Key Takeaway
Court establishes universal definition for prima facie cases in no-fault insurance disputes, showing how proper documentation and timely filing create entitlement to summary judgment.
Understanding Prima Facie Cases in No-Fault Insurance Law
The concept of a “prima facie case” serves as a fundamental building block in no-fault insurance litigation. Essentially, a prima facie case represents the minimum evidence a plaintiff must present to shift the burden of proof to the defendant. In the context of no-fault insurance disputes, establishing this threshold typically involves demonstrating that proper procedures were followed and statutory requirements were met.
The Appellate Term’s decision in Jesa Med. Supply, Inc. v Republic W. Ins. Co. provides valuable insight into what constitutes sufficient evidence for a prima facie case. This ruling clarifies the evidentiary standards that medical providers and other no-fault claimants must meet when seeking summary judgment against insurance carriers who fail to timely respond to claims.
Understanding these standards is crucial for practitioners, as establishing a prima facie case can be the difference between success and failure in no-fault litigation. The burden-shifting nature of prima facie cases means that once properly established, the insurance company must present evidence to create a genuine dispute of material fact.
Jason Tenenbaum’s Analysis:
Jesa Med. Supply, Inc. v Republic W. Ins. Co., 2011 NY Slip Op 51127(U)(App. Term 2d Dept. 2011)
A universal definition of a prima facie case.
“The affidavit also established that the claim was mailed to defendant, as the affiant averred that she had personally mailed the claim, and that defendant did not deny the claim within 30 days. Consequently, plaintiff established its prima facie entitlement to summary judgment (see Westchester Med. Ctr. v Nationwide Mut. Ins. Co., 78 AD3d 1168 ), and the burden shifted to defendant to raise a triable issue of fact”
Key Takeaway
The Jesa Med. Supply decision demonstrates that a prima facie case in no-fault insurance requires clear evidence of proper claim submission and the insurer’s failure to timely respond. When these elements are established through proper affidavits, the burden shifts to the insurance company to demonstrate why the claim should not be paid. This framework provides predictability for practitioners handling no-fault cases.
