Key Takeaway
A 2012 case shows how medical providers can lose no-fault summary judgment motions when their affidavits fail to clearly establish the insurer's denial was untimely or legally insufficient.
This article is part of our ongoing prima facie case coverage, with 73 published articles analyzing prima facie case issues across New York State. Attorney Jason Tenenbaum brings 24+ years of hands-on experience to this analysis, drawing from his work on more than 1,000 appeals, over 100,000 no-fault cases, and recovery of over $100 million for clients throughout Nassau County, Suffolk County, Queens, Brooklyn, Manhattan, and the Bronx. For personalized legal advice about how these principles apply to your specific situation, contact our Long Island office at (516) 750-0595 for a free consultation.
When Prima Facie Cases Fall Short: A Costly Mistake for Medical Providers
In New York’s no-fault insurance system, medical providers seeking payment must establish a strong prima facie case to succeed in court. This requires proving specific elements, including that the insurance company either failed to respond within 30 days or issued a deficient denial. However, as one 2012 case demonstrates, even experienced providers can stumble on these seemingly straightforward requirements.
The case of Complete Radiology, P.C. v Progressive Insurance Co. serves as a cautionary tale about the precision required in no-fault litigation. When providers fail to properly establish their prima facie case, they not only lose their chance at summary judgment but also face the prospect of costly arbitration proceedings. This outcome highlights why understanding the elements of a successful prima facie case is crucial for medical providers navigating the no-fault system.
Jason Tenenbaum’s Analysis:
Complete Radiology, P.C. v Progressive Ins. Co., 2012 NY Slip Op 50583(U)(App. Term 2d Dept. 2012)
“A no-fault provider establishes its prima facie entitlement to summary judgment by proof of the submission to the defendant of a claim form, proof of the fact and the amount of the loss sustained, and proof either that the defendant had failed to pay or deny the claim within the requisite 30-day period, or that the defendant had issued a timely denial of claim that was conclusory, vague or without merit as a matter of law (see Insurance Law § 5106 ; Westchester Med. Ctr. v Nationwide Mut. Ins. Co., 78 AD3d 1168 ; Ave T MPC Corp. v Auto One Ins. Co., 32 Misc 3d 128, 2011 NY Slip Op 51292 ). Here, plaintiff’s affidavit failed to state unequivocally that defendant’s denial of claim forms were either untimely or without merit as a matter of law.”
Cases like this make AAA a lot of money.
Key Takeaway
Medical providers must be precise when establishing their prima facie case for summary judgment. Vague or ambiguous affidavits that fail to clearly state whether an insurer’s denial was untimely or legally deficient will result in the loss of summary judgment and force the case into expensive arbitration proceedings. Clear documentation about denial deficiencies is essential for success.
Legal Update (February 2026): Since this 2012 analysis, New York’s no-fault insurance regulations under Insurance Law § 5106 have undergone several amendments, including updates to claim submission procedures, denial response timeframes, and prima facie case requirements. Additionally, appellate decisions over the past decade have further refined the standards for establishing prima facie cases in no-fault litigation. Practitioners should verify current regulatory provisions and recent case law developments when advising clients on prima facie case strategies.
Legal Context
Why This Matters for Your Case
New York law is among the most complex and nuanced in the country, with distinct procedural rules, substantive doctrines, and court systems that differ significantly from other jurisdictions. The Civil Practice Law and Rules (CPLR) governs every stage of civil litigation, from service of process through trial and appeal. The Appellate Division, Appellate Term, and Court of Appeals create a rich and ever-evolving body of case law that practitioners must follow.
Attorney Jason Tenenbaum has practiced across these areas for over 24 years, writing more than 1,000 appellate briefs and publishing over 2,353 legal articles that attorneys and clients rely on for guidance. The analysis in this article reflects real courtroom experience — from motion practice in Civil Court and Supreme Court to oral arguments before the Appellate Division — and a deep understanding of how New York courts actually apply the law in practice.
About This Topic
Prima Facie Case Requirements in New York
Establishing a prima facie case is the threshold burden that every plaintiff or moving party must meet. In no-fault practice, the standards for a prima facie case on summary judgment have been refined through extensive appellate litigation — covering the sufficiency of claim forms, proof of mailing, medical evidence, and the procedural prerequisites for establishing entitlement to benefits. These articles analyze what constitutes a prima facie showing across different claim types and the evidence required to meet or defeat that burden.
