Key Takeaway
Court grants summary judgment under new prima facie interpretation for no-fault billing manager affidavit establishing timely claim submission within 45 days.
New York Diagnostic Med. Care, P.C. v Geico Cas. Ins. Co., 2012 NY Slip Op 50681(U)(App. Term 2d Dept. 2012)
“The affidavit by plaintiff’s billing manager was sufficient to establish that the claim forms annexed to the motion papers were admissible pursuant to CPLR 4518 (see Art of Healing Medicine, P.C., 55 AD3d 644 ; Fortune Med., P.C. v Travelers Home & Mar. Ins. Co., 14 Misc 3d 136, 2007 NY Slip Op 50243 ), that the claim forms had been mailed to defendant within 45 days of the date services were rendered (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 ; Delta Diagnostic Radiology, P.C. v Chubb Group of Ins., 17 Misc 3d 16 ), and that the basis for defendant’s denials, i.e., that “written proof of claim was provided more than 45 days after the date these services were rendered” was “without merit as a matter of law.” Contrary to defendant’s contention, it is not the date of defendant’s receipt of a claim form which determines whether the submission of a claim form is untimely, but rather the date of plaintiff’s submission of the claim form (see Insurance Department Regulations § 65 – 1.1 [“the eligible injured person or that person’s assignee … shall submit written [*2]proof of claim to the Company … in no event later than 45 days after the date services are rendered”]; see also SZ Med. P.C. v Country-Wide Ins. Co.,12 Misc 3d 52 ; Ops Gen Counsel NY Ins Dept No. 04-02-12 ).”
Related Articles
- The Fourth Department discusses what constitutes a prima facie case in no-fault claims
- Carothers v. Geico: The No-Fault Business Records Showdown
- Court guidance on the business records exception for establishing claims
- Understanding Prima Facie Cases in New York No-Fault Insurance Law
- New York No-Fault Insurance Law
Legal Update (February 2026): The prima facie standards and CPLR 4518 admissibility requirements discussed in this 2012 decision may have evolved through subsequent court interpretations and potential amendments to Insurance Department Regulation § 65. Additionally, procedural requirements for establishing timely submission of no-fault claims and billing manager affidavit standards may have been refined through more recent appellate decisions. Practitioners should verify current provisions of Insurance Department regulations and recent case law developments when establishing prima facie cases for summary judgment in no-fault matters.
