Key Takeaway
NY court rules insurer failed to establish timely denial defense for fraudulent procurement claim, highlighting ongoing debates in no-fault insurance law.
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.
Fraudulent Procurement Defense Precluded in New York Insurance Case
The intersection of fraud defenses and procedural requirements in New York’s no-fault insurance system continues to create complex litigation scenarios. A recent Appellate Term decision highlights the ongoing tension between insurers’ ability to assert fraudulent procurement defenses and the strict timing requirements imposed by New York courts.
In insurance disputes, the distinction between different types of fraud can significantly impact coverage determinations. While fraudulent procurement cases involve allegations that the insurance policy itself was obtained through deception, provider fraud typically relates to billing practices after coverage is established. This distinction has important implications for how courts handle preclusion arguments and timing requirements in insurance litigation.
The case demonstrates the continuing evolution of New York’s approach to fraud defenses in the insurance context, particularly regarding when insurers must raise certain defenses to avoid waiving them.
Jason Tenenbaum’s Analysis:
Gutierrez v United Servs. Auto. Assn., 2015 NY Slip Op 50797(U)(App. Term 2d Dept. 2015)
“Plaintiff correctly argues that defendant failed to demonstrate that it is not precluded from asserting its proffered defense—that the insurance policy at issue was fraudulently procured—as it failed to establish that it had timely denied plaintiff’s claim on that ground (see Westchester Med. Ctr. v GMAC Ins. Co. Online, Inc., 80 AD3d 603 ; Great Health Care Chiropractic, P.C. v Hanover Ins. Co., 42 Misc 3d 147, 2014 NY Slip Op 50359 ).”
Preclusion really should not apply to this defense. While Fair Price dealt with provider fraud, there was always a distinction (as unnatural as it might seem) between provider fraud and EIP fraud. The latter would not result in coverage, whilst the former would be immaterial to coverage. Still think Westchester/GMAC was incorrectly decided.
Key Takeaway
This decision reinforces the procedural hurdles insurers face when attempting to assert fraudulent procurement defenses in New York courts. The distinction between different types of fraud remains critical, as does the timing of when insurers raise these defenses to avoid preclusion issues.
Related Articles
How New York Fraudulent Procurement Law Has Evolved
Verified February 2026This topic has been shaped by appellate rulings over many years. Explore the timeline below.
- Identity Fraud in Insurance Policy Procurement
Early analysis of identity fraud in obtaining insurance policies — establishing the factual predicate for procurement challenges.
- Material Misrepresentation in Insurance Procurement
New York law on material misrepresentation in policy procurement — protections for policyholders against retroactive voiding.
- Fraudulent Procurement and Preclusion
The intersection of fraudulent procurement defenses and preclusion doctrine — can insurers raise procurement fraud after being precluded?
- Fraudulent Procurement Defense
Analysis of the elements and evidentiary requirements for asserting a fraudulent procurement defense.
- Fraudulent Procurement Defense Precluded
Landmark ruling: court precludes fraudulent procurement defense — practitioners and courts disagree on when this defense may be raised.
- Fraudulent Procurement Looks More Like a 3105 Defense
Courts begin recharacterizing fraudulent procurement claims as CPLR 3105 defenses — blurring the doctrinal lines.
- Changed Into a Material Misrepresentation Defense
Doctrinal shift: fraudulent procurement is now functionally a material misrepresentation defense under Insurance Law § 3105.
- Fraudulent Procurement Has Serious Consequences
Most recent analysis: despite doctrinal confusion, fraudulent procurement carries severe consequences including policy voiding ab initio.
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
Triangle 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, 2014A citing of the Anti-Fair Price regulation
Court analysis of Anti-Fair Price regulation's impact on no-fault insurance defenses and preclusion rules in New York personal injury cases.
Aug 20, 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.
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.