Having a process for when and how to refer patients for complicated cases can help protect your dental practice from potential litigation. Here are some tips for building out a trusted network of specialists and avoiding vicarious liability risks.
By Dr. Ty Galvin, D.D.S., and Dr. Mike Gile, D.D.S.
There is a fine line between when to refer to a specialist for a complicated procedure and when to perform the work yourself. Knowing your strengths and limitations — and those of your network of specialists — can help ensure that you make the best decision for your patients and your practice.
Consider the case of the dentist who worked on a patient’s implants for a bone density issue. The dentist used the wrong size implants, they didn’t integrate properly, and they were not solid in the bone. After the dentist spent more than a year trying to get them fixed and adjusted, the patient still had to have them removed and redone by another provider, which led to an $80,000 claim against the first dentist.
While the dentist in the above case should have referred the patient to a specialist familiar with bone density issues, referring a patient to a specialist’s office for a procedure or condition can also bring risks for the referring dentist. The greatest of those risks is a vicarious liability claim against the general dentist if something goes wrong with the specialist’s treatment. For this reason and more, it is important to select your specialists carefully.
The true costs of a vicarious liability lawsuit — or any other for that matter — lie in the often long and invasive litigation process. It can involve getting publicly served with the lawsuit at work and having documents from discovery available online that detail income, past lawsuit history, and other uncomfortable details. Not only is this embarrassing, dentists could lose work and face increased insurance rates and the potential for non-renewal in the future.
3 Steps for referring to specialists
Patients often trust their dentists’ recommendations when a referral is needed. Having a trusted team of specialists and a process for referrals can set you, your patient and the specialist up for success. Here are three steps to achieve just that:
Know when to do the work and when to refer it out. Working with specialists allows a general dentist to focus on their own practice so they can perform procedures that best match their preferences and skill sets. If a procedure is not within your level of knowledge, technical skill, your office’s equipment, or lab and staff support, it is best to refer your patient. If you are unsure of what to do, evaluate whether or not the procedure has an inherent high risk of complications. Some scenarios you may want to consider referring out to a specialist include:
Third molar extractions
Implant fixture placements
“All-On-Four” prosthetic restorations
Intravenous sedation
A specialist’s office would more likely be set up for success and management of problems, should they occur.
Develop a relationship with your specialists. Check their credentials, look at State Board disciplinary actions, listen to feedback from your own patients and meet the provider(s) before recommending that your patient visits him or her. Determine if they meet the following criteria, through referrals from your peers, past patient experiences and more:
High quality of work
Respectful to patients
Good bedside manner
Office works well and communicates effectively with your office
Maintain independence so you can ethically choose the best fit specialist as needed. Avoid having specialists buy you lunch or gifts that could have an air of impropriety. Know that kickbacks are illegal, whether they are box seats at a baseball game or a split fee.
Communicate with the specialist and relay the information to patients. Take time to speak with the specialists who your patients will ultimately use. Have a conversation with the specialist to discuss the patient’s case, get their opinion and discuss the approach to care before referring them or doing the job yourself. This simple step can help prevent issues and resolve any potential problems more quickly.
Remember to convey that information to your patient so they know what to expect. Take time to explain why they are being referred, detail the procedure to be completed, and what they should expect. Educating patients will help them be better prepared for their visit and help avoid miscommunication.
Considering adding a service to your practice?
Many dental practices now are providing additional services such as Botox. Before offering a new service know what is required beyond initial training and certification. Determine how many annual continuing education requirements need to be met. In addition, put protocols in place to keep yourself and staff up to date on industry trends. Even though it is a new service for you, you are still held to the same standard of care for that procedure as other providers who are experts. Consider additional training to have more experience before offering new services to patients.
Review your liability insurance coverage with your agent to ensure it includes the additional services you want to provide. Adding new services or an additional office location to your policy may cost an additional fee.
Whether deciding to refer out to a specialist or to perform the work yourself, or considering adding a new service, keep in mind that the highest standard of care for your patients should guide you to the best approach.
