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.
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.
