Dental FAQs

Answers to common questions about insurance, claims and risk management.

Have a question that we haven’t answered here? Don’t hesitate to get in touch.

Malpractice Coverage

  • Malpractice insurance protects your practice, employees, assets and reputation in the event of allegations of professional negligence. It also pays for your defense.

  • Yes. Professional entity coverage is coverage provided to your corporation or professional entity. With Professional Solutions, you have the option of sharing the limits of your personal policy with your entity or purchasing separate limits for an additional premium.

  • The Professional Solutions policy provides coverage for malpractice claims alleging injury due to the performance of professional services which are within the scope of practice of a dentist in the state(s) in which you are licensed, trained and qualified to perform your practice of dentistry and not otherwise excluded. Some procedures, such as Botox, are not automatically covered as we require specific information before we will add that coverage which includes an additional fee.

  • Policy limits always have a per-claim limit and a policy aggregate limit. The first number in the policy limits is the per claim limit (the most we will pay for one claim) and the second number is the policy aggregate (the most we will pay in one policy year). We offer policy limits ranging from $100,000/$300,000 to $2,000,000/$4,000,000. Check with one of our appointed agents or call us to receive clarification as to what is available in your state.

  • The Consent-to-Settle clause directs the actions of the carrier in the event settlement is considered. Our consent-to-settle clause is unconditional and gives the choice to consent or not consent to the named insured.

  • The primary difference between an occurrence and a claims-made policy is how the policy responds in the event of a claim or suit.

    • Occurrence policies:
      • Provide coverage against claims for alleged incidents that occur while the policy is or was in force.
      • Offer a steady base premium that does not increase as the policy matures.
    • Claims-Made policies:
      • Provide coverage against claims for alleged incidents that both occur and are reported during the policy period.
      • Offer a lower premium during the early years of the policy, which steps up each year until reaching maturity in year five. While this saves some money in your early years of practice, potential coverage gaps can occur.
      • If you cancel your claims-made policy, you may need to purchase tail coverage to ensure a gap in coverage doesn't occur, the price of which is not known until it is purchased.

  • Also known as Extended Reporting Coverage, tail coverage is an optional endorsement that allows you to report claims for alleged injuries that occurred while the policy was in force after your claims-made policy has ended.

  • Yes, Professional Solutions offers two options. You can purchase “nose” coverage to change from claims-made to occurrence coverage. An additional premium is required and is due at the time of change. The second option is to tail out your current claims-made coverage which gives you 30–60 days to pay the additional premium. The costs associated with each option are pretty close, so you can choose the option that best fits your budget. You can change your occurrence coverage to claims-made at any time, at no additional cost, at your renewal.

  • Each dentist/dental specialist must have his or her own policy and limits. However, if a dentist owns a corporation and wants to have a group policy that includes individual limits for each dentist who works under that corporation, a group policy can be written. Each dentist must complete an application and he or she will be underwritten and rated on his or her own merits.

  • Employees are covered provided the employee acts within the scope and course of their employment in performing professional services — unless any other valid and collectible insurance applies.

  • Vicarious liability is the liability which is attributable to you for the actions of others. For example, you are responsible for the actions of your employees and independent contractors who work in your office or under your corporation name.

  • With a completed application, coverage can typically be secured within one week. However, during busy times, such as summer, underwriters will consider the effective dates and give priority to those needing immediate coverage.

  • Yes, we offer premium discounts which recognize your practice history. They are subject to underwriting review and approval during the application process.

  • Professional Solutions writes coverage in most states within the United States, so if you relocate, you may be able to take your current policy with you with little to no interruption.

  • You can log in to your online account or your agent will be happy to assist you in getting the exact information you need. You can also send a request directly to our credentialing department by email to: dentalsubmissions@psicinsurance.com or fax to 800-600-8170.

  • Log in to your online portal to make changes. You may also contact your agent.

Claims

  • A claim is a demand to be compensated for an alleged injury. The most obvious example is when you are being sued. You may encounter a situation with a patient who is unhappy with an outcome. This is not a claim until there is a demand for compensation or formal proceedings based on alleged dental negligence are initiated. We do encourage you to call our Dental Claims Department at 1-800-640-6504 and discuss the situation.

  • If you have been contacted in regard to a lawsuit, or you suspect that you may be contacted in the near future, it is important to contact us immediately so we can proceed in your defense. Call our Dental Claims Department at 1-800-640-6504, to discuss your situation with a professional claim representative.

    DO NOT attempt to contact the patient or the patient's attorney to discuss the lawsuit or any other paperwork you may receive. Avoid the temptation to talk with your friends and colleagues about the lawsuit. It is important that your insurance provider is the first person with whom you discuss the details of the case. You should also gather and secure the patient's records immediately.

