Ins. Co. (2019 NY Slip Op 50016(U)) Civil Court of the City of New York, Kings County, January 2, 2019Claimant's proof held to make out its prima facie case (also decides)Held the provider established its prima facie case through its employee's affidavit and the annexed bills.
Body Acupuncture Care, P.C. v Erie Ins. Co. of N.Y. (2018 NY Slip Op 51362(U)) Civil Court of the City of New York, Kings County, July 6, 2018Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider did not establish that the insurer failed to deny the claims within 30 days or that timely denials were conclusory, vague or without merit, so its motion was denied.
Active Care Med. Supply, Corp. v American Tr. Ins. Co. (2018 NY Slip Op 51408(U)) Civil Court of the City of New York, Kings County, May 17, 2018Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider did not establish that the insurer failed to deny the claims within 30 days or that timely denials were conclusory, vague or without merit, so its motion was denied.
Pavlova v Allstate Ins. Co. (2017 NY Slip Op 27454) Civil Court of the City of New York, Kings County, December 18, 2017Insufficient for another reason (eligibility, timely submission, own papers defeat the claim)Held that for a By Report code the report is part of a completed claim form, so the provider that billed without it failed its prima facie burden and the insurer's time to pay or deny never began.
St. Barnabas Hosp. v Government Empls. Ins. Co. (2017 NY Slip Op 27056) Supreme Court, Nassau County, February 1, 2017Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the hospital failed to make its prima facie showing because its claim was premature: its inadequate responses to two timely verification requests meant the 30-day period to pay or deny never began.
Golden Needle Acupuncture P.C. v MAPFRE Ins. Co. (2016 NY Slip Op 26411) Civil Court of the City of New York, Kings County, November 30, 2016Claimant's proof held to make out its prima facie caseHeld the provider made its prima facie case on two claims through its owner's affidavit describing its mailing procedures and nonpayment within 30 days, but not on a third whose mailing proof bore conflicting date stamps.
Tyorkin v Garrison Prop. & Cas. Ins. Co. (2016 NY Slip Op 50846(U)) Civil Court of the City of New York, Kings County, May 20, 2016Claimant's proof held to make out its prima facie case (also decides)Held the provider met its prima facie burden for purposes of trial through its own affidavit, the annexed bill and a USPS mail extract showing timely mailing, leaving only the fee schedule defense for trial.
Pavlova v Allstate Ins. Co. (2016 NY Slip Op 26123) Civil Court of the City of New York, Kings County, April 11, 2016Claimant's proof held to make out its prima facie caseHeld the provider made its prima facie case for two codes by proof of mailing and an untimely denial, but not for a 'By Report' code lacking the information the fee schedule requires, which the court treated as part of a completed claim form.
East Coast Acupuncture, P.C. v Hereford Ins. Co. (2016 NY Slip Op 26042) Civil Court of the City of New York, Kings County, February 9, 2016Claimant's proof held to make out its prima facie case (also decides)Rejected the insurer's argument that the amended 11 NYCRR 65-3.8 (g) requires the provider to prove fee schedule compliance as part of its prima facie case, holding the regulation adds no element and overbilling remains the insurer's defense.
Alleviation Med. Servs., PC v Hertz Co. (2015 NY Slip Op 25285) Civil Court of the City of New York, Kings County, August 12, 2015Claimant's proof held to make out its prima facie caseHeld the provider made its prima facie case through the insurer's interrogatory answers annexing a denial that admitted the date the claim was received, absent a timely denial.
Westchester Med. Ctr. v Travelers Prop. Cas. Co. of Am. (2014 NY Slip Op 51216(U)) District Court of Nassau County, First District, August 7, 2014Claimant's proof held to make out its prima facie case (also decides)Held the provider established prima facie entitlement by proving the claim was neither paid nor denied within 30 days after the insurer received the requested verification.
