Reading the small print…

Magnifying glass examining small printToday’s GDC registrants’ newsletter highlighted the findings of a recent case which included consideration of the adequacy of the registrant’s indemnity provision. The policy contained some exclusions relating to the transmission of blood-borne diseases. It was that exclusion that led the panel to conclude that the policy did not fulfil Standard 1.8 within the GDC Standards for the Dental Team:

‘You must have appropriate arrangements in place for patients to seek compensation if they suffer harm’

The added explanation goes on to say,

Our priority is that patients who suffer damage should be able to recover any money they might be entitled to through compensation, in the event of a successful claim.

By including an exclusion of the type described the policy would fall away if those particular circumstances occurred. This would mean that the registrant was, in fact, not indemnified at all for this type of occurrence. In turn that would mean that a patient damaged in this way would not be guaranteed of access to financial redress and so the underlying principle of standard 1.8 would be defeated.

The GDC is therefore encouraging registrants to ‘read the small print’ within their policies and decide whether they are appropriately covered. In doing so, it would be wise for practitioners to look carefully at wider areas of exclusion or the conditions of cover and question the true impact of the conditions and exclusions.

For example if a policy places an obligation to keep full and complete clinical records, what would the impact be of not doing so? On some occasions, practitioners can be scant note-takers.  This is not to be recommended and is risky from a point of view of patient care, defence of litigation and, potentially, ethical sanction. But if the same omission also allows the insurer to walk away when adversity strikes, this would in essence mean that again the practitioner is not indemnified for anything he or she does beyond the maintenance of the clinical record. So clinical acts and omissions would be immediately open to the question of being unindemnified and thereby exposing patients to risk.

What about a stipulation that you must sterilise your instruments in line with manufacturers’ instructions and identified best practice? Perfectly reasonable expectations and just what everyone should do. But the fact that not doing so voids your indemnity provision again leaves patients vulnerable exactly at the time of need. So, once again, how would such an exclusion render the cover not fitting in the GDC’s eyes?

It may be that a policy may exclude cover for items manufactured or supplied to a patient in line with the supply of goods and services legislation. What effect would such a provision have in respect of crowns, bridges, dentures, implants and in-surgery milled restorations? Would these normal dental procedures be excluded from cover and if so would the dentist be left effectively uninsured for their provision.

Whilst these examples are not exhaustive, they do represent examples of terms and conditions and exclusions that appear in the small print of some insurance policies being promoted to dentists. There are other clauses that may raise similar questions.  Like many other members of society, dentists may be prone to accepting a contract that appears to offer comprehensive insurance at face value. If it says that it offers you full protection against clinical malpractice claims it may be tempting to accept that proposition at face value.  The small print is off-putting and dull and may not invite close scrutiny. But as has been shown here, at the very least it should prompt some questions of the potential signatory. The warning from the GDC to read the small print underlines this need, and the fact that each case will be judged on its merits means that those procuring indemnity provision can no longer rely on those offering it to be sure that it fits the bill.

The dental profession needs a debate about this subject, and all those providing cover need to be involved in it. At a time when indemnity fees are rising, many may be searching for cheaper options. But finding a cheaper option with holes in it is not a real option at all when your professional registration is at risk if it goes wrong.

So – this is a call to action to all dentists. Review your indemnity arrangements. Look through the small print and see what the conditions and restrictions say. If there are clauses like these described here or with similar consequences ask your insurer what they mean and what the expectations are upon you. It’s also a call to the providers of cover. Tell us what your exclusions are, when they would apply and what the consequence would be to those on cover.

Peter Ward, Chief Executive, British Dental Association

Remember: Dental Care Professionals must ensure they have paid their Annual Retention Fee and made their indemnity declaration by the end of this month. Failure to do so could result in their removal from the GDC’s register leaving them unable to work until it is restored, which is a lengthier process than renewal. Find out more…

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