Fraud Litigation

Fraud Actions on Behalf of Health Insurers

  • Mediated advantageous settlements on behalf of health insurers in several actions involving provider fraud litigations.
  • Represented health insurers in obtaining temporary restraining orders enjoining providers and billing companies from balance billing plan members pursuant to a scheme to coerce egregious overpayments from insurer.
  • Successfully opposed provider’s multiple motions in New Jersey Superior Court to dismiss counterclaims for fraud stemming from provider’s failure to collect co-insurance and deductibles.
  • Obtained summary judgment holding that provider’s failure to collect co-insurance and deductibles entitled insurer to recovery. LIPA v. MetLife, No. 99-02351 (New York Supreme Court, Nassau County).
  • Obtained summary judgment on behalf of UHC dismissing a complaint brought by a provider alleging libel, tortious interference with contractual relations, and anti-trust violations in connection with a claims audit. Long Island Pulmonary Associates, P.C. v. Metropolitan Life Insurance Co., 303 A.D.2d 645, 756 N.Y.S.2d 788, 2003 N.Y. App. Div. LEXIS 3135 (N.Y. App. Div. 2d Dep’t. 2003).

Rescission Litigation on Behalf of Life Insurers

  • Obtained summary judgment based on material misrepresentations by the insured regarding his medical history, which plaintiff claimed the company should have ascertained from the records available. Court rejected plaintiff’s claim that company was estopped from rescinding based on “post-claim underwriting” and Appellate Division clarified that actual notice of misrepresentation is required to be shown. Kerrigan v. Metropolitan Life Ins. Co., 2013 N.Y. Misc. LEXIS 6489 (N.Y. Sup. Ct. 2013) aff’d 117 A.D.3d 562 (1st Dep’t 2014); Motions for Leave to Appeal to Court of Appeals denied.
  • Obtained summary judgment rescinding life insurance policy based on material misrepresentations regarding financial disclosures. Jae v. Metro. Life Ins. Co., No. A-2302-11T4, 2013 N.J. Super. Unpub. LEXIS 340, 2013 WL 535256 (App. Div. Feb. 14, 2013), denied, 68 A.3d 891, 214 N.J. 176 (2013).
  • Obtained summary judgment on claim for rescission based on equitable fraud as a result of insured’s material misrepresentation regarding his cardiac condition on limited insurance agreement and insured’s subsequent death during binder period. Rothy v. Prudential Insurance Company, No. MON-L-4668-11 (N.J. Super. Ct. Nov. 4, 2013).
  • Successfully tried a disability insurance fraud rescission case (outside the contestability period) in the Federal District Court, Southern District of New York (Rakoff, J). The Second Circuit affirmed the district court’s holding that the insured’s misrepresentations “continued in her trial testimony” and that her fraudulent intent was clearly established by the record. Dormer v. Nw. Mut. Life Ins. Co., No. 08 Civ. 8725 (JSR), 2009 U.S. Dist. LEXIS 76611, 2009 WL 2603123 (S.D.N.Y. Aug. 24, 2009), aff’d, 408 F. App’x 452 (2d Cir. 2011).
  • Obtained summary judgment rescinding a $1,000,000 policy based upon material misrepresentations in the policy where plaintiff argued, among other issues, that the insured did not understand English. Park v. Metro. Life Ins. Co., 421 F. App’x 197 (3d Cir.), cert denied, 132 S. Ct. 243, 181 L .Ed. 2d 138 (U.S. 2011).
  • Obtained summary judgment based on financial and medical misrepresentations, finding also that insurers stopped based on agent’s knowledge. New England Life Insurance Co. v. Taverna, 2002 U.S. Dist. LEXIS 10747 (E.D.N.Y. 2002).
  • Obtained summary judgment rescinding two life insurance policies, with face values totaling $1,000,000, based upon misrepresentations in the application regarding the insured’s mental health and cardiac condition. Ghilliani v. MetLife, 78A. 2001 (New York Surrogate’s Court, Suffolk County, 2001).

Fraud Actions on Behalf of Banks

  • Represented banks in connection with mortgage fraud actions against brokers, title insurers, appraisers, and settlement agents.
  • Successfully opposed several motions to dismiss and for summary judgment.
  • Negotiated many settlements.

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