As a dentist or dental professional, we comprehend that your reputation is paramount in your industry, and we are committed to helping in any way possible. Join Tom Chaston, director of All Med Pro as he discusses claims reporting.
Q) When do I have to contact my indemnity provider about a possible patient complaint or claim?
A) This is an area that does cause confusion in the indemnity market because it isn’t always clear what customers’ obligations are and the ramifications of not correctly notifying an incident can be catastrophic. This is complicated further by reporting obligations differing from one indemnity provider to another.
From an insurance perspective, some insurers want their customers to notify them of anything that “may/could” give rise to a claim, and other insurers want customers to notify them of anything that is “likely” to give rise to a claim. If you are unsure of your own reporting requirements, you should check your insurer policy wording.
Our experience of policies that require customers to notify us of incidents that are “likely” to give rise to a claim is that often, the insurer’s perception of whether something is likely or not is different from the customers’. This can create ambiguity and place too much responsibility on the customer, especially for those who may be facing a potential claim for the first time and may not have the experience to properly identify whether a complaint is likely to lead to a claim or not.
At All Med Pro, we want customers to notify us of anything that has the potential to lead to a claim, even if you think the chances of it doing so are remote. If our customers are unsure whether they should contact us, they should do so and talk it through with our in-house dental indemnity claims specialists. In most cases, we will make a note on the customer’s file of the potential claim and will then simply await further updates as and when they are available.
Q) If I notify my indemnity provider of each and every potential incident, won’t that impact my indemnity premiums?
A) We understand the fear that comes with contacting your indemnity provider about potential incidents, especially around the impact on customers’ future premiums. We have many customers who share their experiences of previous indemnity providers increasing premiums due to contacting the advice-line multiple times, even when no claim has arisen.
We are pleased to say that, as far as All Med Pro customers are concerned, we will not increase premiums for calling our advice-line or notifying us of a potential incident. It is vital that we are made aware of anything that has the potential to escalate, as this enables our teams to work with you to mitigate an escalation where possible and reduce costs if a claim does arise.
Q) A patient has complained to the practice, what is the reporting process?
A) Nowadays, we are seeing most patient complaints being made to the practice in the first instance, but also, most claims now also include the practice as a party to the Letter of Claim in addition to the treating dentist(s). The reason solicitors involve the practice (and sometimes multiple practices, hospitals, and treating dentists) is that it increases the prospect of a successful compensation claim for the patient.
After several high-profile cases specifically focused on non-delegable duty of care and vicarious liability (see Rattan v Hughes), there is certainly more for dentists to consider when complaints are initially made to the practice. Historically, the practice would simply pass the complaint/claim on to the dentist for them to handle with their own indemnity provider. We still expect that to happen; however, dental practices and/or principal dentists should additionally contact their own indemnity provider in case there is potential for a vicarious liability claim.
We have also, on occasions, seen patient complaints made to the practice and the dentist not being passed the complaint details in a prompt manner – sometimes with the practice attempting to handle the complaint process directly with the patient until such a time where it escalates into a claim. This causes potential issues for an indemnity provider that has not been notified of the issue, as they have been unable to support with the cost mitigation process.
Q) Sometimes, it feels like offering the patient a refund will get rid of the complaint – are there any issues with doing this?
A) This is sometimes a quick and low-cost way to resolve a patient complaint, and insurers are often supportive of this approach. However, we would still stress that you need to contact your indemnity provider before making such an offer, as your provider may want to have oversight of the patient communication going out prior to it being sent. The reason for this is that it is important in the early stages of a patient complaint that no admission of liability is made or implied, and the wording of any patient communication is clear that an offer of a refund is done so on a “without prejudice basis” and that this does not constitute an admission of liability.
Q) What are the potential implications of not correctly notifying my indemnity provider of a potential claim?
A) Each indemnity provider will treat a late notification on a case-by-case basis and will deal with each on the grounds of its own set of circumstances. Factors that are taken into account include the nature of the patient correspondence received by the practice/dentist and whether the indemnity policy has been renewed since the initial patient complaint was received. However, the risk of a late notification of a potential claim is that the claim will be repudiated in its entirety, leaving the dentist to self-fund both the legal defense costs and potential compensation awards.
It is important to remember that, regardless of whether you feel the patient has a valid complaint or not, your indemnity policy is designed to pick up the legal costs involved with defending a claim, not just the potential compensation that may be awarded if you are found liable. As such, even if you feel there is no case to answer and therefore do not notify your indemnity provider of the case, they will likely have the right to reject the claim in full.
Under Project Sphere, our commitment is to offer exceptional support to dental professionals. A crucial element of this endeavour involves removing any constraints on seeking advice. Historically, and moving forward, there will be no limit to how often you can approach us for guidance, and the frequency of your enquiries will not affect your indemnity fees. We firmly believe that unrestricted access to guidance is vital for enhancing patient safety and fostering professional growth.
Have your indemnity with us and have received a claim?
1, Inform our team of your claim either by calling us on 0203 757 6950 or emailing [email protected] (please note that emails will only be monitored 9-5 Monday to Friday).
2. Our claims manager will then direct your enquiry to the relevant dento-legal team for support.
3. You’ll then receive advice from experienced professionals and be fully supported. “We make every effort to communicate transparently with our clients and provide the best advice for their claims. Our close relationship with a team of legal experts enables us to swiftly and honestly address claims. We understand just how crucial your professional reputation is to you” Nicole Gregory, Claims Manager.
All Med Pro is a trusted insurance company, especially known for helping dentists and healthcare professionals. We understand the unique risks you face, so we offer tailored insurance packages to meet your needs. Choosing All Med Pro means you’ll feel secure knowing you have reliable coverage and support when you need it most. Our commitment to excellent service and industry expertise makes us a top choice for great insurance in healthcare.
Contact Us Today
If you have a query, give us a call at 0203 757 6950 or drop us an email via [email protected]
Alternatively, book a FREE claims consultation call with an expert member of our team: All Med Pro (office365.com)
