Open MRI of Tarrytown v GEICO Ins. Co. |
2009 NY Slip Op 50874(U) [23 Misc 3d 1120(A)] |
Decided on April 30, 2009 |
Civil Court Of The City Of New York, Bronx County |
Taylor, J. |
Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431. |
This opinion is uncorrected and will not be published in the printed Official Reports. |
Open Mri of
Tarrytown, AAO Arah George, Plaintiff,
against GEICO Insurance Co., Defendant. OPEN MRI OF FISHKILL, AAO MICHELLE VANDYKE Plaintiff, GEICO INSURANCE CO., Defendant. OPEN MRI OF YORKTOWN, AAO IMOGEAN RUSS, Plaintiff, GEICO INSURANCE CO., Defendant. OPEN MRI OF EASTCHESTER, AAO ROSEANN RENDA Plaintiff, GEICO INSURANCE CO., Defendant. SUNSHINE IMAGING ASSOCIATON, AAO MYRON WEBB Plaintiff, GEICO INSURANCE CO., Defendant. OPEN MRI OF FISHKILL, AAO MICHELLE VANDYKE Plaintiff, against GEICO INSURANCE CO., OPEN MRI OF YORKTOWN, AAO IMOGEAN RUSS, Plaintiff, - against - against GEICO INSURANCE CO., OPEN MRI OF EASTCHESTER, AAO ROSEANN RENDA Plaintiff, against GEICO INSURANCE CO., SUNSHINE IMAGING ASSOCIATON, AAO MYRON WEBB Plaintiff, - against - against GEICO INSURANCE CO., |
The issue before the Court is whether the submission of a notice to admit is [*2]sufficient to establish a prima facie case to recover no-fault first party benefits for unpaid medical expenses.
Under CPLR §3123 a notice to admit is a "written request for admission by the latter of
the genuineness of any papers or documents...described in and served with the request, or of the
truth of any matters of fact set forth in the request, as to which the party requesting the admission
reasonably believes there can be no substantial dispute at the trial and which are within the
knowledge of such other party or can be ascertained by him upon reasonable inquiry." (CPLR
§3123(a)). If a party fails to respond to a notice to admit within 20 days after service, the
matters therein are deemed admitted for the purpose of the pending litigation. (CPLR
§3123(a)). A notice to admit is a vehicle for resolving and eliminating matters that may be
factually relevant but are not really in dispute, thus a notice to admit is not permissible to seek
admissions to material issues. (Villa v. New York City Hous. Auth., 107 AD2d 619, 620
[1984][1st Dep't]).
In order to establish a prima facie case for first party no-fault benefits a plaintiff
must present the claim forms submitted to the insurer in admissible form, then establish that the
payment of benefits is overdue, and prove the claim and assignment forms were served upon
insurer. (Mary Immaculate Hosp. v.
Allstate Ins. Co., 5 AD3d 742, 742-743 [2004][2nd Dep't]). Laying the proper
evidentiary foundation is commonly done by a witness who can testify that the claim form is a
business record pursuant to CPLR §4518. However, it has become increasingly popular for
plaintiffs to attempt to forgo the necessity of a witness through the use of interrogatory responses
and responses or lack of responses to notices to admit to establish their prima facie case.
The Appellate Term, First Department has allowed the use of interrogatory
responses to establish a prima facie case, stating "having admitted receipt of plaintiff's claims for
no-fault first party benefits, defendants may not now be heard to argue that plaintiff failed to
establish that the claims had been mailed and received. (P.L.P. Acupuncture, P.C., v.
Travelers Indem. Co., 19 Misc 3d 126(A) [2008][N.Y.App. Term 1st Dept.], quoting Fair Price Med. Supply, Inc. v. St. Paul
Travelers Ins. Co., 16 Misc 3d 8,9 [2007][N.Y.App. Term 1st Dept.]). However, there
are notable differences between the use of interrogatories and a notice to admit. As previously
mentioned, a notice to admit may not be used to seek answers to material issues, whereas, an
interrogatory is given under oath and may be used to address any relevant question.
