Key Takeaway
Court case refines prima facie requirements for no-fault insurance claims, clarifying medical providers don't need business records exception proof in NY.
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.
New York Hosp. Med. Ctr. of Queens v QBE Ins. Corp**.**, 2014 NY Slip Op 00639 (2d Dept. 2014)
“The plaintiffs made a prima facie showing of entitlement to judgment as a matter of law on the second cause of action, which related to the claim submitted by Westchester Medical Center in connection with the injuries allegedly sustained by its assignor, Robert de los Santos, by submitting evidence that the prescribed statutory billing form had been mailed to and received by the defendant insurer, which failed to either pay or deny the claims within the requisite 30-day period (see Viviane Etienne Med. Care, P.C. v Country-Wide Ins. Co.,AD3d, 2013 NY Slip Op 08430 ;Westchester Med. Ctr. v Hereford Ins. Co., 95 AD3d 1306, 1306-1307; Westchester Med. Ctr. v Lancer Ins. Co., 94 AD3d 984, 984; Westchester Med. Ctr. v Progressive Cas. Ins. Co., 89 AD3d 1081, 1082). A medical provider is not required, as part of its prima facie showing, to demonstrate the admissibility of its billing records or to prove the truth of their content under the business records exception to the hearsay rule (see CPLR 4518; Viviane [*2]Etienne Med. Care, P.C. v Country-Wide Ins. Co.,AD3d, 2013 NY Slip Op 08430, *6 ). In opposition to the plaintiffs’ showing in connection with the second cause of action, the defendant failed to raise a triable issue of fact as to whether it properly requested further verification of that claim”
Again, note that this new formulation of a prima facie stands true to the Westchester v. Liberty rule that the medical provider must prove the absence of a timely denial, the defective nature of the denial, or the affirmative merits of the claim, e.g.., the services were medically necessary, the EIP showed up to the IME, the bills were in accordance with the fee schedule. I cannot stress enough that this is not a return to the Mary Immaculate v. Allstate glory days where “Defendant established Plaintiff’s prima facie case”. They won the business record dispute, but lost the need to only show a bill is overdue to shift the burden.
Related Articles
- Understanding the prima facie case requirements in no-fault insurance claims
- How the Fourth Department defines prima facie cases in no-fault litigation
- Avoiding common mistakes in establishing prima facie cases
- Business records requirements for prima facie showings in no-fault cases
- New York No-Fault Insurance Law
Legal Update (February 2026): Since this 2014 post, New York’s no-fault regulations have undergone multiple amendments, including revisions to claim processing timeframes, billing form requirements, and prima facie case standards under Insurance Law Article 51. The fee schedules referenced have been updated several times, and procedural requirements for medical provider claims may have evolved. Practitioners should verify current provisions of the no-fault regulations and recent appellate decisions interpreting prima facie case requirements.
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
CPLR 3212(g) struck
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, 2018Account Stated Claims in New York: Why Failure to Annex Bills Requires Automatic Denial
Essential account stated claim requirements in NY after Cutler decision. Why failure to annex billing statements requires automatic denial. Expert legal analysis.
Feb 21, 2011The Fourth Department for the first time in a decade has discussed the issue of what constitues a prima facie case
Learn how the Fourth Department aligned with other NY appellate divisions on prima facie case requirements in no-fault litigation. Key legal development for providers.
Oct 5, 2009Motion to strike “3212(g) findings” denied
Court denies motion to strike CPLR 3212(g) findings in no-fault case, but leaves open question about plaintiff's appeal rights when judges refuse to make such findings.
May 26, 2014Another less than noteworthy prima facie decision
Analysis of New York Diagnostic Med. Care v GEICO decision on prima facie requirements in no-fault insurance claims and medical necessity standards.
Apr 1, 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.