Key Takeaway
New York appellate court case shows how inadequate documentation can doom a no-fault insurance claim, highlighting the evolving standards for prima facie cases.
Understanding Prima Facie Requirements in No-Fault Insurance Claims
The landscape of no-fault insurance litigation continues to evolve as appellate courts refine the standards for establishing a prima facie case. A recent decision from the Appellate Term demonstrates how seemingly minor documentation gaps can prove fatal to an otherwise viable claim. This case serves as a stark reminder that proper evidence presentation remains crucial, even in routine medical supply reimbursement disputes.
The decision highlights a fundamental principle in no-fault insurance law: plaintiffs must establish not just that services were rendered or supplies were provided, but that they were actually delivered to the patient. This requirement has become increasingly scrutinized by courts, building upon precedents that have shaped prima facie standards in recent years.
Jason Tenenbaum’s Analysis:
Jamaica Med. Supply, Inc. v Kemper Cas. Ins. Co., 2011 NY Slip Op 50315(U)(App. Term 2d Dept. 2011)
“The billing records submitted by plaintiff in support of its motion for summary judgment do not assert that the supplies at issue had been delivered to plaintiff’s assignor. Nor did plaintiff’s affiant state that he had delivered the supplies to plaintiff’s assignor.”
I’m starting to think that people are out of their mind for appealing some of these issues. Each subsequent appeal that a misguided plaintiff attorney perfects brings us this much closer to prima facie medical necessity. I wish I was the Respondent on this case.
Key Takeaway
This decision underscores the critical importance of comprehensive documentation in no-fault insurance claims. Medical suppliers must ensure their billing records explicitly confirm delivery to patients, not merely the provision of supplies. As courts continue to tighten evidentiary standards, practitioners should review their documentation practices to avoid similar deficiencies in establishing prima facie cases.