(Villa at 620). Furthermore, the use of a defendant's response to interrogatory questions
in which it is stated that the claims were mailed and received followed by a subsequent denial is
much different than the scenario in which a defendant fails to respond to a notice to admit and it
is therefore deemed admitted that they received the claim.
Courts differ drastically on the treatment of the notice to admit to establish a prima
facie claim. A number of courts find that the use of a notice to admit seeking admissions as to
the receipt of relevant claim forms, bills and defendant's denial of the same goes to the "heart of
the matter" or is a "material issue" and therefore, inadmissible to establish plaintiff's prima facie
case. (see RJ Med. P.C. v. All-State Ins. Co., 15 Misc 3d 1140(A) [2007][NY City Civ.
Ct. Bronx County]; PDG Psychological, [*3]P.C. v. State
Farm Ins. Co., 12 Misc 3d 1183(A) [2006][N.Y.City Civ. Ct. Kings County]). Meanwhile,
other courts have held that the information requested in the notice to admit does not individually
go to the "heart of the matter" even though collectively they may be dispositive. (see Seaside Med., P.C. v. General Assur.
Co., 16 Misc 3d 758 [2007][NY Dist. Ct. Suffolk]). Further, other courts have held that
the admissions of the receipt of relevant claim forms, bills and denials by notice to admit does
not go to the "heart of the matter" and is therefore permissible; however, it does not establish a
prima facie case because the formalities of the business record exception to the hearsay rule have
not been observed. (Bajaj v. General Assur. Co., 18 Misc 3d 25, 28 [2007][NY App.
Term 2nd Dept.]).
This Court is cognizant that the Second Department and First Department often
differ on matters concerning no-fault litigation. However, since the First Department has yet to
speak on the matter, this Court is bound by the Bajaj decision of the Appellate Term,
Second Department. "The doctrine of stare decisis requires trial courts...in this
department to follow precedents set by the Appellate Division of another department until the
Court of Appeals or [the Appellate Division of this department] pronounces a contrary rule."
(Striver 140 v. Cruz, 1 Misc 3d 29, 31 [2003][NY App. Term 2nd Dept.]), quoting
Mountain View Coach Lines v. Storms, 102 AD2d 663, 664 [1984][2nd Dept.]).
The Second Department has held that a plaintiff must lay a proper foundation for the
admissibility under the business records exception to establish a prima facie case. (Bajaj
at 28). According to Bajaj,the use of a notice to admit to ask the defendants if they have
received the claim form is a proper use of the notice to admit. (id.). If defendant fails to
respond to this notice to admit, it is then admissible that the defendant in fact received plaintiff's
claim form. (id.). However, an acknowledgment by defendant that they received the
claim form is not a concession of the facts set forth in the claim. (id.). It remains the
plaintiff's burden to lay the sufficient foundation establishing that the claim form is a business
record, and as such, is admissible to prove the truth of the matters asserted therein. (id.).
This holding continues to be upheld by the Second Department. (see Vista Surgical Supplies,
Inc. v. State Farm Mutual Ins. Co., 22 Misc 3d 128(A) [2009][N.Y.App. Term 2nd Dept.]).
Accordingly, the Court finds that an admission by notice to admit that defendant
received plaintiff's claim form is not a concession of the facts set forth in the claim form. The
plaintiff still has the burden to establish the claim form is admissible as a business record
exception to the hearsay rule to prove the truth of the matters asserted therein. Due to their
failure to establish that the claim forms are business records, plaintiffs have not established a
prima facie case. It is noted that the plaintiffs called no witnesses to testify.
Accordingly, plaintiff's actions are dismissed.
The foregoing shall constitute the decision and order of this Court.
Dated: __April 30, 2009_______________
J.C.C.