Key Takeaway
Court dismisses insurance company's fraud-based declaratory judgment action lacking EUO testimony and claims-specific evidence, calling it a "sad man's DJ"
This article is part of our ongoing declaratory judgments coverage, with 71 published articles analyzing declaratory judgments 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.
Mapfre Ins. Co. of N.Y. v Soltanov, 2017 NY Slip Op 31520(U)(Sup. Ct. NY Co. 2017)
We previously discussed that the poor man’s DJ that did not go over too well. This is the sad man’s DJ. I read the papers last weekend. Justice Bluth, who is not afraid to call out fraud (V.S. Med. Servs., P.C. v. Allstate Ins. Co., 11 Misc. 3d 334, 335 , was not impressed either.
The allegations are far reaching and serious. And to be honest, I would not be surprised if they may be true. It pleads common law fraud and Mallela causes of action at its base. Following that, it pleads causes of action based upon “self referral” and “independent contractor actions”. The former is never actionable on a no-fault claim (Allstate Prop. & Cas. Ins. Co. v. New Way Massage Therapy P.C., 134 A.D.3d 495 , leave to appeal denied, 28 N.Y.3d 909 ). The latter is only actionable if the claim is timely denied on that basis.
Thus, this is a Mallela and fraud case.
The evidence is the DOH admonishing Dr. Arguilles, SIU investigators discussing matters (some of which is clearly outside their expertise) and an expert who says the billing is fraudulent. Missing was what you need to prove this type of case: EUO testimony and claims specific evidence to back up the allegations. An expert who opines on matters without a factual basis is guilty of promoting junk science. I learned that – in all places- at matrimonial CLE.
For instance, I just read a Rico on an Allstate case. Putting aside the substantive issue in that case of whether pattern act mail fraud was committed, presented was EUO testimony to attempt to prove some of the allegations presented in the complaint.
This DJ is based upon information and belief and innuendo. So, while I give myself the title for the poor man’s DJ, this should get the award for the sad man’s DJ.
As a stay was not granted and discovery (should the matter survive a 3211 motion and appeal) will be ongoing, this looks to be an exercise in something.
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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
Declaratory Judgment Practice in New York
Declaratory judgment proceedings provide a mechanism for parties to obtain binding judicial determinations of their legal rights and obligations. In insurance litigation, declaratory judgments are commonly sought to resolve disputes over policy coverage, fraud allegations, and the enforceability of policy conditions. These articles analyze declaratory judgment procedure, the standards courts apply, and the strategic implications of seeking or defending against declaratory relief in New York insurance cases.
71 published articles in Declaratory Judgments
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Sep 28, 2016Common Questions
Frequently Asked Questions
What is a declaratory judgment action in no-fault insurance?
A declaratory judgment action is a lawsuit asking the court to determine the rights and obligations of the parties — typically whether an insurer has a duty to pay no-fault benefits. Insurers often file these actions to establish they have no obligation to pay, citing policy exclusions, fraud, or coverage disputes.
When do insurers file declaratory judgment actions?
Insurers commonly file declaratory judgment actions when they believe a policy is void due to material misrepresentation, the loss was intentional, or there is a coverage dispute. Under NY Insurance Law, the insurer must demonstrate a justiciable controversy and typically seeks a declaration that it has no duty to indemnify or defend.
How does a declaratory judgment affect my no-fault benefits?
If the court rules in the insurer's favor, your no-fault benefits may be terminated. However, if the insurer fails to meet its burden of proof or did not timely commence the action, the court may rule in your favor, requiring the insurer to continue paying benefits. Having experienced counsel is critical in these proceedings.
What are Mallela issues in no-fault insurance?
Mallela issues refer to a defense based on State Farm v. Mallela (2006), where the Court of Appeals held that insurers can deny no-fault claims to medical providers who operate fraudulent enterprises. Under Mallela, if a provider is controlled by unlicensed individuals in violation of Business Corporation Law §1507 or Education Law, the provider is not eligible to receive no-fault reimbursement. Insurers use Mallela defenses in declaratory judgment actions and as affirmative defenses in collection actions.
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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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