eNews Fall 2018

Be Aware of Notification Requirements of Malpractice Incidents and Demands
When you receive a demand from a patient for a refund or monetary damages due to dissatisfaction, have an incident in your office such as a patient swallowing a wire or appliance, or an accident such as an etchant burn on a patient’s face, you should immediately notify your professional liability carrier. 
 

AAOIC will not penalize you for reporting incidents or demands. It will not raise your premiums. Prompt reporting is encouraged because early intervention with claims experts and legal advice often resolves the dispute without a lawsuit.  Immediate notification does not affect your right to refuse to consent to any settlement.  Every company has a time requirement in their policies for notification and failure to notify within that time frame will void your policy.
 

AAOIC will pay up to $10,000 immediately for medical emergencies that occur in an insured’s office--such as etchant burns, eye injuries, swallowing wires and brackets. Doctors can send the patient immediately to emergency rooms, hospitals, or physicians and be reimbursed for those expenses. 
 

Do not try to settle demands or incidents by yourself without help.  AAOIC currently has an etchant burn claim that an insured did not send to any medical provider until after the burn failed to heal.  Nor did the insured notify AAOIC until a year after the accident and the patient hired an attorney. The claim has now escalated into a legal dispute with a large demand. These burn cases can settle for hundreds of thousands of dollars.
 

AAOIC claim managers are on your side and are ready to help you with any potential claims or actual demands.  Do not hesitate to take advantage of this service. Call AAOIC or your professional liability carrier (if not insured by AAOIC) immediately and save yourself some stress.
 

Avoid Unrealistic Patient Expectations with Communication
Addressing problem areas with patients is never fun, but it’s critical orthodontists tackle these conversations as soon as possible. Early discussions can help keep patients from unrealistic expectations and prevent allegations, thereby mitigating the risk of a negative claim.
 

Many conditions that occur during treatment can be prevented with good hygiene and routine dental care. Nevertheless, when a patient experiences root resorption, bone loss, periodontal issues, unplanned treatment outcomes, or a need for orthognathic surgery, orthodontists must advise the patient—and parents when needed—as soon as the issue is discovered. If the conversation is avoided, the situation could grow worse, which may lead to a claim being filed.
 

● Develop a friendly, professional alliance. The orthodontist-patient relationship should invite questions and discussion with shared goals for treatment. An initial conversation outlining the treatment plan, as well as doctor and patient responsibilities, helps assure more realistic outcomes. It can also make a difficult conversation easier since potential problems are more likely to be discussed earlier in treatment. You also may be able to recommend a solution before an issue becomes serious.

● Encourage discussion by asking permission. Remember: your expertise is needed, but many people “shut down” when told what to do. By asking permission to discuss the issue, you are inviting the patient to become a part of the solution and take responsibility for the outcome.

● Use your expertise to offer possible solutions. It’s important to reassure the patient while being firm about ways to handle the problem. Discuss possibilities and determine the next steps together. By trying to understand your patient and encouraging involvement, you are more likely to enlist cooperation for future treatment.

● Document everything and consider terminating treatment when necessary. Some patients will not cooperate with treatment, which can result in serious damage to their teeth. That’s why it’s important that policies and procedures be set to address these situations before they arise. Having proper protocols and giving appropriate notice also mitigates the risk of allegations that could affect your career or reputation if a termination or negative outcome occurs.
 

These tips may also be helpful when handling patient issues. Remember to discuss expectations at the onset whenever possible and encourage open conversations. Whether the difficult discussion is with a patient, parent, or employee, it’s critical to document everything. Learn more about how AAOIC can help!
 

References
Ahmad Abdelkarim, Laurance Jerrold. "Risk management strategies in orthodontics. Part 1: Clinical considerations." American Journal of Orthodontics & Dentofacial Orthopedics 148.2 (2015): 345-349. Web. June 2018. <https://www.ajodo.org/article/S0889-5406(15)00611-3/fulltext>.
—. "Risk management strategies in orthodontics. Part 2: Administrative considerations." American Journal of Orthodontics & Dentofacial Orthopedics 148.3 (2015): 511-514. Web. June 2018. <https://www.ajodo.org/article/S0889-5406(15)00610-1/fulltext>.
Carol A. Jahn, RDH, MS. 5 tips for engaging orthodontic patients and getting better compliance. 13 May 2014. Web. 20 June 2018. <https://www.dentistryiq.com/articles/2014/05/5-tips-for-engaging-orthodontic-patients-and-getting-better-compliance.html>.
Taylor, Emily. Tips for Discussing Orthodontic Treatment with Patients. 7 September 2017. Web. June 2018. <https://www.oralhealthgroup.com/features/tips-discussing-orthodontic-treatment-patients/>.

