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Summer 2019 eNews

An AAOIC Claims FAQ:  Should I Give a Patient a Refund?
Among frequently asked questions of the AAOC Claims Department is:  “A patient is requesting a fee refund.  Should I agree?”


When orthodontic treatment is not going so well and the patient requests a fee refund, what should you do? If you acquiesce, what are the consequences?  Are you admitting liability? Will word get to other patients and everyone will request fee refunds?

Except for an occasional aberration, most fee refund situations can be considered business decisions. If the patient is non-compliant and treatment is not progressing, if the patient is dissatisfied, if he/she is causing stress for you and the staff, your preferred goal is likely to be that he/she change orthodontists or stop treatment.  Will the fee refund encourage the change?  Will it provide the patient enough money so the change will not result in financial hardship?

If the patient is less agitated, perhaps he/she will complain less about your work; the new orthodontist may then be less inclined to criticize your work.  Another benefit of fee refunds—if they are provided by the doctor - is that they are not reportable to the National Practitioners Data Bank.  A simple fee refund has the power to accomplish goals and minimize negative consequences.

In most situations we believe that a fee refund can prevent malpractice claims and regulatory complaints. We always recommend, though, that each case be considered on its own merits. Occasionally there are people who consider a refund to be an admission of liability. If you have a patient requesting a fee refund, call us at AAOIC claims to discuss your situation. We can share what we have learned and help you navigate this process.

Does Consumerism Increase the Risk of Being Sued for Malpractice?


  • What do consumers really want?
    • Ease
    • Convenience
    • Simplicity
    • Value
  • Aligners when they really need fixed appliances
    • Sounds easy
  • Direct to consumer “treatment”
    • It’s easy, convenient, seems simple, and seems like a great value
  • Remote treatment monitoring
    • Sounds easy, convenient, simple and patients do not have to go to the orthodontists for regular visits
    • Time is valuable!
  • Since we know the most prevalent causes of suits are:
    • Periodontal Issues
    • Ectopic/Impacted Teeth
    • Pathology
    • Generalized root resorption whether associated or not with ectopic/unerupted teeth.
  • Can those be properly monitored remotely?
    • In orthodontics “shift” happens
    • And, it can happen very quickly!

Think about it and always remember your professional ethics!


Advise Patients About Their Role in Maintenance

Avoid litigation by advising patients that wearing a retainer is key to maintaining alignment.

When orthodontic patients have their treatment completed, they are excited with the results, but they need to understand those results won’t remain without maintenance. You can help patients by assuring that they understand the importance of wearing their retainers and caring for them properly.

The Primary Way to Avoid Litigation 

It’s important to help patients understand that braces are only the first step to transforming and improving oral health. Maintaining their smile by wearing a retainer and having regular checkups is just as critical to achieving long-term orthodontic success. Remind them that “retainers are prescribed for two reasons: First, to allow the bone that holds teeth to rebuild after teeth have moved, and second, to maintain the healthy new positions of teeth after active treatment ends.”

Click here to access patient education recommendations from the AAOIC for maintenance/retention.

While it is important that patients understand the need to wear their retainers to keep their teeth aligned, it is equally important for orthodontists to limit their long-term liability.

If you continue to see patients in retention, you are still potentially liable for that patient.

AAOIC recommends setting a specific retention period that is included in your orthodontic fee and then formally dismissing your patients, returning them to their general dentist’s supervision (which includes third molar observation if still present).

With fixed lingual retainers, give patients a choice whether to keep them or have them replaced with removable retainers. Inform patients they can be worn until they become loose. Tell them, when they do become loose (and they ultimately will), they can be removed by their general dentist or they can return to you for that additional service. Be sure to provide appropriate instructions on maintaining their orthodontic result for their lifetime. 

It is also important that the options for fixed retainers and dismissal instructions are clearly noted in the treatment record. That way, the statute of limitations can begin to run, which may help in the defense of a case if there is a problem with a patient in the future.

Educating patients about all of their orthodontic treatment is the primary way to avoid litigation. Help them understand the importance of oral health while they are wearing braces and maintaining their smile by wearing a retainer. You may even want to have patients sign a document to acknowledge your discussion about the retainer. If they understand their role in successful treatment, they are less likely to be unhappy with the results or file a claim. Of course, if you ever face a professional liability case, the AAOIC is here to help. Learn more about the malpractice insurance selected by most orthodontists.

Just as helping your patients to have reasonable expectations for long-term results is worth doing right, so is helping protect your family and orthodontic practice from the unexpected. The AAO-Endorsed Insurance Program offers a variety of solutions to help provide the coverage needed for you, your family, and your practice:

  • Group Disability Income1
  • Group 10- or 20-Year Level Term Life1
  • Group Term Life1
  • Group Professional Overhead Expense1
  • Long-Term Care
  • Business Owner’s Package
  • Employment Practices Liability
  • Cyber Liability


1Underwritten by New York Life Insurance Company (NY, NY 10010) on policy form GMR.

Learn more at



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 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 billions of dollars, so 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.


Coverage Reminders
Did you know that each employed or associate orthodontist in your practice must have his/her own professional liability policy? Your AAOIC professional liability policy provides coverage for the acts or omissions of your employees when acting within the scope and course of their orthodontic responsibilities on your behalf.  However, this coverage does not extend to dentists.  Make sure that the other dental specialists employed by your practice have their own professional liability coverage. 


Wow!  For Two Years

Stay on top of risky issues and save 10 percent in premium for two policy years. If you have already attended an AAOIC approved risk management program, you already qualify. If you returned your attendance certificate following the program, the premium credit will be reflected on the policy ‘following’ your program participation and again when you renew your coverage the next year. 


If you did not attend an AAOIC approved risk management program, you may purchase an electronic version of the current available program.  The program is available on DVD for a cost of $50.00 for active AAO members or on flash drive for $55.00. 

To order the program, visit the AAO member website at and click the ‘Store’ tab at the top of the page.  You will need to complete the accompanying exam and return it to our office.  The discount will appear as a premium credit the next time that you renew your coverage and the year thereafter. CE Credit is also available.


We Have Made Renewing Your Coverage a Lot Easier

You may renew your AAOIC policy 60 days prior to expiration or pay an outstanding invoice at your convenience, quickly and online.  Access the AAOIC web portal via the AAO member website or directly by logging onto  Click the ‘Renew Online’ tab to renew or the ‘make a payment’ tab to pay an outstanding premium balance using any major credit card.  


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 Adjuster Jessica Barbachen, 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 ( The AAOIC welcomes the opportunity to work with you.