73 published articles in Prima Facie case
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More Prima Facie case Analysis
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Analysis of two NY appellate cases establishing prima facie requirements for no-fault insurance trials, including burden of proof for claim submission and payment denial.
Jan 8, 2018Judge Hirsh says there is no difference in a hopsital and a standard medical provider's prima facie case
Judge Hirsh clarifies that hospitals and standard medical providers have identical prima facie case requirements in New York no-fault insurance litigation.
May 8, 2011Prima Facie Case Requirements in NY No-Fault Insurance: Avoiding the Omni Chiropractic Mistake
Analysis of Omni Chiropractic v Travelers case on prima facie case requirements in NY no-fault insurance claims, including overdue payment proof and litigation strategy.
Dec 20, 2009The prima facie case in the First Department and sinking of a disclosure based defense
First Department ruling on prima facie case requirements in no-fault insurance, waiver of assignment defenses, and discovery limitations in provider claims.
May 27, 2015Something involving collateral estoppel and prima facie happened here?
Court rules plaintiff failed to establish prima facie case for no-fault insurance recovery, lacking evidence to connect claim forms to prior judgment and proof of unpaid status.
Jun 26, 2013Common Questions
Frequently Asked Questions
What does 'prima facie case' mean in no-fault litigation?
In no-fault litigation, the provider or claimant bears the initial burden of establishing a prima facie case by submitting proof of the claim — including evidence that the services were provided, the claim was timely submitted, and the amount billed is correct. Once the prima facie case is established, the burden shifts to the insurer to demonstrate a valid defense, such as medical necessity denial, lack of coverage, or failure to appear for an EUO or IME.
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About the Author
Jason Tenenbaum, Esq.
Jason Tenenbaum is the founding attorney of the Law Office of Jason Tenenbaum, P.C., headquartered at 326 Walt Whitman Road, Suite C, Huntington Station, New York 11746. With over 24 years of experience since founding the firm in 2002, Jason has written more than 1,000 appeals, handled over 100,000 no-fault insurance cases, and recovered over $100 million for clients across Long Island, Nassau County, Suffolk County, Queens, Brooklyn, Manhattan, the Bronx, and Staten Island. He is one of the few attorneys in the state who both writes his own appellate briefs and tries his own cases.
Jason is admitted to practice in New York, New Jersey, Florida, Texas, Georgia, and Michigan state courts, as well as multiple federal courts. His 2,353+ published legal articles analyzing New York case law, procedural developments, and litigation strategy make him one of the most prolific legal commentators in the state. He earned his Juris Doctor from Syracuse University College of Law.
Disclaimer: This article is published by the Law Office of Jason Tenenbaum, P.C. for informational and educational purposes only. It does not constitute legal advice, and no attorney-client relationship is formed by reading this content. The legal principles discussed may not apply to your specific situation, and the law may have changed since this article was last updated.
New York law varies by jurisdiction — court decisions in one Appellate Division department may not be followed in another, and local court rules in Nassau County Supreme Court differ from those in Suffolk County Supreme Court, Kings County Civil Court, or Queens County Supreme Court. The Appellate Division, Second Department (which covers Long Island, Brooklyn, Queens, and Staten Island) and the Appellate Term (which hears appeals from lower courts) each have distinct procedural requirements and precedents that affect litigation strategy.
If you need legal help with a prima facie case matter, contact our office at (516) 750-0595 for a free consultation. We serve clients throughout Long Island (Huntington, Babylon, Islip, Brookhaven, Smithtown, Riverhead, Southampton, East Hampton), Nassau County (Hempstead, Garden City, Mineola, Great Neck, Manhasset, Freeport, Long Beach, Rockville Centre, Valley Stream, Westbury, Hicksville, Massapequa), Suffolk County (Hauppauge, Deer Park, Bay Shore, Central Islip, Patchogue, Brentwood), Queens, Brooklyn, Manhattan, the Bronx, Staten Island, and Westchester County. Prior results do not guarantee a similar outcome.