Advanced Neurological Care, P.C. v State Farm Mut. Auto. Ins. Co. (2012 NY Slip Op 52203(U)) District Court of Nassau County, First District, November 26, 2012Claimant's proof held to make out its prima facie case (also decides)Held the provider made its prima facie showing through mailing affidavits, the insurer's acknowledgment of receipt, a business-records affidavit and nonpayment within 30 days, but denied its cross motion because questions of fact existed on verification tolling.
Lexington Acupuncture, PC v MVAIC (2012 NY Slip Op 51960(U)) Civil Court of the City of New York, Kings County, October 9, 2012Claimant's proof held to make out its prima facie case (also decides)Held that a provider suing MVAIC need only prove the claim forms were generated, mailed, received and overdue, and need not prove the assignor was a qualified person as part of its prima facie case.
Elmont Open MRI & Diagnostic Radiology, P.C. v New York Cent. Mut. Fire Ins. Co. (2012 NY Slip Op 22242) District Court of Nassau County, First District, August 17, 2012Claimant's proof held to make out its prima facie case (also decides)Held the provider showed timely submission (admitted by the insurer's verification request), business-record status of its documents, compliance with verification and nonpayment within 30 days, so summary judgment was granted on searching the record.
Victory Med. Diagnostics, P.C. v Nationwide Prop. & Cas. Ins. Co. (2012 NY Slip Op 22149) District Court of Nassau County, First District, June 4, 2012Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider's cross motion failed because it did not establish that the claim documents it submitted were admissible business records under CPLR 4518.
Exclusive Med. Supply, Inc. v MVAIC (2012 NY Slip Op 50616(U)) Civil Court of the City of New York, Kings County, April 11, 2012Claimant's proof held to make out its prima facie caseHeld the provider made its prima facie case because its billing manager described the office's billing and mailing practices and personally mailed the bills, and declined to deny the motion for failure to show the denials untimely or meritless.
Motor Veh. Acc. Indem. Corp. v Physical Medicine & Rehab of NY (2011 NY Slip Op 50848(U)) Supreme Court, Queens County, May 13, 2011Claimant's proof held to make out its prima facie case (also decides)Held the provider, cross-moving for payment in the insurer's de novo action, made a prima facie showing that its billing forms were mailed and received and payment was overdue.
Lenox Hill Hosp. v Allstate Ins. Co. (2011 NY Slip Op 50800(U)) District Court of Nassau County, First District, May 3, 2011Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the hospitals failed their prima facie case because their third-party biller's affidavits addressed only mailing and laid no foundation that the claim forms and bills were the hospitals' business records.
Gegerson v State Farm Ins. Co. (2010 NY Slip Op 50604(U)) District Court of Nassau County, Second District, April 8, 2010Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the providers failed their prima facie case because the bill copies submitted, misdated years after suit and differing from the bills received, could not be deemed admissible business records under CPLR 4518.
Style Acupuncture, P.C. v State-Wide Ins. Co. (2010 NY Slip Op 50089(U)) Civil Court of the City of New York, Kings County, January 22, 2010Claimant's proof held to make out its prima facie case (also decides)Held the provider showed by its owner's detailed affidavit that the claim was assigned, submitted and mailed, and the insurer's own denial form showed the denial issued beyond 30 days, establishing the prima facie case.
Perfect Point Acupuncture, P.C. v Auto One Ins. Co. (2010 NY Slip Op 50010(U)) Civil Court of the City of New York, Kings County, January 6, 2010Claimant's proof held to make out its prima facie case (also decides)Held the provider established its prima facie case by proving submission of claim forms, the fact and amount of the loss, and that payment was overdue, shifting the burden to the insurer.
Matter of NY Med. Health P.C. v New York City Tr. Auth. (2009 NY Slip Op 51526(U)) Civil Court of the City of New York, Kings County, July 13, 2009Claimant's proof held to make out its prima facie caseHeld the provider need not have shown at arbitration that its bills were submitted and overdue, because the self-insurer's earlier blanket denial repudiated liability and excused submission of proofs of claim.
