Key Takeaway
Kings County Civil Court rules that receiving an NF-10 denial form from an insurer is sufficient to establish prima facie proof that a medical claim was properly submitted and received.
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.
Denial Forms as Prima Facie Evidence in No-Fault Cases
In no-fault insurance litigation, medical providers must establish that they properly submitted claims to insurers before pursuing payment. Traditionally, this required detailed proof of mailing procedures and delivery confirmation. However, a recent Kings County Civil Court decision has simplified this burden significantly by recognizing that receipt of a denial form itself can serve as prima facie evidence of proper claim submission.
This ruling builds upon the foundation established in Viviane Etienne while addressing practical questions about evidentiary requirements that courts had not previously resolved. The decision represents a pragmatic approach to establishing prima facie cases in medical provider litigation.
Jason Tenenbaum’s Analysis:
AR Med. Rehabilitation v State-Wide Ins. Co., 2015 NY Slip Op 25287 (Civil Ct. Kings Co. 2015)
(1) “Neither the Court of Appeals nor the Second Department in Viviane Etienne addressed whether at trial, a medical provider could forgo evidentiary proof of its mailing procedure by relying upon its receipt of a denial form from the insurer. Prior to Viviane Etienne, the Appellate Term, Second Department found that a medical provider’s receipt of an NF-10 denial form from the insurer was sufficient to establish that the claim form was sent by the medical provider and received by the insurer”
(2) “In light of the above, the Court finds that plaintiff’s submission into evidence of the NF-10 denial is sufficient to establish that defendant received the claim. Plaintiff therefore established its prima facie case. As defendant did not present any witnesses to establish its defense, judgment is awarded to plaintiff.”
This goes beyond the NTA cases and the interrogatory cases. I suppose it makes sense; if this is the case, then why bother with an NTA, subpoena or demanding interrogatories?
Key Takeaway
This decision streamlines the evidentiary burden for medical providers by treating denial forms as sufficient proof of claim submission. Rather than requiring complex proof of mailing procedures, providers can rely on the insurer’s own denial response as evidence that the claim was properly received, potentially eliminating the need for more burdensome discovery methods like notices to admit or interrogatory demands.
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
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May 24, 2010Common 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.