Oceanside Medical Healthcare, P.C. v. Progressive Ins

In Oceanside Medical Healthcare, P.C. v. Progressive Ins. (2002 NY Slip Op 50188[U] [Civ Ct, Kings County]), the Court held that, in an action for first-party no-fault benefits, the insured / assignee makes a prima facie case by submitting "proper proof of the claim and the amount of the loss", and need not include any showing that the services were "necessary" beyond that contained in the prescribed verification form or an otherwise completed claim form. (See id. at 19-20.) The Court expressly did not rule on whether the insured / assignee or the insurer bears the burden of persuasion on the question of medical necessity when the insurer timely denies the claim for lack of medical necessity. (Id., at 22.)