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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Anti-Public Adjuster Clause Is Effective in New York
Post number 5301
Read the full article at https://www.linkedin.com/pulse/public-adjusters-attempt-represent-insured-subject-zalma-esq-cfe-rubfc, see the video at and at and at https://zalma.com/blog plus more than 5300 posts.
Insurers May Contractually Prevent an Insured from Hiring a Public Adjuster
In Peter Barbato & North Jersey Public Adjusters Inc. v. Interstate Fire & Casualty Company, et al, No. 25-cv-5312 (JGK), United States District Court, S.D. New York (December 15, 2025) the plaintiffs, Peter Barbato and North Jersey Public Adjusters, Inc. (“NJPA”), filed suit against several insurance companies, including Interstate Fire & Casualty Company, Independent Specialty Insurance Company, and certain Underwriters at Lloyd’s of London.
FACTS
NJPA is a New Jersey-based public adjusting firm licensed in New York. The dispute centers on ...
Anti-Public Adjuster Clause Is Effective in New York
Post number 5301
Read the full article at https://www.linkedin.com/pulse/public-adjusters-attempt-represent-insured-subject-zalma-esq-cfe-rubfc, see the video at and at and at https://zalma.com/blog plus more than 5300 posts.
Insurers May Contractually Prevent an Insured from Hiring a Public Adjuster
In Peter Barbato & North Jersey Public Adjusters Inc. v. Interstate Fire & Casualty Company, et al, No. 25-cv-5312 (JGK), United States District Court, S.D. New York (December 15, 2025) the plaintiffs, Peter Barbato and North Jersey Public Adjusters, Inc. (“NJPA”), filed suit against several insurance companies, including Interstate Fire & Casualty Company, Independent Specialty Insurance Company, and certain Underwriters at Lloyd’s of London.
FACTS
NJPA is a New Jersey-based public adjusting firm licensed in New York. The dispute centers on ...
Proof of Highly Contaminated Water is Required for Extra Payments
Post number 5300
Read the full article at https://www.linkedin.com/pulse/acting-your-own-lawyer-foolish-barry-zalma-esq-cfe-mbg0c, see the video at and at and at https://zalma.com/blog plus more than 5300 posts.
Acting as Your Own Lawyer is Foolish
Evidence of Breach of Contract Survives Dismissal of All Other Charges
In Lee Lifeng Hsu and Jane Yuchen Hsu v. State Farm Fire And Casualty Company, C. A. No. N24C-09-020 CLS, Superior Court of Delaware (February 27, 2026) a claim to State Farm who paid approximately $61,000 after assessments but denied coverage for additional items including ceramic tiles, the kitchen floor ceiling, underlayment plywood, and numerous personal property items resulted in suit by the Hsu’s acting in pro per.
Facts
Lee Lifeng Hsu and Jane Yuchen Hsu (“Plaintiffs”) purchased a homeowners’ insurance policy from State Farm Fire...
Insurance Condition Requires Following the Intent of the Parties
Post number 5307
Principles of Contract Interpretation Compels Reading Contract as Written
Read the full article at https://www.linkedin.com/pulse/portable-storage-containers-buildings-barry-zalma-esq-cfe-fkg1c and at https://zalma.com/blog.
In Eastside Floor Supplies, Ltd. v. SCS Agency, Inc., Hanover Insurance Company, et al., No. 2024-01501, Index No. 609883/19, 2026 NY Slip Op 01488, Supreme Court of New York, Second Department (March 18, 2026)
In May 2019, a fire damaged business personal property belonging to the plaintiffs, which was stored in portable storage containers at their Manhattan premises. At the time of the fire, the plaintiffs were insured under a businessowners insurance policy (BOP) issued by the defendant Hanover Insurance Company which provided general coverage for business personal property, and which included a specific extension for “Business Personal Property Temporarily in Portable Storage Units” (the portable storage ...
ERISA Saves Fraudulent Claims Suit
Post number 5306
Read the full article at https://www.linkedin.com/pulse/failure-provide-well-pled-facts-defeats-most-action-zalma-esq-cfe-b4zuc and at https://zalma.com/blog plus more than 5300 posts.
Allegations of Fraudulent Insurance Billing Must be Pleaded with Specificity
In Genesis Laboratory Management LLC v. United Healthcare Services, Inc. and Oxford Health Plans, Inc., No. 21cv12057 (EP) (JSA), United States District Court, D. New Jersey (March 13, 2026) Genesis Laboratory Management LLC (“Genesis”), a New Jersey-based molecular diagnostic and anatomic pathology laboratory, provided COVID-19 related testing services and submitted claims for reimbursement as an out-of-network provider to United Healthcare Services, Inc. (“United”) and Oxford Health Insurance, Inc. (“Oxford”). Metropolitan Healthcare Billing, LLC (“Metropolitan”), owned by the same individual as Genesis, handled the billing for Genesis.
FACTUAL BACKGROUND
United and Oxford, who administer both ERISA and ...
ERISA Saves Fraudulent Claims Suit
Post number 5306
Read the full article at https://www.linkedin.com/pulse/failure-provide-well-pled-facts-defeats-most-action-zalma-esq-cfe-b4zuc and at https://zalma.com/blog plus more than 5300 posts.
Allegations of Fraudulent Insurance Billing Must be Pleaded with Specificity
In Genesis Laboratory Management LLC v. United Healthcare Services, Inc. and Oxford Health Plans, Inc., No. 21cv12057 (EP) (JSA), United States District Court, D. New Jersey (March 13, 2026) Genesis Laboratory Management LLC (“Genesis”), a New Jersey-based molecular diagnostic and anatomic pathology laboratory, provided COVID-19 related testing services and submitted claims for reimbursement as an out-of-network provider to United Healthcare Services, Inc. (“United”) and Oxford Health Insurance, Inc. (“Oxford”). Metropolitan Healthcare Billing, LLC (“Metropolitan”), owned by the same individual as Genesis, handled the billing for Genesis.
FACTUAL BACKGROUND
United and Oxford, who administer both ERISA and ...
