Key Takeaway
Court rules that proving military status misrepresentation isn't enough when insurance company fails to timely deny claim in no-fault case.
This article is part of our ongoing material misrepresentation - procurement of insurance policy coverage, with 24 published articles analyzing material misrepresentation - procurement of insurance policy 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.
Understanding Material Misrepresentation and Timing Requirements in No-Fault Insurance
In New York’s no-fault insurance system, insurance companies often attempt to deny claims by alleging that policyholders made material misrepresentations when applying for coverage. However, having evidence of misrepresentation alone isn’t sufficient — timing matters critically. Insurance carriers must follow strict procedural requirements when asserting these defenses, and failing to do so can result in waiving their right to contest coverage entirely.
The material misrepresentation defense has become increasingly common as insurers seek to avoid paying legitimate claims. This defense strategy, which evolved from earlier fraudulent procurement claims, requires carriers to prove both that a misrepresentation occurred and that they followed proper denial procedures.
Jason Tenenbaum’s Analysis:
Healthy Way Acupuncture, P.C. v USAA Gen. Indem. Co., 2016 NY Slip Op 51342(U)(App. Term 1st Dept. 2016)
“While defendant submitted evidence showing that plaintiff’s assignor misrepresented his military status in the underlying insurance policy application, defendant is precluded from asserting that defense as a result of its untimely denial of the claim (see Westchester Med. Ctr. v GMAC Ins. Co. Online, Inc., 80 AD3d 603 ; Gutierrez v United Servs. Auto. Assn., 47 Misc 3d 152, 2015 NY Slip Op 50797 ).”
The result here was preordained.
Key Takeaway
Even when an insurance company can prove that a policyholder made misrepresentations during the application process, the company can lose its right to assert this defense if it fails to deny the claim within the required timeframe. This case demonstrates that procedural compliance is just as important as substantive evidence in no-fault insurance disputes.
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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.
About This Topic
Material Misrepresentation in Insurance Policy Procurement
An insurer may void a policy ab initio if the insured made a material misrepresentation during the application process. Under New York Insurance Law 3105, the misrepresentation must be material to the risk — meaning the insurer would not have issued the policy or would have charged a higher premium had it known the truth. In no-fault practice, misrepresentation defenses can eliminate coverage entirely. These articles analyze the legal standards, the burden of proof on the insurer, and the case law governing rescission based on misrepresentation.
24 published articles in Material misrepresentation - procurement of insurance policy
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Aug 10, 2017Common Questions
Frequently Asked Questions
What constitutes a material misrepresentation that voids an insurance policy?
Under NY Insurance Law §3105, a misrepresentation is material if the insurer would not have issued the policy had it known the truth. Common examples include failing to disclose other drivers in the household, prior accidents, or the true use of the vehicle. The misrepresentation must be in the original application, not in a subsequent claim.
Can an insurer void a no-fault policy retroactively?
Yes. If an insurer can prove material misrepresentation in the policy application under Insurance Law §3105, it can void the policy ab initio — as if it never existed. This means all claims, including no-fault benefits, are denied. However, the insurer must prove the misrepresentation was material and relied upon when issuing the policy.
What is the burden of proof for policy voidance?
The insurer bears the burden of proving that the misrepresentation was material — meaning it would have influenced the insurer's decision to issue the policy or set the premium. Courts apply an objective test, asking whether a reasonable insurer would have acted differently. The insured's intent to deceive is not required.
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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 material misrepresentation - procurement of insurance policy 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.