What To Do If You Have A Claim
Our experienced claim specialists know dentistry. With our experience, we provide you with knowledgeable advice and personal service. We consult with you to resolve the claim as quickly as possible to save you time and paperwork. That's our promise to you.
Reporting an Incident or Claim
Under the terms of your policy, a circumstance or incident, which has occurred and may later develop into a claim, MUST be reported promptly to the insurance company. In some cases, the company claim specialist and/or company-appointed legal counsel may recommend that you take corrective actions to help prevent the incident from developing into an actual claim.
Based on the expertise and experience of the insurance company claim staff and legal counsel, we recommend you follow the steps outlined below, should you have a professional liability, property, or general liability claim.
The Role of the Dentist
What the dentist should do in the event of a professional liability claim:
1. Immediately report any incident likely to result in a claim or lawsuit to your PPP State Administrator. A professional liability claim specialist will be assigned to discuss the facts with you.
2. Once a claim or incident has been reported, consult your insurance company claim specialist to discuss how the matter will be handled. Do not assume or admit any liability, incur any expense or sign or accept releases from anyone without first obtaining approval from the claim specialist.
3. If requested by the insurance company or the defense counsel, document in writing the circumstances surrounding the claim.
4. Assemble in chronological order all pertinent dental records, consent forms, x-rays, lab reports, correspondence, memoranda, etc., related to treatment offered and given to the patient in question.
5. Be sure patient records are maintained. Do not make any alterations, deletions, or additions.
6. Accept all letters, memoranda, suit papers, and other materials related to the claim, without comments. Do not admit liability and do not attempt to place blame.
7. Be prepared to spend time to aid in the investigation, defense or settlement of the claim.
What Information to Report
- The name and address of your practice
- Your insurance policy number
- Date, time, and location of the incident
- Brief narrative description of the incident and your treatment (Do not address the merits of your opinion of the claim)
- Name and address of the person making the claim
- Amount of demand, if known
- Any lawsuit papers or legal proceedings
- Any other pertinent documents or correspondence to aid the investigation
The Role of the Company
What the insurance company will do in the event of a professional liability claim:
1. As soon as your PPP agent is notified of a claim or incident, the insurance company will evaluate the facts, and a claim file will be established.
2. The company claim specialist will contact you promptly to begin the investigation and will coordinate and manage the defense for your claim.
3. If a suit is filed, an attorney experienced in the defense of dental professionals will be engaged by the company in order to protect your interests.
4. As the investigation proceeds, the company claim office will direct, monitor and assess the course of the investigation.
5. The company claim specialist or legal counsel will keep you apprised of the status of your case. If you have any questions, do not hesitate to contact them.
6. The company will evaluate your potential liability and determine the courses of action available It will then make recommendations to you as to the defense or settlement of your claim. At no time will we enter into a settlement without your written consent.
We cannot emphasize enough how important it is to report your claim promptly and accurately. The sooner the insurance company has all the information, the easier it will be to handle your claim.
Property or General Liability Claims
If you insure your property and casualty risks through the Professional Protector Plan and experience a claim, you should follow the same basic procedures outlined above for professional liability claims. Report a property or casualty loss immediately to your PPP State Administrator and be prepared to provide the following details:
- Name and address of your practice
- Date and time of your loss
- Type of loss
- Proof of loss (receipts, ledgers, records, etc.)
- Other pertinent information as requested
A claim specialist will contact you within 24 to 48 hours of reporting your loss. Do not assume or admit any liability, incur any expense or sign or accept releases from anyone without first obtaining approval from the claim specialist.
In addition, take any necessary action to prevent further loss or damage to your property. Do not arrange for repair of damaged property without first consulting your claim specialist.
For property losses of $5,000 or less, the Professional Protector Plan offers "Fast Track" claims service. As the name implies, Fast Track claims service processes the claims quickly and efficiently.