Gov’t Emples. Ins. Co. v. Reg’l Orthopedic Prof’l Ass’n, 2017 U.S. Dist. LEXIS 197599

No duty to seek administrative remedies for IFPA, RICO or other fraud-based claims prior to filing in federal or state court.

The defendants filed a motion to dismiss, asserting the insurance carrier failed to seek administrative remedies, i.e., mandated arbitration in lieu of filing a complaint in federal court. The court found that while there was mandated arbitration in New Jersey, claims under the Insurance Fraud Prevention Act (IFPA), the Racketeer Influenced and Corrupt Organizations Act (RICO) and other fraud-based claims are not required to be litigated via personal injury protection arbitrations. This opinion supports the fact that, while some states have mandated arbitration for disputes centered around recovery of medical expense benefits, fraud-based allegations go beyond this type of dispute and can be litigated in federal or state court. Most state-mandated arbitration forums regarding medical expense benefits do not require fraud-based allegations to be heard in that forum.


Case Law Alerts, 1st Quarter, January 2018

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