NO-FAULT – BUSINESS RECORD EXCEPTION TO HEARSAY RULE – MEDICAL BILLING COMPANY CLAIM FORMSSecond Med., P.C. a/a/o Marvin Calender v. AutoOne Ins. Co.(NYC Civil, Kings Co., decided 5/2/2008)Once a week, someone from Second Medical, PC, would deliver a bunch of patient files to Inga Lev at
Maugust, Inc. Maugust served as Second Medical's billing company. Each file contained one or more medical reports, which described the nature of the services that Second Medical purportedly provided to a particular patient, as well as an executed
AOB form and information identifying the patient's no-fault insurer. Either Ms. Lev or one of her co-workers would prepare no-fault claim forms based upon the information contained on the documents contained in patient files and mail the claim forms, along with an executed assignment, to the insurers responsible for payment of the no-fault benefits.
At the trial of this action, Ms. Lev testified to the above procedure, that the claim form her company had prepared was mailed to AutoOne, and that payment was not made within 30 days. Ms. Lev gave no testimony, however, concerning the practices and procedures that plaintiff Second Medical had utilized in creating the documents contained in the patient files.
Although AutoOne's NF-10, which acknowledged receipt of the Maugust-generated claim form, was offered and received into evidence, AutoOne objected to the admission of the claim form, arguing that Ms. Lev had failed to lay a proper foundation for its admission as a business record pursuant to CPLR § 4518(a). Relying "primarily" on the Appellate Term, Second Department's September 2006 decision in
Pine Hollow Medical, P.C. a/a/o Karen Allen v. Progressive Cas. Ins. Co., another case involving a no-fault medical billing company, plaintiff's counsel argued that since Ms. Lev established plaintiff had a business duty to Maugust to deliver the patient files, and that Maugust routinely relied on the medical reports and other documents contained in the files and fully incorporated them into no-fault claim forms which it created in the regular course of its business, a proper foundation for the admission of the claim form as a business record had been laid.
In sustaining AutoOne's objection and dismissing plaintiff's complaint,
Judge Peter Paul Sweeney reviewed the business record hearsay exception rule of CPLR § 4518(a):
Here, Ms. Lev did not demonstrate any familiarity with plaintiff's [Second Medical's] business practices and procedures. Accordingly, she did not establish that the documents contained in Mr. Calender's patient file were business records within the meaning of CPLR 4518[a]. Further, she did not establish the admissibility of the file documents under any other hearsay exception. Since all the documents contained in Mr. Calender's patient file constituted inadmissible hearsay, it necessarily follows that the no-fault claim form, which incorporated these records, is also hearsay.
Judge Sweeney also distinguished the
Pine Hollow Medical case by stating:
Plaintiff's reliance on Pine Hollow Medical, P.C. is misplaced. In Pine Hollow Medical, P.C., the court stated that "it is well-settled that where an entity routinely relies upon the business records of another entity in the performance of its own business' . . . , and fully incorporate[s]' said information into records made in the regular course of its business. . . , the subsequent record is admissible notwithstanding that the preparer lacked personal knowledge of the information's accuracy,'" (13 Misc 3d 131(A), 2006 NY Slip Op. 51870 (U) [citations omitted & emphasis added] ). While this is a true statement of law, it was never demonstrated in this case that the documents contained in the patient files which Ms. Lev and her co-workers routinely relied upon and fully incorporated into the no-fault claim forms qualified as business records within the meaning of CPLR 4518[a]. The root of plaintiff's argument appears to be that the term "business records" as used in Pine Hollow Medical, P.C. means any records, including records that may constitute hearsay. The premise of plaintiff's argument is without logic or support and is belied by the cases cited in Pine Hollow Medical, P.C.