  • As a busy healthcare professional, it is likely you may be subpoenaed at some time during your career to provide patient records or give a deposition concerning your care of a patient. If you are faced with a situation or concern that you're not sure how to handle, give the PSIC Dental Claims Team a call.

    DO NOT attempt to contact the patient or the patient’s attorney to discuss the subpoena or any other paperwork you may receive.

  • PSIC pays government proceedings defense costs up to $25,000 per policy period. In addition to state disciplinary proceedings, this coverage also includes Quality Improvement Organization Sanction Proceedings.

  • A licensing board investigation is any investigation by your state licensing board. If the board contacts you, and it is not a part of your standard license renewal, then it is an investigation.

  • You should report it to PSIC immediately. Even if you aren't sure whether the situation is an actual claim or licensing board investigation, call the PSIC Dental Claims Department at 1-800-640-6504. Our professional claim representatives will help you determine the best course of action. You will not jeopardize your coverage by asking if you have a claim or investigation. We may help you use your coverage to its fullest advantage or point you to resources of which you may not be aware.

    The licensing board is there to protect the consumer - not the dentist. You need the experience of an attorney familiar with licensing board investigations. Even seemingly innocuous questions can be fraught with pitfalls for a dentist unfamiliar with licensing board investigations.

  • Call the PSIC Dental Claims Department at 1-800-640-6504. Talk to one of our professional claim representatives and let him/her help you determine the best course of action. You will not jeopardize your coverage by asking if you have a claim or investigation. We may help you use your coverage to its fullest advantage or point you to resources you may not have been aware you had.

  • Timing is crucial. When you receive a claim or are under investigation by your licensing board, you often have a limited time to respond — normally between 14 and 30 days. The sooner you report the situation to us, the sooner our defense team can determine the proper course of action. Your attorney needs ample time to help you craft the best defense. Any delay in reporting could impair your defense by limiting the available time for response.

  • Absolutely! Some insurance companies say they will not settle a case without your consent; however, if you don’t provide your consent, their policy may allow for arbitration to determine if you are withholding consent unreasonably. An arbiter’s finding that consent is being unreasonably withheld could authorize the company to settle the claim without your approval. At PSIC, no case is ever settled without your written consent to settle – giving you full voice in settlement issues since it’s your reputation and good name on the line.

  • A deposition is testimony given under oath before a court reporter. Depositions are important in the preparation of a case for trial. Depositions freeze testimony and can be used to impeach your credibility if you later deviate from prior statements. They are used to discover facts of the case and to uncover additional witnesses. Depositions are also used to narrow the issues of the case. Failing to appear for a deposition subjects you to the potential to be held in contempt of court. Always consider exercising your right to legal counsel before providing deposition testimony.

Risk Management

  • When it comes to records retention, unfortunately, there is not an easy “one size fits all” answer to this question. The answer depends on the circumstances surrounding the patient and the practice location.  

    Common questions/scenarios to consider:

    • If the patient is or was a minor, the records should be retained until the minor patient reaches the age of majority, then a specified time period after that date.  
      • What is the age of majority in your state? How long must records be kept after reaching the age of majority? Check with your state regulations. Generally use the statute of limitations.
    • If the patient is or was incompetent at the time of treatment, what are the rules in this situation?  
      • Some states require the records to be retained until after the death of the patient. Does your state define this situation; however, if patient was receiving Medicare/Medicaid those rules will apply as well as majority age
    • If the patient is now deceased, how long should the records be retained after the date of death?  Generally use the same Medicare/Medicaid rules of 6 years
    • If the patient was covered by Medicare or Medicaid how long must the records must be kept?  
      • What is the particular rule in your state?  Generally, it is for at least six years after reimbursement
    • If there is a dispute involving services, does this affect the retention period?  
      • Generally, the records should be kept until the dispute is resolved then the specific length of time based on state code.

    The best resource for the length of retention in each situation is your association or legal counsel to get their input on state statutory code and statute of limitations. 

  • Retention and access to medical records is usually assumed by the new corporate entity/practice.  The written purchase agreement should clearly state a record retention policy that has been agreed upon by both parties.

  • Maintain original paper records for at least 30 days after they are scanned. During this time, randomly review the scanned charts to make sure they all scanned appropriately. Here are some best practices to consider when scanning charts:

    • Visual inspection of each scanned document image ensuring the entire document has been scanned, the image is clear and usable, and is of good quality overall.
    • Comparison between scanned records and the original paper documents confirming accuracy.
    • Validation of the number of original paper documents is compared to the number of scanned records to make certain every document was scanned. Check for two-sided pages and that any blank pages are noted as “Intentionally left blank.”
    • If a good, clear scan is not obtainable, the record should be noted as such being the “best possible scan.” 
    • Quality controls in the manner of a periodic audit by the IT department or practice manager is done when scanning projects are underway to check for critical errors such as documents that are incomplete, illegible, missing pages or missing patient identifiers; or documents being scanned to the wrong chart.

