Key Takeaway
Court analysis of Anti-Fair Price regulation's impact on no-fault insurance defenses and preclusion rules in New York personal injury cases.
This article is part of our ongoing fraud coverage, with 8 published articles analyzing fraud 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.
Optimal Well-Being Chiropractic, P.C. v Utica Mut. Ins. Co., 2014 NY Slip Op 51233(U)(App. Term 2d Dept, 2014)
“While defendant sought summary judgment on the grounds that plaintiff’s assignor had failed to appear for independent medical examinations and that plaintiff was seeking to recover for treatment which the assignor swore he never received, defendant failed to establish that such defenses are not precluded.”
“We note that if the treatment at issue had been rendered after April 1, 2013, pursuant to the revised Insurance Department Regulations, the defense that the services were not provided would not be subject to preclusion (see Insurance Department Regulations § 65-3.8 ). ”
The Court again cites Westchester Lincoln and gives a cf to Unitrin. This point is old but I felt like putting it out there anyway because this is my blog and you are choosing to read it. The Court appears to cite the new anti preclusion regulation as a “defense that..would not be subject to preclusion”. Three points here.
Point I: I was unsure if the Courts would hold that the new regulations could reverse preclusion, but I reread Presbyterian and “re-realized” that preclusion (according to the court) was supported through a dichotomy in the regulations. (Former 65.15(g)(3) v. 65.15(g)(5 and “The interpretive canon of inclusio unius, exclusio alterius “) So, Point I, i.e., can the DFS wipe out preclusion? Answer : yes.
Point II: The failure to provide services is being categorized as a defense. Certain defense attorneys have stated that the wording of the regulation suggests, e.g., billing in accordance with the fee schedule is part of a prima facie case based upon the textual layout of the amendment to the regulations. I never bought into that argument, and I am glad I did not. These preclusion carve outs are being classified as defenses.
Point III: I still think a medical provider should have to prove causation, proper billing and medical necessity. Furthermore, should the proposed attorney fee regulation pass, then the applicants cannot say that they are not being paid enough to prove the same elements that would need to be proven in a tort case.
Related Articles
- Understanding the 30-day payment rule in no-fault insurance fraud recovery
- How fraudulent procurement defenses can be precluded
- When counterclaims based on precludable fraud are rebuffed
- Cases where fraudulent procurement defense was precluded
Legal Update (February 2026): Since this post’s publication in 2014, Insurance Department Regulation § 65-3.8 and related no-fault regulatory provisions have undergone multiple amendments and revisions. The anti-preclusion framework and fee schedule regulations referenced in this analysis may have been substantially modified, and practitioners should verify current regulatory language and recent judicial interpretations of these evolving standards.
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.
Keep Reading
More Fraud Analysis
Fraudulent procurement defense precluded
NY court rules insurer failed to establish timely denial defense for fraudulent procurement claim, highlighting ongoing debates in no-fault insurance law.
May 28, 2015Triangle R again
Court rejects insurer's attempt to pursue fraud depositions without properly preserving defenses, highlighting importance of timely claim denials in no-fault cases.
Aug 25, 2014Fraudulent procurement and preclusuion
New York no-fault insurance law addresses when carriers can raise fraudulent procurement defenses and timing requirements under the 30-day pay or deny rule.
Mar 18, 2014Partial fraud?
Court rules that billing for one undelivered item doesn't void entire no-fault policy, allowing recovery for other legitimately provided medical supplies.
May 29, 2013No-Fault Insurance Fraud Recovery: Understanding the 30-Day Payment Rule in NY
Learn about NY's 30-day payment rule for no-fault fraud recovery. Expert analysis of Lincoln v Alev Medical Supply and its impact on Long Island & NYC personal injury cases. Call...
Jan 20, 2011Counterclaim based upon precludable fraud rebuffed
New York court rejects GEICO's fraud counterclaim in no-fault case, ruling claims precluded due to untimely denial of benefits on fraud grounds.
Aug 17, 2010Common Questions
Frequently Asked Questions
How does fraud affect no-fault insurance claims?
Fraud is a complete defense to no-fault claims. If the insurer proves the claim was fraudulent — staged accident, fabricated injuries, or billing fraud — all benefits can be denied. Common fraud indicators include organized rings, overlapping provider networks, and treatment patterns inconsistent with claimed injuries.
What is a Mallela defense in no-fault cases?
Under State Farm v. Mallela, insurers can deny no-fault claims if the medical provider was fraudulently incorporated — for example, if the practice is secretly owned by a non-physician in violation of Business Corporation Law §1507. This defense voids the provider's right to collect no-fault benefits.
What is the standard for proving fraud in no-fault litigation?
The insurer must prove fraud by clear and convincing evidence in a declaratory judgment action, or by a preponderance of the evidence in defense of a no-fault claim. Staged accidents, fabricated billing, and fraudulent incorporation each have different evidentiary requirements and procedural frameworks.
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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.
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.
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