For more information on protecting your practice, contact The Professional Protector Plan® for Dentists @ 800-922-5694, or through the website: protectorplan.com.
This information is intended for informational purposes only. Nothing contained in this publication is, nor is intended to be, legal or dental advice. Professional Protector Plan for Dentists is not liable for any injury, loss, damage or expense arising out of or in connection with the use of this information.
Protector Plans Executive Liability has launched a primary product offering. The Protector Plans Executive Liability insurance program now offers D&O liability, employment practices liability, fiduciary liability, employed lawyers, crime and miscellaneous professional liability coverage for private and not-for-profit risks. Coverage is available for risks up to $750 million in revenue and assets or 2,500 employees with limits up to $5 million per coverage section.
Backed by an insurance carrier with an AM Best Rating of A XV, all coverage includes duty to defend, no hammer clause and non-rescindable coverage. Coverage enhancements designed specifically for professional firms and healthcare are also available.
Professional Plans Executive Liability supports dozens of industries, including oil and gas, healthcare, hospitality/restaurants, technology, software, consulting, engineering, biotech/pharma and more. When it comes to Miscellaneous Professional Liability, the program specializes in advertising services, event planning services, medical billers, printers, property management, travel agents and fulfillment firms.
Jeffrey S. Grange, president of Protector Plans’ Tampa Programs division, stated, “The addition of the primary product offering supports Protector Plans’ vision to be the leading preeminent full-service delegated underwriting platform for specialty lines in the MGA/MGU channel. We provideproprietary insurance products and solutionstailored to the risk management needs of ourcustomers as a talent-led organization committed to specialization.”
Working with the Protector Plans brands provides customers access to custom insurance solutions for commercial and retail products, extensive underwriting knowledge and fast quote turnaround. We work to simplify the insurance experience, build trust and reduce uncertainty. Protector Plans’ website will be updated regularly with news, blogs, business activity, new product offerings and events. For a full list of policy features and coverage appetite and to submit, email [email protected].
About Protector Plans Executive Liability/B&B Protector Plans
Protector Plans Executive Liability Program provides coverage for all your business insurance needs. The program offers D&O liability, Employment Practices Liability, Fiduciary Liability, Employed Lawyers, Crime and Miscellaneous Professional Liability coverage for private and not-for-profit risks with up to $750 million in revenue and assets or 2,500 employees. Limits are up to $5 million per coverage section.
Brown & Brown Protector Plans, Inc. (“Protector Plans”) is a national administrator of property and casualty insurance solutions whose reputation for innovation and customer service is based on a 40+ year history of meeting the complex insurance needs of professionals. Protector Plans’ fundamental distinction is grounded in insurance product innovation. Protector Plans is a wholly owned subsidiary of Brown & Brown, Inc.
About Brown & Brown, Inc.
Brown & Brown, Inc. (NYSE: BRO) is a leading insurance brokerage firm, delivering risk management solutions to individuals and businesses since 1939. With 15,000+ teammates in approximately 500 locations worldwide, we are committed to providing innovative strategies to help protect what our customers value most. For more information or to find an office near you, please visit bbinsurance.com.
While purchasing your Professional Liability and General Liability insurance from separate carriers is common, purchasing both from one carrier with a single claims team helps reduce gaps in coverage and enables a quick payout of claims.
By Sean Gleason, Cornelius Briscoe and David Simonson
As a dentist running a successful practice, you need multiple types of insurance to cover your risks and liabilities. This includes Professional Liability (PL) insurance — also known as medical malpractice insurance — to cover treatment related injury and medical negligence claims, and General Liability (GL) coverage to protect you if a bodily injury or third-party property damage claim occurs.
However, you may not be aware that many common claims can overlap across these two coverages, creating a potential nightmare when filing claims, dealing with multiple claims handlers simultaneously, uncovering coverage gaps, collecting payments from different carriers… and more!
Consider these three true claims scenarios and lessons learned:
1. A friend designs your website and uses copyrighted photos.
Many dentist practices hire professionals to create their websites. However, some turn to friends — with problematic results. In one case, the dentist’s friend unwittingly used a copyrighted image, which carried an $800 a day fine for each day it was on the website. Fortunately, the practice had coverage for copyright infringement under both its PL and GL policies.