The court went on to discuss and distiguish the non-no-fault cases cited and relied upon by the Appellate Term in
Pine Hollow Medical, ultimately concluding that "since the documents contained in Mr. Calender's patient file constituted hearsay, the no-fault claim form which was based on the information contained in these documents is also hearsay. Hearsay cannot be transformed into non-hearsay simply because a business routinely relies upon it and integrates it into its own records." As plaintiff submitted no other evidence in admissible form establishing the facts asserted in the Maugust claim form, the court held that it had not made out a prima facie case.
No-fault medical provider suits continue to be won or lost on procedural issues and defenses wholly unrelated to substantive coverage defenses. Expect more litigation on this issue, as both providers and insurers will likely assert this holding in support of objections to the proferred admission of any business records that themselves rely on information from other business records.
Post Script - The question of whether the business record exception to the hearsay rule applies to insurance claim documents has come up before in a non-no-fault context. In
Hochhauser v. Electric Ins. Co. (2nd Dept., decided 10/23/2007), the Second Department ruled that since an insured lacks a
business duty, as opposed to a contractual duty, to report to his or her insurer in the course of its investigation regarding insurance coverage, neither the insured’s statement nor testimony regarding such a statement is admissible pursuant to the business records exception to the hearsay rule.
The Court's decision is dead on regarding business records.
Secondly anonymous makes a technical point that at first blush might cause one to leap for it. But if the truth was the recorded statement than it was made for the truth of the matter asserted. If the lie was the recorded statement we run into the issue of what constitutes the "truth of the matter asserted." It is broader than anonymous opines. This is not a case where a prior inconsistent statement is being offered on cross to demonstrate just that -- inconsistency. And it is not a case as it would seem where we are offering a statement to show a state of mind.
The statement was a lie. It is being offered to demonstrate a lie which is non-cooperation. If the same statement were introduced in opposition to a motion for summary judgment than it would be admissible as non-hearsay because it would merely demonstrate inconsistency. Here the lie is being offered to show a lie and most courts would conclude that this is hearsay. To hold otherwise would open the door to a host of out of court statements rendering every case the equivalent of a no fault farce.
Perhaps to refine anonymous' argument it would have been better to classify the statement as a verbal act -- like saying I accept in a contract action. The statement "I don't know who was driving" was a verbal act of non-cooperation and therefore not hearsay. The equivalent of a refusal to answer.
But that brings us to hearsay layers and authentication. An admission would cure one layer. I assume that the recorded statement was transcribed. The transcript is another layer. It is another out of court statement as opposed to a person testifying IN COURT that a Party to the action said this or that. The plaintiff tried to get the transcript in as a business record. No go. If it were admitted as business record than the statement itself would have been an admission.
Hence Larry's EBT analysis. Under the CPLR if the party is given the opportunity to review his transcript the EBT can be used for almost anything.
I don't know the facts of the Tower case. Were the signed statements used to obtain summary judgment or defeat it.
Zuppa, although I understand your concern that the statement is being offered to prove a lie, that's not really correct. Presumably, the insurer has non-hearsay evidence to prove that this statement is, in fact, false. Thus, the necessity of first proving the statement was made (non-hearsay use), followed with admissible evidence proving the falsity of the statement.
An example: In a defamation case, the plaintiff offers the defamatory statement. Objection: hearsay. Response: the statement is not being offered to prove the truth of its content, but to show that it was made. Result: the statement is let in.
I absolutely know your argument but still stand by the fact that courts define what constitutes "the truth of the matter asserted" more broadly.
Your hearsay hypo is convincing but flawed. If a witness came into court and testified Defendant said "Zuppa is a hack" than we'd have an admission which overcomes the single layer of hearsay.
I am sorry but that is evidence. I didn't show up to court with a bag full of cocaine and intro it into evidence: "Here it is your honor." I had to establish chain of custody.
More on point when I introduced taped conversations from wiretaps I had to lay out a massive authentication from the monitoring through the sealing and the unsealing. Evidence is a lost art. It mi[ght] as well be lost since many courts do not even understand it.