Dental Protection has seen cases where dentists change indemnity providers without fully understanding how claims-made insurance policies can leave them unexpectedly exposed. The following case study highlights how reliance on insurance-based cover, without adequate retroactive reporting benefits (RRBs) created a significant risk for the dentist.
Case Study
Dr D, a general dental practitioner with a particular interest in implant dentistry, treated patient A over a number of years and in November 2018, Dr D placed a dental implant to replace a missing tooth.
At the time the implant treatment was carried out, Dr D held indemnity with Dental Protection.
Dr D continued to see Patient A intermittently over the next few years. The appointments included reviews and management of concerns relating to the implant. In March 2021, Dr D changed indemnity provider, moving from Dental Protection to an insurance-based, claims-made policy with a different provider.
Several years after the original implant placement, Patient A raised concerns and subsequently issued court proceedings alleging negligent implant treatment. The allegations related not only to the original implant placement and restoration, but also a failure to adequately review, monitor, and address ongoing issues in later appointments.
When notified of the claim, the insurance company declined to provide cover, for the following reasons, that:
- the implant placement and restoration occurred in 2018 before the start date of Dr D’s insurance policy in 2021
- any later alleged failings were intrinsically linked to the original implant treatment and did not constitute separate, insurable events during their policy period.
- the insurance-based policy did not provide adequate retroactive reporting benefits
Dental Protection instructed solicitors to assist Dr D in relation to the allegations arising from treatment provided between 2018 and 2021. However, because the allegations of negligence covered the period of Dr D’s membership with Dental Protection and Dr D’s time with the insurance company, Dr D was advised that he would be required to make a personal financial contribution for the period that the insurer refused to cover, should the claim be successful.
Dental Protection robustly defended the claim on behalf of Dr D and the claim was struck out on procedural grounds.
Summary
This case highlights how dentists can find themselves unexpectedly exposed when moving between indemnity arrangements, without ensuring comprehensive RRB’s.
Although the outcome was favourable in this instance, the dentist experienced significant stress and financial uncertainty, as a result of the insurer’s refusal to provide cover. Had the claim progressed further, the absence of effective RRBs could have resulted in substantial uninsured liability for Dr D.
Retroactive reporting benefits are designed to protect clinicians against claims arising from treatment provided before the start of an insurance or indemnity policy but reported during its term.
Without adequate RRBs, dentists may find that neither their former nor current provider accepts responsibility for a claim, leaving them personally exposed.
Key Learning Points
- Dentists should be aware that switching providers can leave gaps in protection.
- Retroactive reporting benefits are essential to prevent exposure to historical claims.
- Before changing indemnity arrangements, dentists should seek clear advice and carefully read any new policy to ensure they are not left vulnerable to historical claims.