Millennium Radiology, P.C. v New York Cent. Mut. Fire Ins. Co.(2009 NY Slip Op 50877(U)) Civil Court of the City of New York, Richmond County, April 30, 2009Claimant's proof held to make out its prima facie case (also decides)Held the provider established its prima facie case through its billing manager's detailed affidavit on record-keeping and mailing procedures, stating she personally mailed the bill.
Elmont Open MRI & Diagnostic Radiology P.C. v Progressive Cas. Ins. Co. (2009 NY Slip Op 50693(U)) District Court of Nassau County, First District, April 6, 2009Claimant's proof held to make out its prima facie caseHeld the provider established its prima facie case through its billing supervisor's affidavit of mailing practices and the insurer's denial forms acknowledging receipt within 45 days, with the bills unpaid.
Bayside Rehab & Physical Therapy, P.C. v GEICO Ins. Co. (2009 NY Slip Op 29145) Civil Court of the City of New York, Richmond County, April 3, 2009Claimant's proof held to make out its prima facie case (also decides)Held the provider made its prima facie showing because its billing manager laid a business-records foundation and personally mailed the bills; the motion was nonetheless denied because of the insurer's timely denials.
D & R Med. Supply v Progressive Ins. Co. (2009 NY Slip Op 29139) Civil Court of the City of New York, Kings County, March 31, 2009Claimant's proof held to make out its prima facie case (also decides)Held the supplier established its prima facie case by proving submission of claim forms and overdue payment, its billing manager's affidavit making the claim forms admissible.
New York Hosp. Med. Ctr. of Queens v Countrywide Ins. Co. (2009 NY Slip Op 50764(U)) Supreme Court, Nassau County, March 17, 2009Claimant's proof held to make out its prima facie caseHeld each hospital made its prima facie case through the third-party biller's affidavit showing billing by certified mail and nonpayment, rejecting the insurer's argument that the biller lacked knowledge to satisfy the business-records rule.
Yklik Med. Supply, Inc. v Allstate Ins. Co. (2008 NY Slip Op 28532) Civil Court of the City of New York, Richmond County, December 31, 2008Claimant's proof held to make out its prima facie case (also decides)Rejected the insurer's personal-knowledge challenge, holding the billing manager's detailed affidavit on record keeping and mailing procedure, and his personal mailing of the bill, established the provider's prima facie case.
A.B. Med. Servs. PLLC v GEICO Gen. Ins. Co. (2008 NY Slip Op 52641(U)) Nassau District Court, November 24, 2008Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed its prima facie case on the first six claims because the insurer's denial forms showed each was partially paid and partially denied, or fully denied, within 30 days of receipt.
Rockman v Clarendon Natl. Ins. Co. (2008 NY Slip Op 52093(U)) Civil Court of the City of New York, Richmond County, October 17, 2008Insufficient: claimant did not prove the claim was submitted (mailed to and received by the insurer) (also decides)Held the provider failed to establish its prima facie case because it gave no admissible proof that the 2002 bill was mailed and no evidence concerning mailing of, or a foundation for, the 2007 bill.
Chester Med. Diagnostic, P.C. v Kemper Cas. Ins. Co. (2008 NY Slip Op 52009(U)) Civil Court of the City of New York, Kings County, October 7, 2008Insufficient: claim forms not shown admissible as business records / merits of claim not provedDenied the provider's cross motion because it offered no affidavit from someone familiar with its business practices to make the claim form admissible as a business record, and the insurer's admission of receipt did not cure that.
Manhattan Med. Imaging, P.C. v State Farm Mut. Auto. Ins. Co. (2008 NY Slip Op 51844(U)) Civil Court of the City of New York, Richmond County, September 4, 2008Claimant's proof held to make out its prima facie case (also decides)Held the provider made its prima facie showing through a billing manager's affidavit detailing record-keeping and her personal mailing of the bill, rejecting the insurer's boilerplate and business-records objections.
