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
Second Circuit Narrows Insurers’ Ability to Deny No‑Fault Claims Based on Provider Misconduct
April 1, 2026
This dispute centered on GEICO’s attempt to recover millions of dollars in New York no-fault reimbursements from acupuncture and chiropractic clinics that allegedly engaged in illegal "kickback" schemes to procure patients. The Second Circuit vacated a lower court's ruling in favor of the insurer, determining that a provider’s violation of New York’s professional misconduct or anti-kickback statutes does not automatically render them "ineligible" for reimbursement under the no-fault regulatory framework. The court clarified that unless the misconduct involves a "licensing" failure—specifically where a non-physician exercises actual ownership or control over the professional corporation—the services rendered remain reimbursable. For insurance carriers, this decision serves as a warning that proving "unethical behavior" or "illegal referrals" is no longer a shortcut to denying PIP or no-fault claims. Carriers must now meet a higher evidentiary burden by proving "de facto" illegal corporate structure or control to justify non-payment. Practically, carriers should pivot their litigation strategies to focus on documenting the lack of medical necessity or the fraudulent nature of the services themselves, rather than relying solely on the provider’s underlying professional misconduct.
Case Law Alerts
Michigan Court Invalidates No-Fault Policy Exclusion Conflicting with Statutory PIP Coverage
January 1, 2026
The Michigan Court of Appeals ruled that a no-fault policy exclusion that conflicts with the state’s statutory PIP coverage requirements (MCL 500.3114(1)) is invalid. Muzafer Isovska was injured while driving a Ford Focus, but he held a no-fault policy from USA Underwriters that listed only a Toyota Yaris. The court emphasized that under Michigan’s No-Fault Act, insurers must provide personal protection insurance benefits to any statutorily eligible insured—regardless of whether the vehicle involved is named in the policy. Any exclusion attempting to deny coverage contrary to mandatory statutory language cannot stand. This decision reinforces that courts will strike down policy exclusions that conflict with Michigan’s express PIP coverage mandates. Case Law Alerts, 1st Quarter, January 2026 is prepared by Marshall Dennehey to provide information on recent developments of interest to our readers. This publication is not intended to provide legal advice for a specific situation or to create an attorney-client relationship. Copyright © 2026 Marshall Dennehey, all rights reserved. This article may not be reprinted without the express written permission of our firm.
