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The difference between occurrence-based and claims-made indemnity

Choosing the wrong indemnity cover can potentially leave a practitioner seriously out of pocket.

Len D'Cruz
Len D'Cruz Head of BDA Indemnity

The General Dental Council (GDC) guidance on indemnity is set out within Standard 1.8: 'You must have appropriate arrangements in place for patients to seek compensation if they suffer harm'. While it does not define 'appropriate', from the GDC's viewpoint the need for indemnity is in relation to compensation claims, rather than assistance with GDC matters. It is always worth checking, however, if the indemnity product will also assist if you are the subject of a GDC investigation.

Reading the small print about an indemnity product may be tedious but there are three crucial points to keep in mind when considering your cover.

Contractual insurance policy or discretionary cover

Insurance-based indemnity operates on the same basis as other forms of insurance. The policy wording defines what is covered by this legally enforceable agreement, if you are declined cover, you can seek arbitration from the Financial Ombudsman Service. That same legal protection does not exist with discretionary cover.

A discretionary organisation, being unregulated, can exercise its absolute discretion not to assist you, even if you are in the right subscription category, have paid the correct fees and the matter is within the scope of cover – and there is no independent source of adjudication. Whilst it rarely happens, a discretionary organisation's refusal to assist an individual member can be argued to be justified based on it being a mutual fund and incurring the costs of the case would not be in the interests of other members.

On the opposite side of the certainty of contractual insurance may appear to be its lack of discretion in dealing flexibly with any claims at the fringes or beyond the scope of the policy, that a discretionary approach might encompass. But the reality is that nobody knows for sure whether contractual insurance policies have given the insured dentist the benefit of doubt in individual cases and if so, how often.

Occurrence-based or claims-made cover

With occurrence-based cover, if you are paying the right subscription rate at the time of the incident that later gave rise to a claim, you will be covered in perpetuity, subject to the caveats above. This means that if you were negligent but retired the next day and stopped your payments, even if the complaint and legal claim is made against you three years later, you will be covered (subject to the same caveats).

Claims-made is different. In the case above, if you do something negligent and then retire the next day, you will need to have 'run-off' arrangements in place to cover any claims that are made after you stop paying the policy premiums. These run-off arrangements are sometimes built into the policy, but in other cases require additional payments to be made, either as a single lump sum or as continuing annual payments. It is vital to understand your potential 'run-off' needs and any terms, conditions and costs that will apply. This should be checked with the insurer, and you need to be careful to check the small print.

It is common for complaints and allegations of negligence to arise a long time after treatments have been provided. Only around a quarter of the potential adverse incidents in a year will give rise to a claim against the dentist within the first 12 months of the treatment being provided. With a claims-made policy you might need to continue paying a premium to the company long after you stopped working to ensure coverage. There is no legal obligation for a company to offer 'run-off' cover once you leave the company. consider this before deciding to take up a claims-made policy.

The support of a dentally qualified team

Relationships really do matter. Working with an indemnity provider who understands how you practice, the stresses and challenges you face, the complexity of the clinical care you provide and the environment in which it is delivered, is the first step to having an empathetic and supportive relationship. A listening ear and sound advice from a dental colleague, drawn from years of dento-legal experience, can give you the peace of mind you need when it matters most.

It is very easy to get a quote for indemnity cover. Visit our website and fill in the application to receive an indicative quote via email. You will get a response in a matter of minutes. No offer of indemnity or final quotation is given until after an application form has been completed and accepted.