Lack of Standing Requires Dismissal
Post 5008
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Chutzpah: Attempt to Use Federal Court to Obtain a Share of the Proceeds of an Insurance Fraud
Tyanna Dodson is a chiropractor who sought compensation from ExamWorks, L.L.C.'s ("ExamWorks" ), a medical billing and scheduling provider. Dodson alleged that ExamWorks over-billed her patients' insurers for her services to insurers for independent medical exams (IME) she conducted.
In Tyanna Dodson, Doctor of Chiropractic v. ExamWorks, L.L.C., No. 24-50248, the United States Court of Appeals, Fifth Circuit (on February 28, 2025) Dodson contended that the IME's she conducted to help insurers defeat attempted insurance fraud were billed by ExamWorks fraudulently overcharging he insurer clients. She sued EamWorks for half of the excessive billing and damages because she faced discipline and charges of insurance fraud. The District Court found that she had no standing to bring the suit and ignored the fact that she sued in federal court to gain a share of the proceeds of a fraud.
FACTS
Dodson had entered into a contract with Landmark Exams in 2015, which was later acquired by ExamWorks. She terminated her agreement with ExamWorks in 2018, claiming mishandling of billing for over 80 IMEs (Independent Medical Examinations) she conducted in 2017 and 2018. Dodson sued ExamWorks for overbilling insurers and billing for services she did not perform, bringing claims for breach of contract, breach of fiduciary duty, constructive fraud, and declaratory judgment. She alleged injury from ExamWorks's failure to give her half of its allegedly ill-gotten gains and the risk of professional discipline and criminal liability.
ExamWorks moved to dismiss Dodson's First Amended Complaint for lack of standing and for judgment on the pleadings. The district court dismissed the case. Dodson's appeal contended that the district court erroneously concluded she lacked standing and abused its discretion by denying her motion to amend the judgment.
DECISION
The Fifth Circuit reviewed the case and found that Dodson failed to demonstrate a sufficient injury-in-fact. Dodson's claims of harm from ExamWorks withholding her cut of proceeds from fraudulent billing and the risk of future civil and criminal liability were deemed insufficient.
ANALYSIS
To satisfy Article III standing, a plaintiff must show that:
(1) she has suffered an "injury in fact,"
(2) that the injury "likely was caused or likely will be caused" by the defendant, and
(3) the injury is likely to be "redressed by the requested judicial relief."
Dodson presents a long list of purported injuries which essentially collapse into two for standing purposes: (1) ExamWorks withheld Dodson's cut of its proceeds from fraudulent billing, and (2) she now faces a risk of harm from potential future civil and criminal liability.
DEMAND FOR CUT OF FRAUDULENT CLAIMS
For her cut of the purportedly ill-gotten gains, Dodson alleged that she suffered "benefit of the bargain damages" from ExamWorks's alleged breach of contract. She stated that ExamWorks breached its contract when it "fraudulently billed and overbilled for [her IMEs] and related services without . . . providing [her] with the appropriate fee(s) which she was entitled to as per the parties' contract."
Dodson already received all the proceeds that she could legally receive under her contract. Even if Dodson had suffered such harm, it would not have been to a legally protected interest. To the extent that Dodson seeks to use federal courts to pursue her cut of allegedly illegally obtained funds, does not suffice for Article III standing.
ExamWorks observed that the time bar eliminates Dodson's risk of any professional discipline related to her allegations, which all allegedly occurred in 2018 and before. Any risk of injury that Dodson faces from potential future action by regulators is too speculative for Article III purposes.
Because she has not pleaded sufficient injury for Article III standing, the Fifth Circuit affirmed the district court's dismissal of this case and its denial of Dodson's motion to alter or amend the judgment.
ZALMA OPINION
"Chutzpah" is a Yiddish term that has found its way into the English language. It is defined as unmitigated gall and defined by the example of a person convicted of murdering his parents and seeking mercy from the court because he is an orphan. Dr. Dodson's claim for half of the illegally obtained fees by filing suit in the federal courts is, on its face, not only a claim without standing, it is conduct asking the court to assist her in obtaining "her share" of fraudulent billing.
(c) 2025 Barry Zalma & ClaimSchool, Inc.
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(c) 2025 Barry Zalma & ClaimSchool, Inc.
Please tell your friends and colleagues about this blog and the videos and let them subscribe to the blog and the videos.
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Happy Law Day
ZIFL – Volume 30, Issue 9 – May 1, 2026
Read the full article at https://www.linkedin.com/pulse/zalmas-insurance-fraud-letter-may-1-2026-barry-zalma-esq-cfe-2tywc, see the video at at and at https://zalma.com/blog plus more than 5300 posts.
