Key Takeaway
Eagle Surgical Supply v Allstate case establishes methods for proving prima facie cases in NY no-fault insurance claims using NF-10 denial forms as evidence.
Eagle Surgical Supply, Inc. v Allstate Ins. Co., 2014 NY Slip Op 50343(U)(App. Term 2d Dept. 2014)
Method (1): The biller and the NF-10 –
Plaintiff sufficiently established that the NF-10 denial of claim form that it was trying to introduce into evidence was the denial of claim form that it had received from defendant, which referenced the claim form at issue in this action. Contrary to the ruling of the Civil Court, plaintiff should have been allowed to use that denial to demonstrate that the claim form in question had been submitted to defendant (see East Acupuncture, P.C. v Electric Ins. Co., 16 Misc 3d 128, 2007 NY Slip Op 51281 ; Oleg Barshay, D.C., P.C. v State Farm Ins. Co., 14 Misc 3d 74 ). In such a case, a plaintiff is not trying to use the denial as the plaintiff’s own business record pursuant to CPLR 4518 (a); instead, in this context, the denial is being used as an admission by the defendant that the claim form had been received.
Method 2 would be Interrogatories and Notices to Admit
Method 3 would be the claims representative admitting to receipt of the bills through the denial and lack of payment of the bill.
It is 2003 all over again.
Related Articles
- Understanding the business records exception for establishing prima facie cases
- Carothers v. Geico and the business records requirements for no-fault claims
- Third-party billing records and the Carothers standard in no-fault cases
- Understanding prima facie case requirements in New York no-fault insurance law
- New York No-Fault Insurance Law
Legal Update (February 2026): Since this 2014 post, New York’s no-fault regulations have undergone multiple revisions, including updates to claims processing procedures and denial form requirements. Additionally, appellate decisions interpreting CPLR 4518 business records exceptions and prima facie case standards may have evolved. Practitioners should verify current regulatory provisions and recent case law developments when establishing prima facie cases for no-fault claims.
