Personal Injury Protection (PIP) litigation requires careful and constant attention by any insurance company that provides such coverage. Small changes in the statute or regulatory framework can have a significant impact on the function and practice of PIP coverage and claims processing for an insurance company. Additionally, each day brings about new issues that plaintiffs' bars in PIP states are developing and pursuing in an attempt to gain additional leverage.
Marshall Dennehey recognizes that PIP litigation is as much dependent upon an innovative, efficient and intelligent approach to handling such claims and litigation as it is upon implementing solid and dependable claims practices company wide. We strive to protect our clients' interests and act as a primary resource our clients turn to when questions regarding PIP arise in their regular day-to-day claims processing practice.
Our PIP practice is comprised of attorneys who are familiar with PIP laws and who have experience handling all facets of PIP litigation. These attorneys also devote a portion of their individual practices to insurance fraud and special investigation practice. Together, these groups provide practical solutions for all types of claims arising out of the use and operation of automobiles.
Marshall Dennehey currently defends clients in PIP matters throughout three major states with mandatory PIP coverage including New Jersey, New York, and Florida and act as national and regional coordinating counsel for major insurance carriers.
The areas of primary concern in PIP litigation include:
- General PIP Practice
- Permissive fee schedule litigation
- Medicare Part B statutory compliance (upcoding, physician's fee determinations, NCCI edits, modifiers)
- Application of the reserve provision for emergency services or hospital inpatient care
- Deductible application issues
- Requests for additional documentation
- HCFA form compliance
- Demand letter compliance
- Commercial motor vehicle right of reimbursement
- Licensure issues/lawfully rendered medical services issues
- Exhaustion of benefits issues
- Usual and Customary Reduction
- In permissive fee schedule cases, application of UCR to emergency services and care
- Peer review litigation
- Provider discovery of billing practices and existing billing agreements with insurance carriers
- Medical Necessity
- IME cut-offs and opinions on absence of injury
- Peer review and medical film review
- Pre-suit discovery
- EUO investigation of prior medical history
- Litigation discovery of claimant's medical history and accident facts through subpoena power
Results
Arbitration Win Secured in a Case Involving Allegedly Unpaid Medical Bills
We secured an arbitration win, slashing a $83,000 claim to $625. The applicant, a major medical provider, filed an arbitration matter in the total amount of $83,625, alleging 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 a series of medical treatments rendered post-accident. Counsel for the medical provider argued that the medical billing was never properly paid, therefore, payment of the claims was overdue. However, we successfully argued at the arbitration hearing that the applicant’s demand amount was greatly over exaggerated and that the amount in dispute must be limited to the appropriate fee schedule limit of $625.82. After arguments were heard, the arbitrator ruled in our client’s favor.
Successfully Fully Discontinued a New York No-Fault Action
We were successful in having a New York No-Fault (PIP) action fully discontinued, with prejudice. The plaintiff, a major medical provider, filed suit in Kings County Civil Court in the total amount of $25,805.85, claiming our client owed it for the claimant’s unpaid medical billing. The claimant had been involved in a motor vehicle accident and sought payment for medical treatment. Counsel for the medical provider argued that, since the billing was never paid by the insurer, it was due in full—despite the fact that the same matter had previously been fully exhausted and was processed/handled in full compliance with the applicable medical fee schedule(s). While there were evidentiary issues in our client’s case, our arguments and position were strong. After negotiations and arguments, plaintiff’s counsel acquiesced to a full discontinuance of the matter, with prejudice.
Thought Leadership
Case Law Alerts
Fifth Circuit Enforces Deception Fraud Sublimit in Email Spoofing Loss Case
November 3, 2026
In Blue Compass RV, L.L.C. v. Twin City Fire Insurance Co., No. 25-10894 (5th Cir. June 5, 2026), the Fifth Circuit affirmed dismissal of a policyholder's suit seeking full crime-policy coverage after it wired $1,251,068.34 to a fraudster who had spoofed an email from its contractor with revised banking instructions. Blue Compass argued the loss should fall under its policy's higher-limit Computer and Funds Transfer Fraud provisions ($2,000,000), rather than the narrower Deception Fraud Insuring Agreement ($100,000, subject to a $25,000 retention), on the theory that the fraudster wasn't impersonating a "Vendor" as the policy defined that term. The court disagreed, holding the scheme fit squarely within Deception Fraud — an email impersonating a known business relation to induce payment — and that the policy's exclusion barring recovery under other insuring agreements for losses "resulting directly or indirectly from Deception Fraud" controlled, capping recovery at the $100,000 sublimit the insurer had already paid; the insurer's early tender of that amount, paired with a clean denial of the balance, left the insured without a viable bad-faith claim once the court read the policy's defined terms literally, and the case is a useful reminder for carriers to keep Deception/Social Engineering Fraud definitions and their cross-referenced exclusions tightly drafted, since that precise interplay is what defeated both the coverage and bad-faith claims here.
Case Law Alerts
Minnesota Court of Appeals Upholds Insurance‑Fraud Conviction, Validating Industry Fraud‑Impact Testimony
July 20, 2026
The Minnesota Court of Appeals affirmed Mark Jenni's insurance fraud conviction, which arose after he certified a Park Rapids property as his primary residence on a Liberty Mutual homeowner's policy and then filed an $80,000-plus burglary claim he never reported to the sheriff—on a property where he had previously submitted denied claims through a different carrier. On appeal, Jenni argued prosecutorial misconduct, contending the prosecutor improperly elicited testimony that roughly 10% of claims are non-meritorious and that fraud costs run into the "billions" ultimately borne by consumers. He also claimed that closing arguments improperly appealed to Hubbard County jurors' financial self-interest. The court rejected both arguments, holding the investigator's testimony was relevant to establish his background and context, finding that the prosecutor's "cost to consumers" framing explained why application misrepresentations are criminalized rather than urging conviction on community-interest grounds. For the industry, the decision is favorable to SIU and fraud-prosecution efforts: it endorses carrier fraud-investigator testimony about industry-wide fraud prevalence and cost as admissible context, and it gives prosecutors latitude to argue the downstream consumer-cost rationale without crossing into impermissible community-conscience appeals. The practical takeaway for carriers and SIU referrals is that the "fraud drives up everyone's premiums" narrative—long a staple of fraud-bureau messaging—has now been validated as proper evidentiary and argumentative framing, at least in Minnesota.