Take-away: Advertising coverage may be offered under both policies, but with different wording or coverage options. Having PL and GL in one package enabled the claimant to work with one claims team and have all their options for coverage reviewed and handled appropriately.
2. A patient is injured by falling plastic.
A patient sued his dentist, claiming he had suffered a concussion and cuts to the skin that caused scarring when a piece of plastic lens from the dental light broke off and hit him in the head and face. The incident happened when the dental practitioner was moving the light into place. Was the equipment defective (a GL claim), or was the practitioner negligent (a PL claim)?
Take-away: There could be an overlap in coverages. If the practice has both coverages with one carrier, the claims team can manage the claim from both perspectives, investigating what the source of the falling plastic was; i.e., the equipment or the practitioner.
3. A sedated patient falls in the bathroom.
A sedated patient needed to use the restroom in the middle of treatment. The dental assistant helped him to the bathroom entrance. While inside, the patient fell, hit his head on the toilet and suffered a brain injury. The patient later sued, claiming he fell because he was over sedated, triggering a PL claim.
Take-away: The claims team was able to investigate the fall to determine if the accident qualified as a PL claim due to malpractice, or a GL claim because the fall was caused by something else. As a result, the team could ensure that the appropriate coverage kicked in.
Beware of potential gaps and exclusions
It’s important to know where there may be gaps in coverage between PL and GL policies. An in-house claims team familiar with both will have critical insight into:
Concurrent policy limits that could affect coverage. Dental GL is an occurrence-based policy where claims that occur during the policy period are paid regardless of when they’re filed, versus a claims-made policy that only considers claims filed during the policy period. This can get tricky if there is an incident that continues for years or there are multiple claims that cross policy periods where there were different limits.
Restrictions on the number of facilities PL will cover. A dentist might practice in multiple facilities — one they own and another they practice in — but their PL could restrict their coverage to only one facility. This leaves only Dental GL to cover the exposure if PL is insured on another policy.
Restrictions on intellectual property. A company’s most important asset is frequently its intellectual property, covered under advertising injury coverage in a GL policy. Some GL policies may restrict coverage for personal injury, libel, slander and defamation. For example, if one dentist disparages another and is sued.
Issues arising from treating non-dental problems. A dentist getting involved in diagnosing an issue such as sleep apnea that should have been referred to an associate could pose a coverage gap between PL and GL insurance.
Protect yourself and your practice
Every dentist has either experienced or worried about these or other troubling scenarios.
What will you do if faced with such a claim? Do you understand the coverages you have and where there may be overlaps or gaps? Are you confident you will get the support you need with the carriers you have?
If not, look for another way. Consider a carrier that offers both PL and GL coverage.
For more information about using one carrier for both your Professional Liability and General Liability coverage needs, contact PPP Risk Management.
This information is intended for informational purposes only. Nothing contained in this publication is, nor is intended to be, legal or dental advice. Professional Protector Plan for Dentists is not liable for any injury, loss, damage or expense arising out of or in connection with the use of this information.
Predictions for the 2023 hurricane season have recently been published. With the devastation from Hurricane Ian still fresh in our minds, it is recommended that couples protect their wedding investment with wedding insurance.
Hurricane season runs June 1st through November 30th, which means that weddings taking place almost half of the year are at risk. The National Oceanic and Atmospheric Administration (NOAA) is forecasting 12 to 17 named storms (winds of 39 mph or higher), of which 5 to 9 could become hurricanes (category 3, 4 or 5; with winds of 111 mph or higher).
So, what happens if a tropical storm or hurricane hits, causing your wedding venue to shut down, what if your parents can’t catch a flight to Florida to see you get married, or what if your bridal shop is damaged from a storm before your wedding date and your dress gets ruined?
There’s wedding insurance for that.
What Hurricane Scenarios Could be Covered?
