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Summary judgment granted on Mallela case
Mallela issues

Summary judgment granted on Mallela case

By Jason Tenenbaum 8 min read

Key Takeaway

Court grants summary judgment in Mallela case, ruling healthcare providers must meet licensing requirements for no-fault insurance reimbursement under NY Insurance Law.

This article is part of our ongoing mallela issues coverage, with 32 published articles analyzing mallela issues 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.

Summary Judgment Granted on Mallela Case

The Mallela defense has become a cornerstone strategy for insurance companies seeking to deny no-fault benefits to healthcare providers who fail to meet New York State licensing requirements. This defense, rooted in Insurance Law Section 5102(a)(1), requires that providers demonstrate proper licensing and corporate structure to be eligible for reimbursement. The recent decision in Physical Performance Testing of NY v New York Cent. Mut. Fire Ins. Co. provides another clear example of how courts apply these strict requirements.

Understanding the Mallela defense framework is crucial for both healthcare providers and insurance companies navigating no-fault disputes. While providers must ensure they meet all licensing requirements, insurance companies can use this defense when arbitration is demanded by applicants.

Jason Tenenbaum’s Analysis:

Physical Performance Testing of NY v New York Cent. Mut. Fire Ins. Co., 2013 NY Slip Op 50581(U)(App. Term 1st Dept. 2013)

The Court was clear: “It is well-settled that a provider of healthcare services is not eligible for reimbursement of assigned first-party no-fault benefits “under section 5102(a)(1) of the Insurance Law if the provider fails to meet any applicable New York State or local licensing requirement necessary to perform such service in New York”

“Applying these principles to the matter at bar, Mutual has made a prima facie showing of entitlement to summary judgment dismissing the complaints by demonstrating that the services rendered by Physical are not reimbursable expenses under the No-Fault Law. In opposition, Physical failed to raise a triable issue of fact with respect to its claims because they were not performed by a medical professional corporation, or a licensed health provider.”

Key Takeaway

This decision reinforces that healthcare providers must meet all licensing requirements to receive no-fault insurance reimbursement. Courts will grant summary judgment when insurance companies demonstrate that services were not performed by properly licensed entities or medical professional corporations. Provider compliance with licensing requirements is non-negotiable under New York’s no-fault law.


Legal Update (February 2026): Since this 2013 post, New York’s no-fault regulatory framework under Insurance Law Section 5102 has undergone several amendments affecting provider eligibility requirements and licensing standards. Additionally, Department of Financial Services regulations governing healthcare provider qualifications and corporate structure requirements may have been updated. Practitioners should verify current provisions of Section 5102(a)(1) and related DFS regulations when applying Mallela defense strategies or assessing provider eligibility for no-fault reimbursement.

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

Mallela Fraud Defense in No-Fault Insurance

The Mallela defense — named after the Court of Appeals decision in State Farm v. Mallela — allows insurers to deny no-fault claims by proving that a medical provider fraudulently incorporated to circumvent licensing requirements. Establishing a Mallela defense requires extensive investigation and evidence of corporate structure, ownership, and control. These articles analyze the Mallela doctrine, its procedural requirements, and the evolving case law that shapes how courts evaluate fraudulent incorporation claims in no-fault practice.

32 published articles in Mallela issues

Keep Reading

More Mallela issues Analysis

View all Mallela issues articles

Common Questions

Frequently Asked Questions

What are Mallela issues in no-fault insurance?

Mallela issues refer to a defense based on State Farm v. Mallela (2006), where the Court of Appeals held that insurers can deny no-fault claims to medical providers who operate fraudulent enterprises. Under Mallela, if a provider is controlled by unlicensed individuals in violation of Business Corporation Law §1507 or Education Law, the provider is not eligible to receive no-fault reimbursement. Insurers use Mallela defenses in declaratory judgment actions and as affirmative defenses in collection actions.

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Attorney Jason Tenenbaum

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.

24+ years in practice 1,000+ appeals written 100K+ no-fault cases $100M+ recovered

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 mallela issues 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.

Filed under: Mallela issues
Jason Tenenbaum, Personal Injury Attorney serving Long Island, Nassau County and Suffolk County

About the Author

Jason Tenenbaum

Jason Tenenbaum is a personal injury attorney serving Long Island, Nassau & Suffolk Counties, and New York City. Admitted to practice in NY, NJ, FL, TX, GA, MI, and Federal courts, Jason is one of the few attorneys who writes his own appeals and tries his own cases. Since 2002, he has authored over 2,353 articles on no-fault insurance law, personal injury, and employment law — a resource other attorneys rely on to stay current on New York appellate decisions.

Education
Syracuse University College of Law
Experience
24+ Years
Articles
2,353+ Published
Licensed In
7 States + Federal

Discussion

Comments (12)

Archived from the original blog discussion.

