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.
Subscribe to my substack at https://lnkd.in/gmmzUVBy
Go to X @bzalma; Go to the Insurance Claims Library – https://lnkd.in/gwEYk
Louisiana Statute Prevents Enforcement of Contract Term Requiring Arbitration of Disputes
Post 5241
Read the full article at https://www.linkedin.com/pulse/international-convention-requiring-enforcement-award-barry-sttdc, see the video at and at and at https://zalma.com/blog plus more than 5200 posts.
In Town of Vinton v. Indian Harbor Insurance Company, Nos. 24-30035, 24-30748, 24-30749, 24-30750, 24-30751, 24-30756, 24-30757, United States Court of Appeals, Fifth Circuit (December 8, 2025) municipal entities including the Town of Vinton, et al sued domestic insurers after dismissing foreign insurers with prejudice. The insurers sought arbitration under the Convention on the Recognition and Enforcement of Foreign Arbitral Awards (the “Convention”) but the court held Louisiana law — prohibiting arbitration clauses in such policies—controls, as the Convention does not apply absent foreign parties who ...
Refusal to Provide Workers’ Compensation is Expensive
Post 5240
Read the full article at https://lnkd.in/guC9dnqA, see the video at https://lnkd.in/gVxz-qmk and at https://lnkd.in/gUTAnCZw, and at https://zalma.com/blog plus more than 5200 posts.
In Illinois Department of Insurance, Insurance Compliance Department v.USA Water And Fire Restoration, Inc., And Nicholas Pacella, Individually And As Officer, Nos. 23WC021808, 18INC00228, No. 25IWCC0467, the Illinois Department of Insurance (Petitioner) initiated an investigation after the Injured Workers’ Benefit Fund (IWBF) was added to a pending workers’ compensation claim. The claim alleged a work-related injury during employment with the Respondents who failed to maintain workers’ compensation Insurance.
Company Overview:
USA Water & Fire Restoration, Inc. was incorporated on January 17, 2014, and dissolved on June 14, 2019, for failure to file annual reports and pay franchise taxes. It then operated under assumed names including USA Board Up & Glass Co. and USA Plumbing and Sewer. The business ...
Arsonist Incompetently Moves Pro Se to Avoid Prison
Post 5239
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In Christopher A. Barosh v. Morris Houser, et al., Civ. No. 22-0769, United States District Court, E.D. Pennsylvania (November 25, 2025) a convicted arsonist and insurance fraudster moved the USDC acting in Pro se filed Objections to Magistrate Judge Reid’s Recommendation that the US District Judge dismiss his § 2254 Petition to avoid jail.
BACKGROUND
In October 2005, Barosh set fire to his girlfriend’s Philadelphia home — some 25 hours before the cancellation of the property’s insurance policy. Several witnesses saw Barosh leaving the property shortly before the fire erupted. After the fire, Barosh made “two separate admissions of guilt.”
He attempted to pay an acquaintance to provide him with an alibi for the time of the arson. The eyewitnesses, brother, and ...
The Professional Claims Handler
Post 5219
Posted on October 31, 2025 by Barry Zalma
An Insurance claims professionals should be a person who:
Can read and understand the insurance policies issued by the insurer.
Understands the promises made by the policy.
Understand their obligation, as an insurer’s claims staff, to fulfill the promises made.
Are competent investigators.
Have empathy and recognize the difference between empathy and sympathy.
Understand medicine relating to traumatic injuries and are sufficiently versed in tort law to deal with lawyers as equals.
Understand how to repair damage to real and personal property and the value of the repairs or the property.
Understand how to negotiate a fair and reasonable settlement with the insured that is fair and reasonable to both the insured and the insurer.
How to Create Claims Professionals
To avoid fraudulent claims, claims of breach of contract, bad faith, punitive damages, unresolved losses, and to make a profit, insurers ...
The History Behind the Creation of a Claims Handling Expert
The Insurance Industry Needs to Implement Excellence in Claims Handling or Fail
Post 5210
This is a change from my normal blog postings. It is my attempt. in more than one post, to explain the need for professional claims representatives who comply with the basic custom and practice of the insurance industry. This statement of my philosophy on claims handling starts with my history as a claims adjuster, insurance defense and coverage lawyer and insurance claims handling expert.
My Training to be an Insurance Claims Adjuster
When I was discharged from the US Army in 1967 I was hired as an insurance adjuster trainee by a professional and well respected insurance company. The insurer took a chance on me because I had been an Army Intelligence Investigator for my three years in the military and could use that training and experience to be a basis to become a professional insurance adjuster.
I was initially sat at a desk reading a text-book on insurance ...
The History Behind the Creation of a Claims Handling Expert
The Insurance Industry Needs to Implement Excellence in Claims Handling or Fail
Post 5210
This is a change from my normal blog postings. It is my attempt. in more than one post, to explain the need for professional claims representatives who comply with the basic custom and practice of the insurance industry. This statement of my philosophy on claims handling starts with my history as a claims adjuster, insurance defense and coverage lawyer and insurance claims handling expert.
My Training to be an Insurance Claims Adjuster
When I was discharged from the US Army in 1967 I was hired as an insurance adjuster trainee by a professional and well respected insurance company. The insurer took a chance on me because I had been an Army Intelligence Investigator for my three years in the military and could use that training and experience to be a basis to become a professional insurance adjuster.
I was initially sat at a desk reading a text-book on insurance ...
