Lance's Corner

New York State Appellate Division First Department Requires Insurer to Defend Dentist in Dispute Over Use of Photograph to Endorse Dental Practice

Apr 16, 2024
The Appellate Division, First Department, of the New York State Supreme Court in -- Wesco Insurance Company v. Nunez Dental Services, P.C. -- required an insurance company to defend the dentist in a matter relating to the dentist's use of a photograph of a woman claiming endorsement of the dentist's dental practice.  The plaintiff woman alleged that, in 2018, her images had been altered to falsely indicate that she endorsed defendant dental practice.  It was not clear if a 2009 image had previously been manipulated.  The woman asserted that this was unauthorized and the photo had been altered without her permission in violation of the New York State Civil Rights Law.  The insurance company cited various policy exclusions as to why it could disclaim defending the dentist, but the court found them all unavailing and ordered the insurer to provide a defense for the dentist.  The case is an interesting illustration of the need to exercise care when using photographs of patients for marketing purposes.  A copy of the court opinion is below.

Before: Singh, J.P., Friedman, Rodriguez, Higgitt, Rosado, JJ.
 

Index No. 155341/21, 595031/22 Appeal No. 1785 Case No. 2023-01733

Wesco Insurance Company et al., Plaintiffs-Respondents,

v

Nunez Dental Services, P.C., et al., Defendants-Appellants.



Camila Davalos etc., Counterclaim Plaintiff-Appellant,

v

Tower Insurance Company et al., Counterclaim Defendants. (And a Third-Party Action.)

The Casas Law Firm, P.C., New York (John V. Golaszewski of counsel), for appellants.

Gunnercooke US LLP, New York (Max W. Gershweir of counsel), for Wesco Insurance Company and Technology Insurance Company, respondents.

Order, Supreme Court, New York County (Louis L. Nock, J.), entered on or about February 8, 2023, which, to the extent appealed from, denied defendant Camila Davalos' cross-motion for summary judgment on defendants' counterclaims seeking a declaration that plaintiffs were required to defend and indemnify defendant Nunez in the underlying action in federal court, and granted plaintiffs' motion for summary judgment on their second and third causes of action seeking a declaration that they were not obligated to provide a defense and indemnification in the underlying action, and dismissed the counterclaims against them, unanimously modified, on the law, to the extent of denying plaintiffs' motion for summary judgment, and otherwise affirmed, without costs.

Plaintiffs failed to establish, as a matter of law, that they had no duty to defend Nunez in the underlying action.  The duty to defend is triggered by the allegations contained in the underlying complaint (see BP A.C. Corp. v One Beacon Ins. Group, 8 NY3d 708, 714 [2007]), and an insurer may be required to defend even though it is not ultimately required to indemnify once the litigation has run its course (see Automobile Ins. Co. of Hartford v Cook, 7 NY3d 131, 137 [2006]).  Plaintiffs have failed to meet their burden of establishing that they have no duty to defend on the basis that the prior publication exclusion bars coverage, as the underlying complaint does not indicate that the injury arose out of any publication which first took place before the beginning of the policy periods (see BP at 714; Consolidated Edison Co. of N.Y. v Allstate Ins. Co., 98 NY2d 208, 218 [2002]).  The extrinsic evidence plaintiffs rely on, which was obtained in this subsequent litigation and which does not serve to clarify any alleged ambiguities in the underlying complaint, does not relieve them of their duty to defend Nunez (cf. Town of Moreau v Orkin Exterminating Co., 165 AD2d 415 [3d Dept 1991]).

Plaintiffs have also not established, as a matter of law, that the prior publication exclusion precludes indemnification.  The record establishes that an image of the plaintiff in the underlying action was first used in 2009, but the record does not establish what that use consisted of.  It cannot be determined on this record that the publications attached to the underlying complaint, which were retrieved in approximately late 2018, consisted of substantially the same offending material as was published in 2009 (cf. St. Surfing, LLC v Great Am. E&S Ins. Co., 776 F3d 603, 610 [9th Cir 2014]; Tudor Ins. Co. v First Advantage Litig. Consulting, 2012 WL 3834721, *12 [SD NY 2012], affd 525 Fed Appx 60 [2d Cir 2013]).  Moreover, the plaintiff in the underlying action alleged that her images had been altered in order to make it appear that she was a customer of or endorsed Nunez's dental practice, and the record does not establish whether the 2009 publication was also so altered (see e.g. Taco Bell Corp. v Continental Cas. Co., 388 F3d 1069, 1073 [7th Cir 2004]).  Without the 2009 publication in the record, we also find that defendants have not established, as a matter of law, that the prior publication exclusion is inapplicable.

