Key Takeaway
Court rejects insurer's attempt to pursue fraud depositions without properly preserving defenses, highlighting importance of timely claim denials in no-fault 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.
The Appellate Term’s decision in Okslen Acupuncture P.C. v Unitrin Advantage Ins. Co. delivers another victory for healthcare providers in no-fault litigation, reinforcing the strict procedural requirements insurers must follow when raising fraud defenses. This case exemplifies how courts continue to apply the pivotal Triangle R decision, which established that insurers cannot pursue certain defenses unless they properly preserve them through timely denials.
The ruling underscores a fundamental principle in New York’s no-fault system: insurers who fail to deny claims within the statutory timeframe forfeit their right to challenge those claims on substantive grounds later in litigation. This procedural safeguard prevents insurers from accepting the benefits of delayed decision-making while still maintaining their defensive options.
Jason Tenenbaum’s Analysis:
Okslen Acupuncture P.C. v Unitrin Advantage Ins. Co., 2014 NY Slip Op 51290(U)(App. Term 1st Dept. 2014)
“The defendant-insurer failed to demonstrate entitlement to depositions relating to its excessive treatment and fee schedule defenses, in the absence of any affirmative showing that it preserved those defenses by timely denying plaintiff’s 2006 first-party no-fault claim (see Triangle R. Inc. v Progressive Ins. Co., 36 Misc 3d 151, 2012 NY Slip Op 51685). In view of the foregoing, we need not and do not address plaintiff’s alternative argument that the noticed depositions were otherwise unwarranted.”
If you are that serious about the fraud, then bring a Supreme Court action where courts will give you more latitude to pursue a common-law fraud action. Or, try your hand at a Rico if you have enough information on the provider.
Key Takeaway
This decision reinforces that insurers must act decisively within statutory timeframes to preserve fraud defenses. Courts will not allow discovery related to fraudulent procurement defenses when insurers fail to demonstrate they properly denied claims initially. For insurers suspecting genuine fraud, pursuing separate Supreme Court actions or federal RICO claims may provide better litigation pathways than attempting to resurrect waived defenses in no-fault proceedings.
Legal Update (February 2026): Since this post’s publication in 2014, New York’s no-fault fee schedules have undergone multiple revisions, and regulatory amendments have been implemented affecting reimbursement rates and procedural requirements. The Insurance Department has updated various fee schedule provisions and claim processing regulations that may impact the application of procedural defenses discussed in this analysis. Practitioners should verify current fee schedule amounts, regulatory timeframes, and procedural requirements when applying the Triangle R doctrine to contemporary no-fault litigation.
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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.
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Mar 20, 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.
If you need legal help with a fraud 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.