Cancellation or postponement of the wedding may be covered if a hurricane were on its way to ruin your special day*. If your vendors or your venue didn’t refund your contracted deposits due to the cancellation, our policy can potentially help reimburse the lost money to you so you can begin planning another date. While in some cases it is very easy to determine that the hurricane will hit your city on your wedding date, you never know when a storm might make a last-minute path change that could impact your day. Purchase your policy well in advance of your event date to ensure appropriate coverage is in place.
* Exclusions apply if the policy is purchased within 14 days of the event date.
If you lived in Tampa Bay in 2022 during Category 4 Hurricane Ian, you’ll remember how suddenly the storm changed its course. Initially predicted as a direct hit for Tampa, instead the historic storm made landfall in southwest Florida before continuing its devastation across the state. Everyone scrambled to acquire last-minute supplies and many areas underwent mandatory evacuations. Weddings were suddenly canceled as people began driving to cities not in Ian’s path.
Special Event insurance coverage can potentially help if this happens to you or if roads are suddenly closed due to: the extreme weather; a state of emergency is declared, or if your venue can’t open due to the storm.
Coverage for cancellation or postponement may also apply If the couple or their immediate family is unable to make it to the wedding due to travel impediments caused by the hurricane, due to flight cancellations.
If the hurricane isn’t as severe as expected, and you’re able to hold your wedding, but find out that a vendor is closed due to the storm or can’t deliver the contracted services, (such as a bakery that can’t make your cake due to no power), coverage may be available for lost deposits if they chose not to refund you.
Our policies may also protect you from loss if the hurricane strikes well before your wedding date but causes you financial loss. An example of this would be the extreme damage Texas experienced after Hurricane Harvey. This storm damaged homes and businesses alike, and bridal dress shops and alteration stores were left with ruined dresses when the hurricane subsided.
What Mistakes Do Couples Make When it Comes to Getting Hurricane Coverage?
In 2017, many people were trying to buy a wedding insurance policy after they had found out that Hurricane Harvey, Irma, or Maria was heading their way. Couples scrambled to prepare last minutes in 2018 for Hurricane Michael, and unfortunately, many weddings were impacted in 2022 when Hurricane Ian made its arrival. To have extreme weather coverage, policies need to be issued at least 14 days in advance of the event date, at a very minimum, catastrophic weather event coverage will not apply once they are known events.
Even if your wedding is not during hurricane season, it is possible your venue can become severely damaged or may not have power for weeks due to the storm. This can lead to cancellations for months to come while the venue undergoes repairs. Hurricanes Maria and Irma caused so much devastation in islands popular for destination weddings that plenty of weddings were canceled during and after hurricane season while the islands rebuilt their infrastructure.
A wedding is an investment and the start of a life-long journey; don’t wait until the last-minute to protect your investment. Purchasing wedding insurance sooner rather than later gives you peace of mind from the start of your wedding planning until the day itself.
How Much Does Wedding Insurance Cost?
Through the Wedding Protector Plan, cancellation/postponement coverage typically begins at $160, which will cover a wedding that costs up to $7,500. As the national average for weddings is closer to the $25,000-$35,000 range, policies that will adequately cover that amount will be typically $249 for $25,000 in coverage or $300 for $35,000 for Florida residents*. If your budget is higher or lower than this, we have very affordable coverage for weddings of all budgets.
While many of our claims arise from money lost to vendors or the venue due to uncontrollable circumstances, we offer optional liability and liquor liability that can be added to the policy. Some venues nowadays are even beginning to require that you carry liability coverage on the day of the wedding in case a guest has an accident or damages something on the property. If you need this coverage, liability begins at only $165 for a $1,000,0000 General Aggregate, and you can add this coverage to your cancellation/postponement coverage policy through us.
*Subject to change
What Can Be Covered?
Our policies offer protection for the contracted payments you have made to your venue and contracted vendors, such as your DJ, caterer, florist, photographer, bridal shop, etc. If these vendors happen to go out of business, not show up to the wedding, or don’t deliver the services you’ve paid for and outlined in your contract, our policy can help pay you back the deposits you’ve lost to them and can even help you pay for a replacement vendor.
