In a move that likely fell under most radars, the Appellate Division, 2d Department has granted the defendant's motion for leave to appeal their decision in Fair Price Medical Supply Corp. v. Travelers Indem. Co., 42 A.D.3d 277 (2d Dep't, 2007) to the Court of Appeals. The App. Div. has posted the motion decision.
I have a feeling that the judges are going to get less and less sympathetic to the defendant's position the higher up the appeal goes on the food chain. Personally, I don't see the Court of Appeals reconsidering the underlying rationale of Presbyterian Hosp. in City of N.Y. v Maryland Cas. Co., 90 NY2d 274 (1997), no matter how much some of us would like that to occur in light of the state of things ten years on.
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6 comments:
I completely missed it.
It didn't fall under the radar at all...at least not to we defense attorneys:)
Provider fraud should NEVER be waived. When did fraud stop being fraud?
"When did fraud stop being fraud?"
30 days after the bills were received
The better question is actually: when did fraud start being fraud? Answer: when catchphrases got the better of good lawyering.
You won't find the word "fraud" anywhere in the majority or concurring opinions in Central General Hosp. v. Chubb, 90 N.Y.2d 195 (1997). You'll find a single variation of the word, namely "fraudulent" in Presbyterian Hosp. v. Maryland Cas. Co., 90 N.Y.2d 274 (1997), but only in the majority opinion, and not in the way carriers like: "The tradeoff of the no-fault reform still allows carriers to contest ill-founded, illegitimate and fraudulent claims, but within a strict, short-leashed contestable period and process designed to avoid prejudice and red-tape dilatory practices." New York's seminal no-fault cases don't create a solid foundation for anything that should be referred to as a "fraud defense."
Indeed, "fraud" isn't the word you want to use if you're a good insurance defense attorney. You want to say "lack of coverage." The Appellate Division, Second Department has reminded us a few times of this distinction, but it still goes basically unnoticed. Then again, "lack of coverage" isn't a catchphrase that instills fear in anyone's heart.
All of that said, I think there's a solid lack-of-coverage argument to be made in the carriers' favor in Fair Price. Nevertheless, the defense bar is getting itself wrapped up too much in the language of fraud, and to the detriment of their clients' interests.
You should add your last comment to your post. If you don't mind, I'll stick it in mine.
"Indeed, "fraud" isn't the word you want to use if you're a good insurance defense attorney. You want to say "lack of coverage."
They took your advice and argued coverage before the Court of Appeals-- a change in strat from HJD, which I also worked on.
I countered by establishing that coverage had, in fact, been triggered. Further, I disproved Appellant's and Amici's technical coverage analysis, primarily, by pointing out that it was dependant upon the burden of proof being the exact opposite of what common law and no-fault law dictated.
By establishing the BOP, I was able to poke a gapping hole in their coverage analysis. Then, it was only a matter of precedent and policy kicking in. I was not surprised by the decision.
Jeff F.
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