Key Takeaway
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.
Court Clarifies Burden of Proof in No-fault Insurance Litigation
New York’s no-fault insurance system creates specific procedural requirements that both insurers and medical providers must navigate carefully. A recent appellate decision highlights an important distinction about what plaintiffs must prove at trial versus what defendants must establish when challenging no-fault claims.
The case involves the fundamental question of prima facie burden in no-fault litigation — specifically, whether medical providers must prove their compliance with insurance company verification requests as part of their initial case, or whether such compliance issues fall under the defendant’s burden to prove meritorious defenses.
This decision adds to the ongoing evolution of prima facie case requirements in New York’s appellate courts, where different departments have sometimes reached varying conclusions on similar procedural issues.
Jason Tenenbaum’s Analysis:
TAM Med. Supply Corp. v Travelers Ins. Co., 2018 NY Slip Op 50315(U)(App. Term 2d Dept. 2018)
Sometimes, these orders are written in such a way where the Plaintiff has to actually prove something at trial. What I find obnoxious is that the proof of submission of the verification in the first instance is a boilerplate affidavit with nothing to substantiate is averments. Can somebody already take this up?
“Contrary to plaintiff’s assertion, the Civil Court properly stated that plaintiff bears the [*2]burden at trial of proving its prima facie case (see V.S. Med. Servs., P.C. v Travelers Ins. Co., 49 Misc 3d 152, 2015 NY Slip Op 51760 ). However, inasmuch as it is a defendant’s burden at trial to show that it has a meritorious defense and that such a defense is not precluded (see Presbyterian Hosp. in City of N.Y v Maryland Cas. Co., 90 NY2d 274, 282 ), the Civil Court improperly determined that, at trial, plaintiff must prove “whether it fully complied with verification requests.""
Key Takeaway
The appellate court confirmed that while medical providers must establish their prima facie case at trial, proving compliance with verification requests falls under the insurance company’s burden to demonstrate meritorious defenses. This ruling prevents courts from improperly shifting verification compliance issues onto plaintiffs during the initial burden phase.