THE SOURCE FOR THE INSURANCE FRAUD PROFESSIONAL
ZIFL – Volume 30, Issue 9 – May 1, 2026
Zalma’s Insurance Fraud Letter (ZIFL) continues its 30th year of publication dedicated to those involved in reducing the effect of insurance fraud. ZIFL is published 24 times a year and is written by Barry Zalma.
DOJ Creates National Fraud Enforcement Division
Will the Feds Take on Insurance Fraud? Possibly as Part of a National Anti-Fraud Effort
On April 7, 2026, the Acting Attorney General, Todd Blanche, issued a memorandum establishing the Department of Justice National Fraud Enforcement Division (NFED). The memo describes an ambitious, but perhaps redundant, vision for this ...
When Abalone Died As a Result of Multiple Causes The Efficient Proximate Cause Requires Payment
Post number 5345
Read the full article at https://www.linkedin.com/pulse/efficient-proximate-cause-doctrine-saves-claim-barry-zalma-esq-cfe-yndlc, see the video at and at and at https://zalma.com/blog plus more than 5300 posts.
In American Abalone Farms, LLC v. Star Insurance Company et al., H052643, California Court of Appeals, Sixth District (April 27, 2026) the Court of Appeals dealt with an insurance coverage issue that required application of the efficient proximate cause doctrine.
FACTS
American Abalone Farms, LLC ("American Abalone" ) operates an aquaculture farm in Santa Cruz County, California, raising abalone in tanks. In August 2020, the CZU Lightning Complex Fires led to a prolonged power outage and road closures near the farm. As a result, the farm’s water pumps failed, causing the death of most of the ...
Breach of a Specific Condition Precedent Is a Complete Defense
See the video at and at and at https://zalma.com/blog plus more than 5300 posts.
In United Services Automobile Association and State Farm Mutual Automobile Insurance Company v. Anthony Wenzell, 2026 CO 25 (Colo. Apr. 27, 2026) Anthony Wenzell was rear-ended in a car accident. He had a significant prior 2014 accident that required back surgery.
Wenzell claimed underinsured-motorist (UIM) benefits under three policies: (1) the tortfeasor’s liability policy, (2) his own primary UIM policy with State Farm, and (3) an excess UIM policy issued by USAA (under his brother’s policy, which contained an “other insurance” clause making USAA’s coverage excess over any collectible insurance).
After receiving the claims, both USAA and State Farm repeatedly requested that Wenzell execute comprehensive medical-release authorizations so they could obtain his full medical records and ...
It is Fraud to Make the Same Claim Twice
Read the full article at https://www.linkedin.com/pulse/fraud-make-same-claim-twice-barry-zalma-esq-cfe-c4g8c and at https://zalma.com/blog.
Chutzpah: After Being Paid for a New Roof Insured Makes Second Claim For Same Damages
Post number 5347
No One is Entitled to be Paid for the Same Loss Twice
In Mohammed Ali Khalili v. State Farm Lloyds, No. 14-25-00611-CV, Court of Appeals of Texas (April 30, 2026) Khalili maintained a State Farm Lloyds homeowners insurance policy for decades. In 2008 he filed a roof-damage claim; State Farm paid him to replace the entire roof (shingles and gutters). Khalili never replaced the roof and repeated his claim.
BACKGROUND
In 2021 he filed a second roof claim. State Farm’s inspectors found the roof “very old” with extensive non-storm-related damage. The claim was denied because (1) the damage did not exceed the deductible and (2) State Farm had already paid for a full roof replacement.
PROCEDURAL HISTORY
State Farm filed motion for summary...
It is Fraud to Make the Same Claim Twice
Read the full article at https://www.linkedin.com/pulse/fraud-make-same-claim-twice-barry-zalma-esq-cfe-c4g8c and at https://zalma.com/blog.
Chutzpah: After Being Paid for a New Roof Insured Makes Second Claim For Same Damages
Post number 5347
No One is Entitled to be Paid for the Same Loss Twice
In Mohammed Ali Khalili v. State Farm Lloyds, No. 14-25-00611-CV, Court of Appeals of Texas (April 30, 2026) Khalili maintained a State Farm Lloyds homeowners insurance policy for decades. In 2008 he filed a roof-damage claim; State Farm paid him to replace the entire roof (shingles and gutters). Khalili never replaced the roof and repeated his claim.
BACKGROUND
In 2021 he filed a second roof claim. State Farm’s inspectors found the roof “very old” with extensive non-storm-related damage. The claim was denied because (1) the damage did not exceed the deductible and (2) State Farm had already paid for a full roof replacement.
PROCEDURAL HISTORY
State Farm filed motion for summary...
What Must be Done after Notice of a Claim is Received by the Insurer
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A first party property policy does not insure property: it insures a person, partnership, corporation or other entity against the risk of loss of the property. Before an insured can make a claim for indemnity under a policy of first party property insurance the insured must prove that there was damage to property the risk of loss of which was insured by the policy. The obligation imposed on the insured ...