Uniondale Chiropractic Off. v State Farm Mut. Auto. Ins. Co. (2008 NY Slip Op 51687(U)) District Court of Nassau County, First District, August 7, 2008Claimant's proof held to make out its prima facie caseHeld the provider made its prima facie case on all bills: the treating chiropractor's affidavit laid a business-record foundation, the insurer admitted receiving twenty bills, and his described office mailing practice proved mailing of the other three.
Lenox Hill Radiology v New York Cent. Mut. Fire Ins. Co. (2008 NY Slip Op 28275) District Court of Nassau County, First District, July 25, 2008Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider's cross motion failed because its affiant, employed by plaintiff's counsel, showed no knowledge of the provider's record-keeping practices and so laid no business-records foundation for the claim form.
Craigg Total Health Family Chiropractic Care PC v QBE Ins. Corp. (2008 NY Slip Op51398(U)) Nassau District Court, June 30, 2008Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the providers failed their prima facie case because the biller's affidavit did not satisfy CPLR 4518, failing to describe record-keeping practices or her actual employer, and the insurer's denials did not cure the missing foundation.
Carle Place Chiropractic v New York Cent. Mut. Fire Ins. Co. (2008 NY Slip Op 51065(U)) District Court of Nassau County, First District, May 29, 2008Claimant's proof held to make out its prima facie caseHeld the treating provider's affidavit established timely submission and that the claims were unpaid and overdue, with receipt admitted by the insurer, so the provider's cross motion was granted.
Elmont Open MRI & Diagnostic Radiology, P.C. v GEICO Ins. Co. (2008 NY Slip Op 50113(U)) District Court of Nassau County, First District, January 18, 2008Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie case because it laid no business-records foundation for its claim forms, the insurer's admission of receipt did not concede their facts, and a foundation first offered in reply could not be considered.
Friendly Physician, P.C. v Progressive Ins. Co. (2007 NY Slip Op 52269(U)) Civil Court of the City of New York, Kings County, December 3, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie case because its billing manager's affidavit did not show the claim forms were business records under CPLR 4518 or that she knew the office's practices.
Westchester Med. Ctr. v Encompass Ins. Co. (2007 NY Slip Op 52475(U)) Supreme Court, Nassau County, November 2, 2007Claimant's proof held to make out its prima facie case (also decides)Held the provider made a prima facie showing by evidence that the statutory billing forms, sent by certified mail, were mailed and received and that payment was overdue.
KOI Med. Acupuncture v State Farm Ins. Co. (2007 NY Slip Op 51705(U)) Nassau District Court, September 10, 2007Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider's motion failed because its billing agent's affidavit laid no business-records foundation for the claim documents, and the insurer's admission of receipt did not concede the facts asserted in the claim forms.
Complete Orthopedic Supplies, Inc. v State Farm Ins. Co. (2007 NY Slip Op 27192) Civil Court of the City of New York, Queens County, May 14, 2007Claimant's proof held to make out its prima facie case (also decides)Determined under CPLR 3212 (g) that the provider established its prima facie case because the insurer admitted receiving both claims, leaving the fee schedule disputes for trial.
Friendly Physician, P.C. v Country-Wide Ins. Co. (2007 NY Slip Op 50747(U)) Civil Court of the City of New York, Kings County, April 6, 2007Claimant's proof held to make out its prima facie case (also decides)Held the provider established its prima facie case because its billing manager's affidavit described standard mailing practices and the insurer's denial forms established the dates the claims were received.
Elmont Open MRI & Diagnostic Radiology, P.C. v Country-Wide Ins. Co. (2007 NY Slip Op 27072) District Court of Nassau County, First District, February 23, 2007Claimant's proof held to make out its prima facie caseHeld the provider made out its prima facie case through the insurer's admitted receipt and an invalid denial form, rejecting the insurer's argument that the provider also had to prove medical necessity.
Mid Atl. Med. P.C. v Victoria Select Ins. Co. (2006 NY Slip Op 52039(U)) Civil Court of the City of New York, Kings County, October 24, 2006Claimant's proof held to make out its prima facie case (also decides)Held the provider established prima facie entitlement by showing submission of proper claims and overdue payment, though its motion failed on the insurer's coverage defense.
