Friday, April 14, 2017

No-fault claims and allegedly fraudulent providers.

Practice point:  A provider that is not solely owned and controlled by physicians, as required by Business Corporation Law §§ 1507(a) and 1508(a), is ineligible for no-fault reimbursements, and insurers may look at the actual ownership and operation of the practice, namely, whether the practice was actually controlled or owned by an unlicensed individual in violation of state and local law. However, insurance carriers cannot delay payment of reimbursement claims to pursue investigations without good cause, and "good cause" requires a demonstration of behavior tantamount to fraud. Violations such as a failure to hold an annual meeting, pay corporate filing fees, or submit otherwise acceptable paperwork on time will not rise to the level of fraud.

Case:  Carothers v. Progressive Ins. Co., NY Slip Op 02615 (2d Dep't April 5, 2017)

Here is the decision.

Monday's issue:  A legal malpractice claim.