  • Sharing office space is not uncommon but is one situation in which you should definitely seek the counsel of a business attorney. A well-defined and specific contract is of the utmost importance. Common areas to consider:

    • Specifically define the shared office relationship
    • Investigate the dentist who might be coming in for potential issues that might spill over to your reputation
      • What is their background?
      • Check the dental board for licensing issues 
      • Check for Insurance audits
      • Do an internet search to see what the public is saying about them
    • Spend time with the individual so you can discover any issues so there are no surprises where you could potentially have to report them for illegal or unethical practices
    • If you are sharing any services, such as supplies, staff or equipment, these should be clearly spelled out in the agreement
    • Be sure that signage, business cards and forms such as letterhead and phone messages are created (and used) to prevent any type of ostensible agency appearance.  Ostensible agency comes into place when a relationship exists between two parties that lead the public to believe that the one represents (or is the agent of) the other.  For example think of hospital radiologists, many times they are only contracted to the hospital and not really employees of the hospital.
    • Detail in the agreement how emergencies will be handled and ownership of records
    • Have the patients sign an acknowledgement that the two practices are separate practices and each dentist is responsible for their own treatment
    • Make sure the contract has an indemnity agreement so that each dentist is responsible for their own actions
    • Confirm that the dentist has malpractice coverage and property liability coverage.  Require proof – don’t just take their word for it

  • Yes, if the patient has requested an interpreter, whether it is due to a disability or English as a second language, it is necessary you cover the cost for that service. You cannot refer them to another provider based on this request or request they bring a friend or family member to interpret. Review the Americans with Disabilities Act (ADA): What Dental Professionals and Staff Need to Know.

  • This really depends on your patient panel and location. If EMT coverage/hospital access is far away, you may need different equipment than an urban practice located near a hospital.  And your patient panel will determine the size/type of equipment.

    Three guidelines to consider regarding this purchase:

    •  Don’t “over buy” a kit where you have no idea how to use the medication/equipment included (this goes for being up to date on how to use it)
    • Keep your kit in a prominent, easy-to-access location that everyone in the office knows about
    • Assign someone to be responsible for periodically checking all kit items to make sure nothing has expired and that all equipment is operational.

  • Yes. Although you may only be seeing them for specific treatment you are initiating a “doctor-patient” relationship.  As such, you owe a duty of beneficence to the patient, meaning a duty to promote the patient’s welfare. The ADA describes this as: “The competent and timely delivery of dental care within the bounds of clinical circumstances presented by the patient, with due consideration being given to the needs, desires and values of the patient.”

    If you recognize findings that you reasonably believe may be adverse to the patient’s dental health and may or may not require immediate attention but, if not acted upon, may worsen over time and possibly result in an adverse patient outcome, you should advise the patient and document your records accordingly.

    You may also consider documenting the fact the patient is presenting only for specific treatment therefore a complete and thorough exam may not be completed.  Another consideration is including language in the informed consent form that the treatment is limited to the specific treatment. However, again, if you notice something during the treatment, it would be best to address the issue with the patient and/or refer the patient accordingly.

  • Document your recommendations and the patient’s noncompliance. Advise the patient of the potential consequences. Try to determine why the patient is not wanting to have any studies (X-rays, etc.) completed so you can target the conversation to those areas. Confirm that patient’s noncompliance, your discussion and potential consequences in a letter to the patient sent both regular and certified mail with a return receipt. Consider withdrawing from the patient’s care if you are not in the middle of treatment.

  • Yes, our cyber endorsement includes payment for alleged ransom attacks. The basic cyber endorsement has a limit of $50,000. (Cyber endorsement not available in New York.)

  • Most importantly, all actions of collection for past due amounts should cease immediately upon notice of the bankruptcy. If you are using an outside source for collections, be sure they are aware of the bankruptcy and take the appropriate action. An attempt to collect the unpaid fees is a violation of a court order and can cost you plenty in attorney fees, court costs and punitive damages.

    Generally, a provider can discharge a patient when the doctor/patient relationship has become broken.  However, keep in mind that refusing to give the patient any more appointments based on non-clinical reasons (e.g. past due accounts) could be considered constructive abandonment and should be avoided. Regardless of whether the debt is discharged in bankruptcy, the provider should not be obligated to treat someone for free.  Consult a bankruptcy lawyer to confirm if that rationale is correct in your jurisdiction.  And, depending on the type of bankruptcy, some debts may still be paid, again, your attorney can advise you further on your options such as filing a claim with the court.

    The healthcare provider should keep in mind that standards of care still need to be adhered to, even if a bankruptcy is involved. Once a healthcare provider has undertaken a course of treatment, the healthcare provider should not discontinue that treatment without giving the patient adequate notice and the opportunity to obtain the services of another provider. Care should be taken that the patient’s health is not jeopardized in the process. 

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