Bronx Expert Radiology, P.C. v Allstate Ins. Co. (2006 NY Slip Op 51992(U)) District Court of Nassau County, Third District, October 13, 2006Claimant's proof held to make out its prima facie case (also decides)Held the provider established its prima facie entitlement because it was undisputed the insurer received the bill and denied it more than 30 days later.
Queensboro Med. Rehab, P.C. v Progressive Cas. Ins. Co. (2006 NY Slip Op 51936(U)) Civil Court of the City of New York, Kings County, October 12, 2006Claimant's proof held to make out its prima facie case (also decides)Held the provider established its prima facie entitlement through the insurer's denial forms acknowledging receipt, but the medical-necessity issues of fact precluded summary judgment except for fees on a late-paid claim.
Montgomery Med., P.C. v State Farm Ins. Co. (2006 NY Slip Op 51116(U)) Nassau District Court, June 13, 2006Claimant's proof held to make out its prima facie case (also decides)Held the provider established its prima facie case by showing its claims were timely submitted, receipt was acknowledged, and they were not paid or timely denied; summary judgment was nonetheless denied on a fraudulent-incorporation fact issue.
Montgomery Med., P.C. v State Farm Ins. Co. (2006 NY Slip Op 51003(U)) Nassau District Court, May 31, 2006Claimant's proof held to make out its prima facie case (also decides)Held the provider established its prima facie case because its claims were timely submitted and acknowledged as received, and the insurer neither paid nor timely denied them; delay letters did not toll the period.
Vinings Spinal Diagnostic v Travelers Prop. Cas. Ins. Co. (2006 NY Slip Op 50999(U)) Nassau District Court, May 30, 2006Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider proved submission of its claim but not that payment was overdue, since the insurer showed a timely mailed denial, so no prima facie case for summary judgment.
Celtic Med., P.C. v Liberty Mut. Ins. Co. (2006 NY Slip Op 50825(U)) Nassau District Court, May 9, 2006Insufficient for another reason (eligibility, timely submission, own papers defeat the claim) (also decides)Held that the provider, having stipulated to preclusion for failing to produce invoices, medical necessity letters and charts, could not make out its prima facie case, and dismissed the action.
Alleviation Supplies Inc. v Enterprise Rent-A-Car (2006 NY Slip Op 26177) Civil Court, Richmond County, April 10, 2006Claimant's proof held to make out its prima facie case (also decides)Held the provider established its prima facie case by showing submission of the claim, admitted received in the insurer's denial, and nonpayment, but the motion failed on the insurer's limitations defense.
SK Med. Servs., P.C. v New York Cent. Mut. Fire Ins. Co. (2006 NY Slip Op 50721(U)) Civil Court of the City of New York, Richmond County, April 5, 2006Claimant's proof held to make out its prima facie case (also decides)Held the provider's papers established that it submitted the claims setting forth the fact and amount of loss and that payment was overdue, but denied its motion as premature pending discovery.
Capri Med., P.C. v New York Cent. Mut. Fire Ins. Co. (2006 NY Slip Op 50538(U)) Civil Court of the City of New York, Kings County, March 30, 2006Claimant's proof held to make out its prima facie case (also decides)Held the provider established its prima facie case through the assignment, denial forms and the insurer's billing manager's affidavit that denials issued more than 30 days after receipt, shifting the burden to the insurer.
New York Craniofacial Care, P.C. v Allstate Ins. Co. (2006 NY Slip Op 50500(U)) Civil Court of the City of New York, Kings County, March 29, 2006Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)Held the provider failed its prima facie case because its affidavit said only that the claims were unpaid and was silent on denials, while a claim is overdue only if neither paid nor timely denied.
A.B. Med. Servs. PLLC v New York Cent. Mut. Fire Ins. Co. (2006 NY Slip Op 26131) Civil Court of the City of New York, Kings County, March 7, 2006Claimant's proof held to make out its prima facie case (also decides)Held the providers established prima facie entitlement by proof that they submitted the claim forms stating the fact and amount of loss and that payment was overdue.