We also find that plaintiffs failed to establish, as a matter of law, that the criminal acts exclusion bars coverage in this case.  The exclusion at issue applies to injury arising out of a criminal act committed by Nunez or at the direction of Nunez.  The record does not establish that Nunez has been convicted of any crime related to the events addressed in the underlying complaint (cf. Allstate Ins. Co. v Swanson, 46 AD3d 1453, 1454 [4th Dept 2007]), nor does it even show that Nunez was ever charged with a crime (cf. Kehoe v Nationwide Mut. Fire Ins. Co., 299 AD2d 318, 319 [2d Dept 2002]).  Multiple issues of fact exist concerning Nunez's knowledge of whether Nunez had obtained the rights to use plaintiff's image, whether Nunez acted with the required mens rea to constitute a misdemeanor under Civil Rights Law § 50, and whether it was a separate party, namely, an individual hired to advertise Nunez's business, who committed the alleged criminal act without being directed to do so by Nunez (see Massa v Nationwide Mut. Fire Ins. Co., 74 AD3d 1661, 1664 [3d Dept 2010]; see also Penal Law § 15.15[2]).  While it is possible that the alleged conduct may be found to constitute a misdemeanor, we note that this is not a case were Nunez was convicted of anything, or where Nunez has failed to propose a scenario in which Nunez's conduct was tortious yet not criminal (cf. Harleysville Preferred Ins. Co. v Rams Head Savage Mill, LLC, 237 Md App 705, 741 [2018]).

We have considered the parties' remaining arguments, including that coverage is excluded by the copyright exclusion, and find them unavailing.

THIS CONSTITUTES THE DECISION AND ORDER OF THE SUPREME COURT, APPELLATE DIVISION, FIRST DEPARTMENT.

ENTERED: March 5, 2024

USDOL Issues Comprehensive Employer Guidance on Long COVID

The United States Department of Labor (USDOL) has issued a comprehensive set of resources that can be accessed below for employers on dealing with Long COVID.

Supporting Employees with Long COVID: A Guide for Employers

The “Supporting Employees with Long COVID” guide from the USDOL-funded Employer Assistance and Resource Network on Disability Inclusion (EARN) and Job Accommodation Network (JAN) addresses the basics of Long COVID, including its intersection with mental health, and common workplace supports for different symptoms.  It also explores employers’ responsibilities to provide reasonable accommodations and answers frequently asked questions about Long COVID and employment, including inquiries related to telework and leave.

Download the guide

Accommodation and Compliance: Long COVID

The Long COVID Accommodation and Compliance webpage from the USDOL-funded Job Accommodation Network (JAN) helps employers and employees understand strategies for supporting workers with Long COVID.  Topics include Long COVID in the context of disability under the Americans with Disabilities Act (ADA), specific accommodation ideas based on limitations or work-related functions, common situations and solutions, and questions to consider when identifying effective accommodations for employees with Long COVID.  Find this and other Long COVID resources from JAN, below:

Long COVID, Disability and Underserved Communities: Recommendations for Employers

The research-to-practice brief “Long COVID, Disability and Underserved Communities” synthesizes an extensive review of documents, literature and data sources, conducted by the USDOL-funded Employer Assistance and Resource Network on Disability Inclusion (EARN) on the impact of Long COVID on employment, with a focus on demographic differences.  It also outlines recommended actions organizations can take to create a supportive and inclusive workplace culture for people with Long COVID, especially those with disabilities who belong to other historically underserved groups.

Read the brief

Long COVID and Disability Accommodations in the Workplace

The policy brief “Long COVID and Disability Accommodations in the Workplace” explores Long COVID’s impact on the workforce and provides examples of policy actions different states are taking to help affected people remain at work or return when ready.  It was developed by the National Conference of State Legislatures (NCSL) as part of its involvement in USDOL’s State Exchange on Employment and Disability (SEED) initiative.

