In the world of professional liability, dental claims often are given little attention by companies, since they pale in value compared with physician and hospital claims. While the average paid dental claim ranges from $30,000 to $50,000, medical claims are approximately 10 times this size (James Hurley, consulting actuary, Tillinghast, a Business of Towers Perrin, oral communication, July 2006). However, that does not mean that becoming involved in a professional liability action is any less traumatic or costly for a dentist than it is for a physician.
First, it is instructive to look at a breakdown of claims by dental practice. The following numbers (from James Hurley, consulting actuary, Tillinghast, a Business of Towers Perrin, oral communication, July 2006) are approximate since they do not represent industry-wide data:
- – prosthodontics, approximately 28 percent of all dental claims;
- – endodontics, 17 percent;
- – restorative dentistry, 16 percent;
- – diagnosis, 9 percent;
- – oral surgery, 9 percent;
- – periodontics, 7 percent;
- – implants, 5 percent;
- – orthodontics, 4 percent;
- – miscellaneous claims, 5 percent.
These percentages, for the most part, probably reflect the amount of time spent in each of these specialties in a normal dental practice. Logically, one might anticipate that approximately one-half of dental claims would emanate from restorative and prosthetic procedures. What is curious is the fact that endodontic procedures account for 17 percent of the total, almost double the percentage of claims in the other specialty practice areas. It is unknown whether this also reflects the amount of time spent, or if dentists are more likely to attempt certain types of complicated endodontic treatment rather than use referrals.
What does this mean, and how will it affect you if you experience a claim? Regardless of the origin of a claim, receiving notice of it usually is a traumatic event for any practitioner. Sometimes a claim may be anticipated, but more often it is not. Either way, your first action should be contacting your malpractice insurance company. A representative should be able to explain the claim process and give you professional support.
If a claim goes all the way to a full trial, it can mean as much as several weeks out of your dental practice. This includes time spent in consultation with the insurance company, in preparation with your designated defense counsel, in deposition and, of course, in the actual trial itself. The amount of time varies depending on the severity of the claim. Thus, one would expect a claim for a faulty restoration to normally be much less time-consuming than a claim for failure to diagnose oral cancer.
Given the psychological trauma and the large cost of time away from your practice that a claim involves, what can you do to avoid or mitigate a claim? One of the most important actions can be to discuss with your insurance company any untoward "dental incidents" that occur in your office as soon as possible after they occur. While this should not represent any negative report against your record, it often is helpful in resolving disputes between the dentist and the patient before they become claims. Advice from a professional third party also acts to calm the practitioners’ emotions, thus avoiding a further breakdown in communication in the doctor-patient relationship. These incidents can range from a billing dispute to dissatisfaction with services rendered to an alleged failure to diagnose dental disease. Remember that no matter how small an incident seems, a resulting claim can mean extensive time away from your practice. Early intervention is important, since usually the longer a dispute exists, the more polarized the parties can become. Make sure that your insurance company is able and willing to provide this type of service.
Other factors affecting the initiation and subsequent defense of a claim are extensive and accurate record keeping, the use of informed consent, the maintenance of effective two-way communication, the development of an accurate and detailed diagnosis and treatment plan, and the recognition of a practitioner’s limitations (knowledge of when to refer a patient to a specialist). By aligning himself or herself with a professional and caring liability company that understands the nature of dental claims, a dentist is less likely to feel that he or she is standing alone when a claim occurs. The dentist should become an integral part of the claim process, not only in providing oral and written records and testimony but also in taking a realistic and cooperative approach to the ultimate resolution of the claim. That is to say, if expert opinions clearly point out that the standard of care has not been met, it often is less traumatic and less costly to settle a claim at that point. On the other hand, if the expert opinions support the treatment rendered, the practitioner and his or her malpractice company should defend these claims vigorously to preserve the dentist’s professional reputation, as well as to prevent his or her being reported to the National Practitioner Data Bank or other government agencies.
One of the most important actions can be to discuss with your insurance company any untoward ‘dental incidents’ that occur in your office as soon as possible after they occur.
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CONCLUSION
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While a claim may be inevitable in the course of one’s practice, how it is dealt with can result in a world of difference. Handling dental office "incidents" and claims properly can result in much less stress for the practitioner, as well as accomplishing the best result.
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CONCLUSION
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