Key Takeaway
Court ruling demonstrates how incomplete delivery documentation can derail a durable medical equipment provider's prima facie case for no-fault insurance benefits.
Understanding Prima Facie Requirements in Durable Medical Equipment Cases
In New York’s no-fault insurance system, medical equipment providers must establish a prima facie case to recover benefits from insurers. This requires proving both that services were actually provided and the amount owed. A recent Appellate Term decision illustrates how seemingly minor gaps in documentation can completely undermine an otherwise valid claim.
The case involved a medical supply company seeking summary judgment against an insurance carrier for unpaid durable medical equipment. While the provider submitted billing records and an affidavit from a company representative, the court found critical deficiencies in proving actual delivery of the supplies to the injured person.
Jason Tenenbaum’s Analysis:
Queens Med. Supply, Inc. v IDS Prop. & Cas. Ins. Co., 2013 NY Slip Op 51996(U)(App. Term 2d Dept. 2013)
“The billing records submitted by plaintiff 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 [*2]to plaintiff’s assignor. Rather, he stated that it is his general practice to either (1) deliver his supplies directly to the eligible injured person or (2) deliver them to the prescribing healthcare providers for subsequent delivery to the eligible injured person. He did not specify in his affidavit which method of delivery was used in this case. Accordingly, plaintiff’s moving papers failed to demonstrate plaintiff’s prima facie entitlement to summary judgment, in that they failed to prove the fact and the amount of the loss sustained (see Jamaica Med. Supply, Inc. v Kemper Cas. Ins. Co., 30 Misc 3d 142 ).”
Key Takeaway
Medical equipment providers cannot rely on general business practices to establish delivery. Courts require specific documentation proving that supplies were actually delivered to the injured person or their healthcare provider in each individual case. This decision reinforces the importance of detailed prima facie documentation in no-fault insurance disputes.
This ruling joins other decisions showing how courts scrutinize prima facie evidence and demonstrates the precision required in no-fault litigation documentation.
