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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. We pay attention
to details. And we work with you to control claim costs. At
all times, we'll work to protect your professional reputation
and the assets of your practice. 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 will 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 the insurance company
claim staff and legal counsel, we recommend you follow the steps
outlined on the following pages should you have a professional liability,
property, or general liability claim. You may not be able to follow
each step in every claim situation, but this reporting approach
will help us give you prompt efficient claims service, provide you
with timely legal defense, if it is needed, and achieve the maximum
benefit for your insurance dollar.
The Role of the Dentist
What the dentist should do in the event of a professional
liability claim:
- Immediately report any incident likely to result in a claim
or lawsuit to your PPP agent. A company professional liability
claim specialist will be assigned to discuss the facts with you.
- Once a claim or incident has been reported, consult your insurance
company claim specialist before you agree to attend any conferences
arranged for the specific purpose of discussing the claim.
- Do not sign or accept releases from any parties without first
obtaining approval from your insurance company claim specialist.
- If requested by the insurance company or the defense counsel,
document in writing the circumstances surrounding the claim. This
should be done as soon as possible, because time can cloud your
memory and obscure details. This narrative will become an important
part of your defense, so be prepared to spend the necessary time
to prepare a complete and concise report. Please keep this information
compiled in a separate file, apart from the patient treatment
chart.
- 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.
- Be sure dental records are maintained. Do not make any alterations,
deletions, or additions.
- Accept all letters, memoranda, suit papers, etc., without comments
or arguments. Do not admit liability and do not attempt to place
blame.
- 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:
- 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 when appropriate.
- The company claim specialist will contact you promptly to begin
the investigation. The specialist then will coordinate and manage
the defense for your claim.
- 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.
- As the investigation proceeds, the company claim office will
direct, monitor, and assess the course of the investigation.
- The company claim specialist or legal counsel will keep you
advised of the status of your case, as necessary. If you have
any questions, do not hesitate to contact them.
- At the appropriate time, the company will evaluate your potential
liability and determine the courses of action available. The company
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.*
* Subject to state regulations
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 agent.
They will advise you of any action you may need to take. Please 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 make every effort to contact you
within 24 hours of reporting your loss. Do not 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, however, arrange
for repair of damaged property without first consulting your
claim specialist.
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