Preferred Med. Imaging, P.C. v Liberty Mut. Fire Ins. Co. (2006 NY Slip Op 50278(U)) Suffolk District Court, January 19, 2006Claimant's proof held to make out its prima facie caseVacated a master arbitrator's award that required the provider to prove medical necessity despite the insurer's untimely denial, holding that requirement contrary to settled law and entering judgment for the provider.
Mega Supply & Billing Inc. v Allstate Ins. Co. (2005 NY Slip Op 52168(U)) Civil Court, Kings County, December 30, 2005Claimant's proof held to make out its prima facie case (also decides)Granted the provider summary judgment, the insurer undisputedly having neither paid nor denied within 30 days and having shown no tolling, since it did not establish that its policy authorized the EUO it requested.
Multiquest PLLC v Allstate Ins. Co. (2005 NY Slip Op 52209(U)) Civil Court, Queens County, December 19, 2005Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie case because the owner's general familiarity with office practices could not lay a CPLR 4518 foundation for the exhibits and did not establish mailing of the claim.
Multiquest, P.L.L.C. v Allstate Ins. Co. (2005 NY Slip Op 52069(U)) Civil Court, Queens County, December 19, 2005Insufficient: claimant did not prove the claim was submitted (mailed to and received by the insurer)Held the provider failed its prima facie case because the affidavit of service neither described the office procedure for mailing bills nor the method of mailing, so mailing of the claim was not established.
First Help Acupuncture, P.C. v Lumbermens Mut. Ins. Co. (2005 NY Slip Op 51815(U)) Civil Court of the City of New York, Kings County, November 9, 2005Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld the provider failed its prima facie case because its affiant, identified only as an employee, did not show familiarity with its record-keeping practices and so could not lay a business-records foundation for the bills.
Multiquest, PLLC v Allstate Ins. Co. (2005 NY Slip Op 25356) Civil Court, Queens County, August 30, 2005Claimant's proof held to make out its prima facie case (also decides)Held the provider proved it submitted a timely and proper claim that the insurer neither paid in full nor timely denied, before the case was decided on the insurer's eligibility defense.
Maximum Physical Therapy, P.C. v Allstate Ins. Co. (2005 NY Slip Op 51215(U)) Civil Court, Queens County, July 7, 2005Insufficient: claimant did not prove the claim was submitted (mailed to and received by the insurer)Held the provider failed its prima facie case because the attorney lacked personal knowledge and the officer's affidavit was conclusory boilerplate with no mailing dates, services or sources of knowledge.
Advanced Med. v Progressive Cas. Ins. Co. (2005 NY Slip Op 50945(U)) District Court of Nassau County, First District, June 24, 2005Insufficient: claimant did not prove the claim was submitted (mailed to and received by the insurer) (also decides)Held the provider could not establish a prima facie case because it submitted only an incomplete copy of the denial form and furnished no proof of mailing its claim.
First Help Acupuncture, P.C. v Hudson Ins. Co. (2005 NY Slip Op 50565(U)) Civil Court of the City of New York, Kings County, April 18, 2005Insufficient: claim forms not shown admissible as business records / merits of claim not provedHeld that because the insurer timely denied the claim, the provider had to prove medical necessity as part of its prima facie case, so the arbitrator rationally found against it and the master arbitrator's award stood.
T.S. Med. P.C. v Country Wide Ins. Co. (2005 NY Slip Op 50581(U)) Civil Court of the City of New York, Kings County, March 31, 2005Claimant's proof held to make out its prima facie caseHeld the arbitrators erred as a matter of law in requiring the provider to prove medical necessity as part of its prima facie case, since that burden rests on the insurer.
Westchester Med. Ctr. v Progressive Cas. Ins. Co. (2005 NY Slip Op 50348(U)) District Court of Nassau County, First District, March 21, 2005Claimant's proof held to make out its prima facie case (also decides)Held the hospital met its prima facie burden because its papers showed the claim forms were received and never paid or denied, facts the insurer confirmed in its opposition.