Unfortunately, vendor-related issues topped Travelers’ 2022 list of wedding mishaps at almost one-third (31%) of paid claims. An example is when a national bridal dress shop, closed numerous stores nationwide, leaving many dress orders unfulfilled. With the unstable economy affecting the financial stability of a variety of businesses, it’s smart to insure your deposits.
The cost of the wedding is also protected if you had to cancel or postpone the wedding due to catastrophic weather events, such as hurricanes, or venue unavailability, such as your venue double-booking or getting damaged during a hurricane and closing for repairs. Our policies can cover the rehearsal, rehearsal dinner, ceremony, reception, and post-wedding day brunch. * The costs for all these events should be factored into the level of coverage you are purchasing.
The optional liability and liquor liability coverage can protect the couple if a guest has an injury on-premises and sues the newlyweds, or if someone breaks something at the venue and the couple has to pay for those damages.*
*Subject to policy terms, conditions, and exclusions.
When Do I Need to Purchase It?
We recommend purchasing a policy as soon as you begin putting deposits down for your wedding. Unfortunately, we have heard many stories about venues that continued booking weddings even though they were in the process of foreclosing or had begun the process of selling the venue to new owners that may not honor previous event bookings.
We have also heard plenty of tales of couples who paid a vendor a deposit and then were never able to get back in contact with that business. Once you have already found out that you have experienced a financial loss, it is too late to have coverage for that circumstance if you have not purchased a policy.
Insurance is designed to protect against unforeseen and uncontrollable losses that occur after you have purchased a policy. We can issue policies up to two years in advance of the wedding date, and we always recommend purchasing the policy sooner rather than later.
If you are not sure whether you need liability coverage for your venue, but you’ve already put a deposit down, you can purchase the cancellation/postponement coverage so your deposits are protected for potential losses like a venue or vendor bankruptcy, and you can add liability and liquor liability coverage onto our policy up until a few days prior to the wedding.
Offered through Travelers, the Wedding Protector Plan provides wedding insurance coverage for the ceremony, reception, rehearsal, rehearsal dinner, and a post-wedding brunch without a deductible. There’s also the option to add liability coverage for the many other things that could go wrong. With last year’s devastation from hurricanes, wildfires, and other storms fresh in everyone’s mind, and with venues increasingly requiring insurance, find out how wedding insurance can protect your special day. Get a Quote or Purchase A Policy when the wedding planning begins.
The information in this post is general in nature. Any description of coverage is necessarily simplified. Whether a particular loss is covered depends on the specific facts and the provisions, exclusions, and limits of the actual policy. Nothing in this post alters the terms or conditions of any of our policies. Please read the policy for a complete description of coverage. Coverage options, limits, discounts, and deductibles are subject to individuals meeting our underwriting criteria and state availability.
As COVID-19 is a known infectious disease and presents circumstances that may reasonably give rise to cancellation and/or postponement of your event, coverage will not be afforded in any way for such circumstance.
Finding and keeping quality employees can be a challenge for dental practices in the post-pandemic world. Adjusting your approach to staffing and personnel management can yield positive results.
By Dr. Ty Galvin, D.D.S., and Dr. Mike Gile, D.D.S.
When someone utters the phrase about good help being hard to find, many dentists will agree.
The recent COVID-19 pandemic created staffing issues for dental practices as administrative personnel and hygienists may not have returned to work once pandemic restrictions were loosened or eliminated. This phenomenon has dentists looking at hiring and retention efforts in a whole new light.
According to a study by the American Dental Association Health Policy Institute, the labor crunch within the industry has caused an 11% reduction in dental practice capacity. Approximately 40% of all dental practices surveyed responded that they were either currently or recently recruiting dental assistants, while 36% were currently or recently recruiting hygienists. About one-third also revealed that appointment schedules are not full, due in part to inadequate staffing.
With the staffing landscape changing, dentists recognize that changes are needed to find and retain new employees, since new hires may view a current position as a steppingstone, moving on when the opportunity to earn more money arises.
