Key Takeaway
Court ruling demonstrates the challenging burden healthcare providers face when establishing prima facie cases in no-fault insurance summary judgment motions.
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.
Understanding Prima Facie Requirements in No-Fault Insurance Cases
The concept of establishing a “prima facie” case represents one of the most significant hurdles healthcare providers face when pursuing no-fault insurance claims through summary judgment motions. This legal standard requires plaintiffs to demonstrate, as a matter of law, that they are entitled to judgment without the need for a trial. In the context of no-fault insurance disputes, this typically means proving that an insurance company’s denial was either untimely or lacked merit.
The recent Appellate Term decision in A.B. Med., PLLC v GEICO illustrates just how demanding this standard can be for medical providers seeking payment for services rendered to patients injured in motor vehicle accidents. The case demonstrates that even when pursuing what might seem like straightforward claims, the burden of establishing a prima facie case remains substantial and technically demanding.
Understanding these requirements is crucial for healthcare providers navigating the no-fault system, as failure to meet the prima facie standard at the summary judgment stage can result in costly and time-consuming litigation.
Jason Tenenbaum’s Analysis:
A.B. Med., PLLC v GEICO, 2013 NY Slip Op 50203(U)(App. Term 2d Dept. 2013)
“As plaintiff’s affidavit in support of its motion failed to demonstrate that defendant’s denial of claim forms were either untimely or without merit as a matter of law, plaintiff failed to establish its prima facie [*2]entitlement to summary judgment.”
These prima facie cases are extremely tough on the plaintiff’s bar. I wonder if this formulation will find its way to the trial context?
Key Takeaway
This decision reinforces the stringent evidentiary requirements healthcare providers must meet when seeking summary judgment in no-fault cases. The court’s emphasis on demonstrating that denials are “without merit as a matter of law” sets a high bar that often requires careful analysis of the denial document itself and comprehensive supporting documentation. Providers should ensure their affidavits thoroughly address both the timeliness and substantive merit of insurance company denials before pursuing summary judgment.
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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
Keep Reading
More Prima Facie case Analysis
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New York appeals court clarifies burden of proof standards in no-fault insurance cases, addressing when plaintiffs must prove compliance with verification requests at trial.
Mar 29, 2018Prima facie case for trial purposes
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, 2018A civil court upholds Domotor, but applies it in a strange fashion
Understanding how NY courts apply the Domotor case in no-fault insurance disputes. Long Island and NYC personal injury attorney explains the legal implications.
Feb 2, 2010What is a prima facie case? I still do not have an answer
Court of Appeals clarifies prima facie case requirements for no-fault insurance summary judgment, requiring proof of mailing and business records compliance.
Jun 11, 2015Prima facie case lost
New York court ruling shows healthcare providers face uphill battle when using third-party billing services to establish prima facie cases in no-fault insurance claims.
Jul 16, 2013Second Medical – loses at prima facie again
Second Medical loses another prima facie case in NY personal injury law. Learn what makes a strong prima facie case and avoid common litigation mistakes.
Feb 17, 2012Common 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.