Socrates Psychological Servs., P.C. v Progressive Cas. Ins. Co. (2005 NY Slip Op 25096) Civil Court of the City of New York, Queens County, March 15, 2005Insufficient: claimant did not prove the claim was submitted (mailed to and received by the insurer) (also decides)Denied the provider's summary judgment cross motion because it offered no proof that the claim was mailed and did not explain the gap between the bill date and the date the insurer received it.
Vista Surgical Supplies, Inc. v Utica Mut. Ins. Co. (2005 NY Slip Op 25091) Civil Court of the City of New York, Kings County, March 10, 2005Insufficient: claimant did not prove the claim was submitted (mailed to and received by the insurer)Held the supplier's proof insufficient because the attorney lacked personal knowledge and the officer's boilerplate affidavit stated no case-specific facts such as mailing dates, merely adopting counsel's affirmation.
Vital Points Acupuncture, P.C. v New York Cent. Mut. Fire Ins. Co. (2005 NY Slip Op 50267(U)) Civil Court of the City of New York, Kings County, March 3, 2005Claimant's proof held to make out its prima facie case (also decides)Held the provider made its prima facie showing of mailing, receipt and overdue payment, rejecting the insurer's objections to the proof of claim and assignment as waived because it never requested verification of them.
Amaze Med. Supply Inc. v Travelers Prop. Cas. Corp. (2005 NY Slip Op 50201(U)) Civil Court, Kings County, February 22, 2005Claimant's proof held to make out its prima facie caseHeld the supplier established its prima facie case with admissible proof that it submitted claim forms stating the fact and amount of loss and that payment was overdue.
Metro Med. Diagnostics, P.C. v Allstate Ins. Co. (2005 NY Slip Op 50327(U)) Civil Court, Kings County, February 17, 2005Claimant's proof held to make out its prima facie case (also decides)Rejected the insurer's argument that unauthenticated assignments and unsigned verification forms defeated the provider's prima facie case, holding that submission of a complete proof of claim and the amount of loss suffices.
Delta Diagnostic Radiology, P.C. v Lumbermans Mut. Ins. Co. (2005 NY Slip Op 50326(U)) Civil Court, Kings County, February 10, 2005Claimant's proof held to make out its prima facie case (also decides)Held the provider showed its claim was submitted and remained outstanding through a postal-stamped mailing log and the insurer's denial form acknowledging receipt, rejecting the insurer's admissibility objections.
PDG Psychological P.C. v State Farm Mut. Ins. Co. (2005 NY Slip Op 50150(U)) Civil Court of the City of New York, Kings County, February 10, 2005Claimant's proof held to make out its prima facie case (also decides)Granted the provider summary judgment after noting receipt of the bill was shown by the insurer's own denial form and the denial issued more than 30 days later without an effective toll.
Boai Zhong Yi Acupuncture Servs. PC v General Assur. Ins Co. (2005 NY Slip Op 50329(U)) Civil Court of the City of New York, Kings County, February 9, 2005Claimant's proof held to make out its prima facie caseHeld the provider need not prove medical necessity, authenticate the assignment or present its bills in admissible form; proof of mailing and receipt and nonpayment within 30 days sufficed.
MZ Dental, P.C. v Progressive Northeastern Ins. Co. (2004 NY Slip Op 24524) District Court, Suffolk County, December 23, 2004Insufficient: claimant did not prove the claim was submitted (mailed to and received by the insurer) (also decides)Held that in three actions with no denial form showing receipt, the providers failed their prima facie case because the attorney's affirmation of mailing was not made by the person who actually mailed the bills.
Siegel v Progressive Cas. Ins. Co. (2004 NY Slip Op 24532) Civil Court of the City of New York, Kings County, December 21, 2004Insufficient for another reason (eligibility, timely submission, own papers defeat the claim)Held an assignment is an essential, non-waivable element of the claim, so the provider failed to establish entitlement because it never showed it included an assignment with its claim.