Hire slowly, fire swiftly
Not only is employee turnover disruptive to your practice, but it’s also costly. Recruiting and hiring a new employee can cost up to $4,700 on average.[1]
Consider top-line dollars in the equation as well: Hygienists can generate as much as $150,000 annually in revenue for your practice. So, being short-staffed isn’t just a problem of a lack of bodies to help; it can also be an indicator of a weaker bottom line.
As a result, you want to build a staff that exhibits three principal qualities as a whole:
Stability. A busy practice needs employees who will perform tasks and duties consistently in the office. While work/life balance should be emphasized, issues like absenteeism and presenteeism must be addressed.
Competency. Employees need to excel in patient care and the technical aspects of their jobs. Job hopping may indicate that these skills are lacking.
Loyalty. New hires who readily adopt a patient-centric mentality will tend to be more engaged and focused on a long-term career. It’s essential to identify who among your staff may not be team players.
To minimize turnover and maximize long-term employees, take your time and consider adopting the following hiring practices:
Leverage multiple recruiting sites. About 25% of dental practices use recruiters.[2] Consider a standardized application and link it to job listings on Indeed, Zip Recruiter, Craigslist or publications that have wide local circulations.
Seek referrals from trusted sources. You may have employees, family or friends who know qualified candidates for employment. Offer a referral fee to help drive activity.
Create detailed job descriptions. Well-written job descriptions reflecting benefits packages may help attract top talent while dissuading unqualified prospects who take up time and resources.
Use a temp service. Temp agencies can help pre-screen applicants, so you have a good sense of whether the person is a fit. Fees for this service pale in comparison to lost revenue from understaffing.
Beware of hiring other dentists’ employees. Poaching employees from others could harm your reputation in the professional community.
Connect with local training facilities. You can find a steady stream of prospects through college or trade school programs conducted near your office.
If an employee is not working out, it’s best to terminate the relationship quickly. Here are some signs that an employee is not the right fit:
A general feeling. While running a practice and working alongside many types of people, you often instinctually know if a specific employee is not meeting your expectations. We need to give employees a chance, but if they aren’t a fit, don’t let them linger.
A lack of chemistry. You’re in an industry in which “people skills” resonate. Employees who clash with fellow employees and/or patients likely won’t work out in the long run.
Poor job performance. You have quality standards for services, procedures and outcomes. If performance falls short of those standards, it’s another indication that termination may be necessary.
Use probationary periods to set a time during which a new hire’s performance will be assessed. A 30-60-90-day probationary period can give you enough time to gauge whether an employee will work out, while allowing quick removal if they are not performing.
3 reasons hygienists and dental assistants leave your office
According to the ADA, there are three main reasons hygienists and dental assistants leave a job:
workplace culture
insufficient pay
being overworked
Awareness of these issues can help you implement measures to prevent quality employees from leaving.[3]
Since you spend so much time with your employees, it’s imperative to create an office culture that strives for an optimal level of work-life balance. Learning about your employees’ personal lives not only improves employee engagement, but results in greater production levels, reduced training costs and higher patient retention ratios in the process. In addition, verbally recognizing hard work and creating a comfortable office atmosphere helps increase employee satisfaction.
Hosting team-building events outside of the office such as dinners or sporting events also gives everyone a chance to socialize and bond. Make it a point to recognize employee birthdays and work anniversaries as well to increase employee engagement.
On the business side, actions like supporting a hygienist who may be running behind can help build loyalty. This might involve providing a sample to a patient or finding another staff member to help turn over a room. Employees are much less likely to seek employment elsewhere if they are part of a team. Wages and benefits packages also should be competitive with other practices in the area.
Finally, management style should reflect gentle accountability. Avoid micromanaging your employees. Instead, empower them to make decisions withing the practice and encourage them to make contributions that might fall outside their designated roles. Most important, stay calm and professional while deescalating office dramas and avoiding micromanagement.
This information is intended for informational purposes only. Nothing contained in this publication is, nor is intended to be, legal or dental advice. Professional Protector Plan for Dentists is not liable for any injury, loss, damage or expense arising out of or in connection with the use of this information.
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