Key Takeaway
Learn about staged accident fraud in NY no-fault insurance cases.
This article is part of our ongoing no-fault coverage, with 271 published articles analyzing no-fault 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.
State Farm Mut. Auto. Ins. Co. v Pace, 2022 NY Slip Op 30391(U)(Sup. Ct. Kings Co. 2022)
“With regard to State Farm’s first, second, and third causes of action, parties generally are not entitled to recover no-fault benefits for damages resulting from intentional events (Matter of Allstate Ins. Co. v Massre, 14 AD3d 610, 61 I , citing State Farm Mut. Auto. Ins. Co. v Laguerre, 305 AD2d 490, 490-91 ). When determining if a collision was intentional, the court looks to circumstantial factors. Common considerations include the age of the policy at the time of the loss, the value and age of the car involved, cancellation of the policy shortly thereafter, interrelationships among the parties involved, inconsistencies in testimony regarding the circumstances of the subject collision, and inconsistencies in the identities of the individuals involved.
(PDG Psychological, P.C. v Stale Farm Ins. Co., 12 Misc 3d 1183, 2006 NY Slip Op 51398 *6 ; VS. Med. Services, P.C. v Allstate Ins. Co., 11 Misc 3d 334, 343 ; Matter of Progressive County Mut. ins. Co. by McNeil, 4 Misc 3d 1022, 2004 NY Slip Op 50998, *2 )
Ms. Rivera states in her affidavit that the policy was thirty-three days old, and provides a copy of the subject policy (Rivera affirmation at ,i 16). Ms. Rivera also notes in her affidavit the following testimony from the EUOs of Ms. Conway and Ms. Chandler: Ms. Conway claims to have known all occupants of the vehicle for several years prior to the accident (Conway EUO at 32). Conversely, Ms. Chandler denies having known any of them until the day of the crash (Chandler EUO at 13 ).
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Ms. Conway claims the group had planned to go to the theater on Court Street that night, but they had not picked a movie, did not know the show times, and did not know that the theater would be closed by the time they arrived (Conway EUO at 18-20). Ms. Conway claims the group had not seen or spoken to each other for three months prior to the day of the crash (Conway EUO at 32).
Ms. Conway claims the accident occurred in the roundabout on Grand Army Plaza (Conway EUO at 21 ). Ms. Chandler, however, denies the accident occurred in the roundabout (Chandler EUO at 22). Ms. Conway claims the car was moved to a service lane immediately following the collision (Conway EUO at 26. Ms. Chandler claims the car remained in the street immediately following the collision (Chandler EUO at 24). Accordingly, State Farm has sufficiently established the facts of its first, second, and third causes of action”
New policy, inconsistent statements. Fraud.
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Legal Context
Why This Matters for Your Case
New York's no-fault insurance system, established under Insurance Law Article 51, is one of the most complex insurance frameworks in the country. Every motorist must carry Personal Injury Protection coverage that pays medical expenses and lost wages regardless of fault, up to $50,000 per person.
But insurers routinely deny valid claims using peer reviews, EUO scheduling tactics, fee schedule reductions, and coverage defenses. The Law Office of Jason Tenenbaum has handled over 100,000 no-fault cases since 2002 — from initial claim submissions through arbitration before the American Arbitration Association, trials in Civil Court and Supreme Court, and appeals to the Appellate Term and Appellate Division. Jason Tenenbaum is one of the few attorneys in the state who both writes his own appellate briefs and tries his own cases.
His 2,353+ published legal articles on no-fault practice are cited by attorneys throughout New York. Whether you are dealing with a medical necessity denial, an EUO no-show defense, a fee schedule dispute, or a coverage question, this article provides the kind of detailed case-law analysis that helps practitioners and claimants understand exactly where the law stands.
About This Topic
New York No-Fault Insurance Law
New York's no-fault insurance system requires every driver to carry Personal Injury Protection (PIP) coverage that pays medical expenses and lost wages regardless of who caused the accident. But insurers routinely deny, delay, and underpay valid claims — using peer reviews, IME no-shows, and fee schedule defenses to avoid paying providers and injured claimants. Attorney Jason Tenenbaum has litigated thousands of no-fault arbitrations and court cases since 2002.
271 published articles in No-Fault
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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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