Document Patient Communication
An orthodontist was asked what he learned from a recent malpractice claim.  He replied, “Document conversations with the family/patient.”  He had chosen to provide limited treatment to a young patient (upper arch only) because he believed the patient would have developed an underbite as he grew.  He discussed his treatment plan with the family; but he did not document his conversation or that of with the family. The parents eventually became dissatisfied with the treatment plan and progress. They took their child to another orthodontist and demanded a fee refund and more.  Orthodontist A could not support his statement that he had discussed his treatment plan with the family. He did not document well enough what he had discussed with the parents. In litigated claims, the law assumes, “What is not in writing did not happen.”
 

As you are treating your patients, document your records well, including any important conversations with anyone involved in the treatment.  You never know when you will need to defend yourself.
 

The More You Know…
Did you know that AAOIC Professional Liability Insurance is the most popular orthodontic malpractice insurance in the United States and that many AAO members consider it to be the greatest single benefit of membership?   Did you know that over 50 percent of all eligible active AAO members are already insured through AAOIC?
 

A few additional facts about AAOIC:
• If you have a claim, that claim is reviewed by a committee of experienced AAO member orthodontists, not just an insurance claims processor.
• There is no settlement of any claim without your consent.
• The company is strong financially and is backed by Reinsurers with A.M. Best ratings of A, A+ and A++; therefore, AAOIC will be there when needed and for the long haul.
• AAOIC is the only professional liability insurance company endorsed by your association, the AAO.

Know the facts. Don’t be fooled by slick advertising and misrepresentations by other professional liability insurance carriers!
 

Our Quarterly Alert
● Potential Periodontal Issues
Patients receiving orthodontic treatment with periodontal issues may lead to malpractice claims. Therefore, we would like to remind you that it is highly recommended the periodontal health of every orthodontic patient be carefully evaluated before any orthodontic treatment is begun. If periodontal health deficiencies are discovered or suspected, it is recommended that a periodontal consultation be obtained before orthodontic treatment is initiated.
 

● Know Who’s Minding the Store!
Did you know that whether you renew your coverage electronically or by paper application there is a fraud/misrepresentation warning?  This means that we take seriously each response to every underwriting question that we ask you. If you delegate this important responsibility to someone else, be sure to check the responses before signing off.  You are responsible for the answers!
   

● Do You Have a Part-Time Practice?
A part-time policy is simply a limit on the number of hours that you actively practice in a given week, which from AAOIC’s perspective could decrease your risk exposure.  Due to this possible decrease in risk, AAOIC provides a 40 percent annual discount if you consistently practice 20 hours or less per week in a combination of all office locations, which also means that your office is closed the remainder of the week and staff is not engaged in any patient care.  If your office(s) is/are open 20 hours or fewer per week and you have not notified AAOIC, you may qualify for the part-time discount.  Call us!  We will let you know if you qualify.
 

● Help Us Save Some Trees
When it is time to renew your professional liability policy, you will receive an email notice from our office.  Renew your coverage online.  Save paper, postage and time.  Log onto https://www.aaoic.com and click the tab “Renew Online.”
 

You may be required to enter your AAO member credentials.   Next, respond to the seven brief questions, pay with a major credit card and you are done.  It’s just that simple!  Your policy documents will be mailed to you the same day.   If you need immediate proof of coverage following renewal, email us at www.underwriting@aaortho.org.
 

ALSO:  If you move or change your email address, please let us know. If we can’t find you, we can’t notify you regarding important coverage information. In addition, if your practice status changes (such as becoming incorporated or you go to work for someone), it is critical you inform AAOIC.
 

Steps to Follow in the Event of a Patient Complaint or Claim
If you receive a patient complaint or claim, consider the following recommendations.

1. Call your insurance representative. If you have a conversation with a patient or a family member who has expressed dissatisfaction with the treatment, give your insurance representative a call to discuss what happened and what to do.
2. Have your information on hand. You will need to provide key information from the patient's record. Access to the file or computer record during the telephone call will save time.
3. Anticipate a return call. Make sure you leave telephone and fax numbers so that your insurance representative can contact you. If you are insured with the AAO Insurance Company (a Risk Retention Group) (AAOIC) and have encountered an incident or claim, contact AAOIC Claims Representative Jessica Kaesberg, or AAOIC Claims Manager Elizabeth Franklin at 401 N. Lindbergh Blvd., St. Louis, MO 63141-7816. The AAOIC hot-line number is 800-240-2650. You can also report an incident or claim through the AAOIC website (aaoic.com). The AAOIC welcomes the opportunity to work with you.