Key Takeaway
Court ruling establishes important precedent on burden of proof for insurance companies claiming medical bills were already paid in no-fault cases.
When insurance companies defend against medical providers’ lawsuits by claiming bills have already been paid, they must meet specific evidentiary standards to prove their defense. A recent Appellate Term decision provides crucial guidance on what constitutes sufficient proof in these contested payment scenarios.
In no-fault insurance litigation, medical providers frequently sue insurers for unpaid bills related to motor vehicle accident treatments. Insurance companies often respond by asserting they have already satisfied these obligations, but this defense requires more than mere allegations—it demands concrete evidence that can withstand judicial scrutiny.
The burden of proof in summary judgment motions places the initial responsibility on the moving party to establish their case with admissible evidence. When an insurance company moves for summary judgment based on alleged prior payment, they must present documentation that clearly demonstrates the specific bills in question were actually paid. Vague assertions or incomplete records will not suffice to meet this prima facie burden.
Jason Tenenbaum’s Analysis:
Davidov Med., P.C. v Firemans Fund Ins. Co., 2010 NY Slip Op 52220(U)(App. Term 2d Dept. 2010)
The first time the issue of whether a bill has been paid, sufficient to warrant the granting of a motion for summary judgment has been addressed. Here is the monumental holding of the court:
“Upon a review of the record, we find that defendant did not make a prima facie showing that it had paid the four specific bills alleged by plaintiff in its complaint to be outstanding. Accordingly, defendant’s motion should have been denied”
Key Takeaway
This decision establishes that insurance companies cannot simply claim bills were paid without providing adequate documentation. The court requires specific, verifiable proof that the exact bills in dispute were actually satisfied. This ruling strengthens medical providers’ position in no-fault litigation by requiring insurers to meet rigorous evidentiary standards when asserting payment defenses.