Download the policy brief

Understanding and Addressing the Workplace Challenges Related to Long COVID

The report “Understanding and Addressing the Workplace Challenges Related to Long COVID” summarizes key themes and takeaways from an ePolicyWorks national online dialogue through which members of the public were invited to share their experiences and insights regarding workplace challenges posed by Long COVID.  The dialogue took place during summer 2022 and was hosted by USDOL and its agencies in collaboration with the Centers for Disease Control and Prevention and the U.S. Surgeon General.

Download the report

Working with Long COVID

The USDOL-published “Working with Long COVID” fact sheet shares strategies for supporting workers with Long COVID, including accommodations for common symptoms and resources for further guidance and assistance with specific situations.

Download the fact sheet

COVID-19: Long-Term Symptoms

This USDOL motion graphic informs workers with Long COVID that they may be entitled to temporary or long-term supports to help them stay on the job or return to work when ready, and shares where they can find related assistance.

Watch the motion graphic

A Personal Story of Long COVID and Disability Disclosure

In the podcast “A Personal Story of Long COVID and Disability Disclosure,” Pam Bingham, senior program manager for Intuit’s Diversity, Equity and Inclusion in Tech team, shares her personal experience of navigating Long COVID symptoms at work.  The segment was produced by the USDOL-funded Partnership on Employment and Accessible Technology (PEAT) as part of its ongoing “Future of Work” podcast series.

Listen to the podcast

HHS OIG Issues Annual Report on State MFCUs

Per the notice below, the Office of the Inspector General (OIG) of the United States Department of Health and Human Services (HHS) has issued its annual report on the performance of state Medicaid Fraud Control Units (MFCUs).

Medicaid Fraud Control Units Fiscal Year 2023 Annual Report (OEI-09-24-00200) 

Medicaid Fraud Control Units (MFCUs) investigate and prosecute Medicaid provider fraud and patient abuse or neglect. OIG is the Federal agency that oversees and annually approves federal funding for MFCUs through a recertification process. This new report analyzed the statistical data on annual case outcomes—such as convictions, civil settlements and judgments, and recoveries—that the 53 MFCUs submitted for Fiscal Year 2023.  New York data is as follows:

Outcomes

  • Investigations1 - 556
  • Indicted/Charged - 9
  • Convictions - 8
  • Civil Settlements/Judgments - 28
  • Recoveries2 - $73,204,518

Resources

  • MFCU Expenditures3 - $55,964,293
  • Staff on Board4 - 257

1Investigations are defined as the total number of open investigations at the end of the fiscal year.

2Recoveries are defined as the amount of money that defendants are required to pay as a result of a settlement, judgment, or prefiling settlement in criminal and civil cases and may not reflect actual collections.  Recoveries may involve cases that include participation by other Federal and State agencies.

3MFCU and Medicaid Expenditures include both State and Federal expenditures.

4Staff on Board is defined as the total number of staff employed by the Unit at the end of the fiscal year.

Read the Full Report

View the Statistical Chart

Engage with the Interactive Map

GAO Issues Report on Medicaid Managed Care Service Denials and Appeal Outcomes

The United States Government Accountability Office (GAO) has issued a report on federal use of state data on Medicaid managed care service denials and appeal outcomes.  GAO found that federal oversight is limited because it doesn't require states to report on Medicaid managed care service denials or appeal outcomes and there has not been much progress on plans to analyze and make the data publicly available.  To read the GAO report on federal use of state data on Medicaid managed care service denials and appeal outcomes, use the first link below.  To read GAO highlights of the report on federal use of state data on Medicaid managed care service denials and appeal outcomes, use the second link below.
https://www.gao.gov/assets/d24106627.pdf  (GAO report on federal use of state data on Medicaid managed care service denials and appeal outcomes)
https://www.gao.gov/assets/d24106627_high.pdf  (GAO highlights on federal use of state data on Medicaid managed care service denials and appeal outcomes)

CMS Issues Latest Medicare Regulatory Activities Update

The Centers for Medicare and Medicaid Services (CMS) has issued its latest update on its regulatory activities in the Medicare program.  While dentistry is only minimally connected to the Medicare program, Medicare drives the majority of health care policies and insurance reimbursement policies throughout the country.  Therefore, it always pays to keep a close eye on what CMS is doing in Medicare.  To read the latest CMS update on its regulatory activities in Medicare, use the link below.
https://www.cms.gov/training-education/medicare-learning-network/newsletter/2024-03-14-mlnc