A.B. Med. Servs. PLLC v New York Cent. Mut. Fire Ins. Co. (2004 NY Slip Op 51847(U)) Civil Court of the City of New York, Kings County, November 10, 2004Claimant's proof held to make out its prima facie case (also decides)Held the providers made their prima facie showing through the billing manager's affidavit that he personally mailed the claim forms, which the insurer admitted receiving, and that the claims were not paid or denied within 30 days.
King's Med. Supply Inc. v Country-Wide Ins. Co. (2004 NY Slip Op 24394) Civil Court of the City of New York, Kings County, October 19, 2004Claimant's proof held to make out its prima facie caseHeld the insurer's NF-10, an admission showing receipt and denial after 30 days, established the supplier's prima facie case, and that documented cost and other supporting documents were not part of that burden.
A. M. Med. Servs., P.C. v AIU Ins. Co. (2004 NY Slip Op 51084(U)) District Court of Nassau County, Third District, September 29, 2004Insufficient: claimant did not prove the claim was submitted (mailed to and received by the insurer)Held the provider failed its prima facie case because its officer's affidavit, lacking first-hand knowledge, did not show what was mailed, when claims were sent or received, or that payment was not made within 30 days.
Careplus Med. Supply Inc. v Allstate Indem. Co. (2004 NY Slip Op 51148(U)) Civil Court, Kings County, September 24, 2004Claimant's proof held to make out its prima facie caseHeld the supplier made its prima facie case because, besides the claim and assignment, it submitted the referral, supplier invoices and cancelled checks documenting the paid cost of the equipment, rejecting demands for model numbers.
A.B. Med. Servs. PLLC v Farm Family Cas. Ins. Co. (2004 NY Slip Op 24346) Civil Court of the City of New York, Kings County, September 14, 2004Claimant's proof held to make out its prima facie caseHeld the provider established its prima facie case by proof that it mailed and the insurer received its claim forms and the insurer did not pay or deny within 30 days, rejecting the argument that an undated, unauthenticated assignment defeated it.
A.B. Med. Servs. PLLC v Travelers Prop. Cas. Corp. (2004 NY Slip Op 24289) Civil Court of the City of New York, Kings County, August 9, 2004Claimant's proof held to make out its prima facie case (also decides)Reaffirmed that proof of submission of a properly completed claim made the provider's prima facie case, and that the provider bore no burden on its motion to show medical necessity.
Palladium Car & Limo Serv. Corp. v Liberty Mut. Ins. Co. (2004 NY Slip Op 50987(U)) Civil Court, Kings County, July 22, 2004Insufficient for another reason (eligibility, timely submission, own papers defeat the claim)Held the transportation provider failed its prima facie case because its document only authorized direct payment and was not a valid assignment of the right to sue.
Rizz Mgt. Inc. v Kemper Ins. Co. (2004 NY Slip Op 50723(U)) Civil Court, Queens County, June 30, 2004Insufficient for another reason (eligibility, timely submission, own papers defeat the claim)Held the provider failed to establish a prima facie case because its timely motion papers contained no assignment of benefits, a necessary part of complete proof of claim, and the late supplemental assignment was disregarded.
Rockaway Blvd. Med. P.C. v Progressive Ins. (2004 NY Slip Op 24184) Civil Court of the City of New York, Queens County, June 2, 2004Insufficient for another reason (eligibility, timely submission, own papers defeat the claim)Held the provider failed its prima facie case because the HCFA-1500 form it submitted omitted the treating-to-billing provider relationship required by the NF-3, so it was not a complete proof of claim.

Trial courts in the Fourth Department (1 decision)

Proscan Radiology of Buffalo v Progressive Cas. Ins. Co. (2006 NY Slip Op 51242(U)) City Court of Buffalo, June 27, 2006Claimant's proof held to make out its prima facie caseHeld the insurer's denial form, an admission that the claim and assignment were received and not paid or denied within 30 days, established the treating physician's and billing entity's prima facie case.

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