AK
ALAN Klaus
Without seeing the papers can’t make a determination on this case. What was the Mutual proof and I bet Physicals atty dropped the ball unless they weren’t licensed at all.
C
curious
I think the company was not licensed How do you think atty “dropped the ball.”
KL
Kurt Lundgren
Why did plaintiff appeal if company was not licensed? There must have been an issue there. A good firm appealed this case.
CA
Captain America
You dropped the ball by taking the client in the first place.
AK
Alan Klaus
Like I said if not licensed than thats it and I said that abt the atty bc these cases are very hard to win for the carriers if the Providers atty is prepared.
J
JT Author
Good seeing you too Kurt. They really spruced up the Jay Dietz EBT center in Brooklyn since I was there last…
KL
kurt lundgren
Easy Captain, easy …. if there were only Mother Teresas out there lawyers would not have work. Same here Jason, and good job beating up my client. No wonder the court report said he looked like Sly Stalone.
CA
Captain America
Sorry Kurt I am not an attorney so I would not know. I am a Marvel Super Hero along with lesser heroes such as Thor and Iron Man. But if I may chime in as a layperson Super Hero. If the client is paying cash its easier to lose a case — I would think.
CA
Captain America
Was the underlying case handled by the Law Offices of Lana Sukhmen. She usually does good work.
JT
Jason Tenenbaum Author
The Captain America I know is faster than an adjuster denying a NF-3, can clear IME doctors in a single bound, and is more powerful than any mere mortal attorney. So I rephrase my last comment. Without super villains where would you be??
CA
Captain America
Anonymous we have one slight disagreement. No one in the universe is faster then an adjuster denying an NF-3. Adjusters deny them before they are even sent. Adjusters are so fast that they exceed light speed and travel back in time to deny claims. The Appellate Term actually stated such in a case were the provider argued that the claim was improperly denied because the denial pre-dated the treatment. See, Segfried and Roy Chiropractic PC v. Mug An Old Lady Mutual Insurance Company, 69 NYS.5d 69, 69 (App Term 2nd July 2013)
KL
Kurt Lundgren
For the record, anonymous was me Cap. I don’t post anonymously but must have failed to put in my name on reply. I stand corrected about the adjuster issue. And, I do know your secret identity. It can now be revealed to the world that you are ….. Oprah.

Legal Resources

Understanding New York Mallela issues Law

New York has a unique legal landscape that affects how mallela issues cases are litigated and resolved. The state's court system includes the Civil Court (for claims up to $25,000), the Supreme Court (the primary trial court for unlimited jurisdiction), the Appellate Term (which hears appeals from lower courts), the Appellate Division (divided into four Departments, with the Second Department covering Long Island, Brooklyn, Queens, Staten Island, and several upstate counties), and the Court of Appeals (the state's highest court). Each court has its own procedural requirements, local rules, and case-assignment practices that can significantly impact the outcome of your case.

For mallela issues matters on Long Island, cases are typically filed in Nassau County Supreme Court (at the courthouse in Mineola) or Suffolk County Supreme Court (in Riverhead). No-fault arbitrations are heard through the American Arbitration Association, which assigns arbitrators throughout the metropolitan area. Workers' compensation claims go to the Workers' Compensation Board, with hearings at district offices across the state. Understanding which forum is appropriate for your case — and the specific procedural rules that apply — is essential for a successful outcome.

The procedural landscape in New York also includes important timing requirements that can affect your case. Most civil actions are subject to statutes of limitations ranging from one year (for intentional torts and claims against municipalities) to six years (for contract actions). Personal injury cases generally have a three-year deadline under CPLR 214(5), while medical malpractice claims must be filed within two and a half years under CPLR 214-a. No-fault insurance claims have their own regulatory deadlines, including 30-day filing requirements for applications and 45-day deadlines for provider claims. Understanding and complying with these deadlines is critical — missing a filing deadline can permanently bar your claim, regardless of how strong your case may be on the merits.

Attorney Jason Tenenbaum regularly practices in all of these venues. His office at 326 Walt Whitman Road, Suite C, Huntington Station, NY 11746, is centrally located on Long Island, providing convenient access to courts and offices throughout Nassau County, Suffolk County, and New York City. Whether you need representation in a no-fault arbitration, a personal injury trial, an employment discrimination hearing, or an appeal to the Appellate Division, the Law Office of Jason Tenenbaum, P.C. brings $24+ years of real courtroom experience to your case. If you have questions about the legal issues discussed in this article, call (516) 750-0595 for a free, no-obligation consultation.

New York's substantive law also presents distinct challenges. In motor vehicle cases, the no-fault system under Insurance Law Article 51 provides first-party benefits regardless of fault, but limits the right to sue for non-economic damages unless the plaintiff establishes a "serious injury" under one of nine statutory categories. This threshold — codified at Insurance Law Section 5102(d) — requires medical evidence showing more than a minor or subjective injury, and courts have developed detailed standards for each category. Fractures must be documented through imaging studies. Claims of permanent consequential limitation or significant limitation of use require quantified range-of-motion testing with comparison to norms. The 90/180-day category demands proof that the plaintiff was unable to perform substantially all of their usual daily activities for at least 90 of the 180 days following the accident.

In employment discrimination cases, the legal standards vary depending on whether the claim arises under state or local law. The New York State Human Rights Law employs a burden-shifting framework: the plaintiff must first establish a prima facie case by showing membership in a protected class, qualification for the position, an adverse employment action, and circumstances giving rise to an inference of discrimination. The burden then shifts to the employer to articulate a legitimate, non-discriminatory reason for its decision. If the employer meets this burden, the plaintiff must demonstrate that the stated reason is pretextual. The New York City Human Rights Law, by contrast, applies a broader standard, asking whether the plaintiff was treated less well than other employees because of a protected characteristic.

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