Key Takeaway
Court ruling clarifies that summary judgment motions are limited to specific pleadings, requiring defendants only address claims actually raised in no-fault cases.
“Here, in light of the limited basis of the plaintiff’s motion for summary judgment on the complaint, which was premised solely on the defendant’s alleged failure to timely pay or deny the no-fault claim within 30 days of receipt of proof of the claim (see Insurance Law § 5106; 11 NYCRR 65-3.8, ), “the defendant’s only burden in opposition … was to raise a triable issue of fact regarding its timely … denial of the claim” (Lenox Hill Hosp. v Government Empls. Ins. Co., 89 AD3d 905, 905; see Viviane Etienne Med. Care, P.C., v Country-Wide Ins. Co., _____ AD3d _____, 2013 NY Slip Op 08430 ; Westchester Med. Ctr. v Progressive Cas. Ins. Co., 89 AD3d 1081, 1082-1083). In opposition to the plaintiff’s prima facie showing of entitlement to judgment as a matter of law, the defendant satisfied its burden by raising a triable issue of fact as to whether it did in fact mail a proper NF-10 denial of claim form to the plaintiff only 22 days after its receipt of the claim verification that it had previously requested”
This shift has been years in the making, based upon the Westchester-Liberty case that came out a few years ago. To reach the merits of the defense, the plaintiff needs to show the defense lacks merit. Thus on medical necessity case, plaintiff must affirmatively show that the service is medially appropriate; On a DWI case (which this case was), Plaintiff must show that Defendant was not drunk or that the intoxication was not a proximate cause of the loss. It is an interesting standard and, in practice, the only reason a plaintiff moves for summary judgment is to establish its prima facie case. CPLR 3212(g). I wonder when the Appellate Division will (if ever) reach this discrete issue.
Related Articles
- Understanding how prima facie cases are established in no-fault insurance disputes
- How claim representative affidavits can cure NF-10 form inaccuracies
- Preserving objections to denial forms in New York no-fault cases
- Business records exception guidance for establishing prima facie cases
- New York No-Fault Insurance Law
Legal Update (February 2026): Since this 2014 post, the regulatory framework governing no-fault claim denials and summary judgment standards may have been modified through amendments to 11 NYCRR Part 65 regulations and updates to Insurance Law § 5106 procedural requirements. Additionally, evolving case law may have further refined the burden-shifting standards for prima facie showings in no-fault summary judgment motions. Practitioners should verify current regulatory provisions and recent appellate decisions when applying these summary judgment principles.
