Scott Ginsberg is a member of the Casualty Department with extensive experience defending numerous insurance carriers in disputes involving New York Personal Injury Protection claims. He also helps clients develop strategies for defending complex litigation related to medical provider fraud. As a seasoned litigator with extensive trial and motion practice experience, Scott is highly regarded for his combination of creativity, strategic judgment and courtroom prowess.
Scott also handles matters as a member of the Fraud/Special Investigation Practice Group. He focuses on fraud investigation, primarily dealing with evaluating both medical provider fraud and intentional/staged losses. Scott also has significant experience conducting Examinations Under Oath as it relates to both specific claims and broader SIU investigations.
Prior to joining Marshall Dennehey, Scott managed his own firm for several years where he focused primarily on New York personal injury protection claims. Additionally, he developed experience litigating all aspects of insurance defense, premises liability, construction and labor law, vehicular negligence and homeowners' claims.
Scott earned his juris doctor from the Maurice A. Deane School of Law at Hofstra University, where he served as an Editor for the Family Court Review. Scott earned a B.S. in Psychology and a B.A. in Criminology & Law from the University of Florida, where also he served as the president of the Criminology & Law Honor Society.
He is admitted in the states of New York and New Jersey.
Results
Failure to Provide Requisite Statutorily Required Medical Assignment-of-Benefits Form results in Dismissal of New York No-Fault Arbitration Matter
We successfully defended and submitted post-hearing arguments and secured dismissal of a New York no-fault arbitration matter. The applicant, a major medical provider, filed an arbitration matter in the amount of $361,601.62, claiming our client owed it for the claimant’s unpaid medical bills following a major motor vehicle accident. The claimant had been involved in the motor vehicle accident and sought payment for medical treatment for a series of treatments rendered while hospitalized, post-accident. Counsel for the medical provider argued that the medical billing was never properly nor timely denied, therefore, payment of the claims was overdue. However, we successfully argued at the arbitration hearing that the applicant’s client failed to provide the requisite statutorily required medical assignment-of-benefits form, assigning the hospital the right to sue on behalf of the injured party. After arguments were heard, the arbitrator ordered post-hearing submissions to be filed by both sides. After researching, drafting and filing a post-hearing submission, the arbitrator ruled in our client’s favor, thereby dismissing the matter based on the applicant’s total failure to submit the requisite form, saving our client hundreds of thousands of dollars.
Dismissals of Multiple New York No-Fault/PIP Arbitrations
The arbitrations were commenced by medical providers against the respondent-carrier for non-payment of medical bills insofar as the policyholder and the claimant engaged in material misrepresentation in the procurement of the policy, and in the presentation of the claim. We submitted a defense brief that included numerous exhibits, including examination under oath transcripts, an affidavit from the respondent-carrier’s underwriting department and screenshots of insurance premium payments from the claimant to the policyholder. At the hearings, the defense argued that the respondent-carrier owed no duty of coverage insofar as the policyholder and the claimant engaged in material misrepresentation in the procurement of the policy and in the presentation of the claim. Specifically, the policyholder fraudulently obtained an insurance policy with the respondent-carrier on behalf of the claimant. The misrepresentation was deemed “material” insofar as the respondent-carrier would have charged a higher premium based on the actual garaging location of the insured vehicle and, moreover, would not have otherwise insured the claimant. The arbitrator held that the respondent-carrier established, by a preponderance of credible evidence, that the instant loss involved fraud and misrepresentation in the procurement of the insurance policy; the policyholders’ misrepresentation with regard to the ownership, operation and garaging of the insured vehicle was material; the respondent-carrier would not have issued the policy if the facts had been disclosed by the policyholders, and that the respondent-carrier was justified in denying the claim.
