FAQs for ADA Dentist Renewals 2024




What drives Guild’s approach to premium calculations?

 

Guild Insurance has partnered with the Australian Dental Association (ADA) state branches in New South Wales, Victoria, South Australia and Tasmania for over 24 years to deliver exclusive pricing and other benefits to ADA members.

In 2007, 1 in 50 dentists were facing the stress of a claim, by 2012 this had increased to 1 in 20. This year, 1 in 10 dentists are likely to have a claim made against them. This increase in claims frequency has a significant impact upon the total costs of claims and ultimately the insurance premium you are charged.

In 2017, we developed a new approach to pricing after listening to feedback from dental professionals and tested this feedback against our claims data. We heard you loud and clear, dentists should be rewarded when they don’t make a claim, and we agree. This prompted us to introduce an insurance product that reflects each practitioner’s individual circumstances.

In 2018 after successfully winning the ADA tender with ADA New South Wales (ADA NSW), ADA Victoria (ADAVB), ADA South Australia (ADA SA), and ADA Tasmania (ADATAS), Guild was reappointed as the preferred professional indemnity insurer to the ADA branches.

Informational statements regarding insurance premiums, discounts, no claims bonuses or otherwise are for general description purposes only. These statements do not amend, modify or supplement any underwriting guidelines in force. Contact us for details regarding terms, conditions, coverage, exclusions, products, services and programs which may be available to you. Your eligibility for particular products, services and discounts or no claims bonuses is subject to the final determination of underwriting qualifications and acceptance by us.




No claim bonus:

Which claims types contribute to my total claims experience?

The claim types that we use in calculating the no claims bonus are:

Health fund audits are not included in your total claims experience.

How many claims can I have before there is an impact on my no claims bonus?

Having 2 or more professional indemnity claims and/or having any finalised statutory board inquiries in the last 5 years will affect your no claims bonus. Having a very large cost claim can also have a bearing on your premium.

How long will my claims affect me for?

Your no claims bonus is calculated based on the number of claims made in the preceding 5-year period.

I have only made a notification, why have you considered this as a claim?

A notification is not considered to be a claim.

A claim arises only when costs are incurred resulting from a third-party demand or legal support is provided for a statutory board inquiry or investigation.

Some notifications, due to their complexity, the nature of the patient’s demands, or resistance to resolution, have a heightened risk of escalating into a claim against you. In these cases, a Community Relations Officer (CRO)/Peer Advisor, may seek your approval to take the matter further on your behalf. This may include requesting legal assistance to attempt to avoid an escalation occurring. In such situations, this legal advice will incur a cost against your policy.

If you believe that a notification has unfairly impacted your eligibility for the no claims bonus, please call Guild Insurance on 1800 810 213 and request an independent review of your individual circumstances.

I’ve only spoken with my state representative and did not receive any assistance from Guild, why are you including this as a claim?

The partnership between the ADA NSW, ADAVB, ADA SA, ADATAS, and Guild Insurance means that CROs and Peer Advisors are able to act on behalf of Guild. This includes acting as an agent of Guild to assist in the management of your matter. As such, although you may only be directly interacting with a CRO or Peer Advisor, they, after seeking your approval to take the matter further, may seek legal advice.

I disagree with my claims experience, what can I do?

If you have any concerns about your eligibility for the no claims bonus, please call Guild Insurance on 1800 810 213 and request an independent review of your individual circumstances.

I didn't want or need legal advice, why are there legal costs?

When a matter is notified due to its complexity, the nature of the patient’s demands, or resistance to resolution, a CRO or Peer Advisor, after seeking your approval to take the matter further, may request legal assistance to prevent a complaint resulting in a claim. This legal advice incurs a cost that can trigger a claim.






Clinical experience:

I am a graduate and only have a few years clinical experience, will I pay more?

As a recent graduate, premiums include a significant price reduction to help you establish your career. You will continue to receive a reduced premium until your 5th year of practice, giving you access to up to 9 years of free or reduced premiums.

As an ADA member, you will always be rewarded with an exclusive member premium. This is in part a reflection of your access to the extensive CPD program available to members, including the free CPD material available on RiskHQ. Not only will you continue to benefit from this member premium for as long as you remain a member, but by making the most of the CPD and risk material available to you, you will be able to increase your understanding of the risks you face, and work to minimise and avoid them. In turn you can maintain the benefit of your no claims bonus while building your clinical experience.

I’m not a graduate but I don’t have 15 years of experience, am I paying more?

Experience is only one part of the calculations that make up your individual premium. As you are starting to build your professional experience, you will be keen to stay up to date with your profession. As such, ADA NSW, ADAVB, ADA SA and ADATAS members have always been rewarded with an exclusive member premium. This is in part due to recognising your commitment to your profession, and the extensive CPD program available to members, including the free CPD material available on RiskHQ. Maintaining your ADA membership will continue to qualify you for this additional exclusive member benefit. By making the most of the CPD and risk material available to you, you will be able to increase your understanding of the risks you face, and work to minimise and avoid them. In turn you can maintain the benefit of your no claims bonus while building towards your clinical experience.

I’ve been practising for over 40 years, are you penalising me for my experience?

Experience is only one part of the calculations that make up your individual premium. The ADA NSW, ADAVB, ADA SA and ADATAS Guild professional indemnity insurance policies are on a ‘claims made’ basis, providing cover for professionals in relation to claims made against them and reported to your ADA state branch or Guild during the period of cover. These claims can arise long after the professional service which gives rise to the claim was conducted.

Our claims data has shown there is an increased incidence of claims for those who have been practising for this length of time. These claims do not necessarily come from clinical errors.  An example of a claims trend that is unique to practitioners in this group is when it comes to practitioners who are retiring or selling their practice. There is an increasing incidence of the incoming practitioner discussing their predecessor’s treatment plans and highlighting procedures that they believe require further work, sometimes encouraging the patient to lodge a claim or complaint or do so themselves under mandatory notification procedures.

My Australian Health Practitioner Regulation Agency (Ahpra) registration year is incorrect, what do I do?

In calculating your years of clinical experience, we relied upon Ahpra’s registration data. In a small number of cases, the Ahpra data may have been incorrect or missing.

If you need to update your year of registration, you can call Guild on 1800 810 213, email gilbsc@guildinsurance.com.au or visit  PolicyHub. We also recommend that you correct this information with Ahpra as this is publicly available information. You can call Ahpra on 1300 419 495.







Defined Procedures:

 

What do you consider to be orthodontics for the purposes of defined procedures?

We define orthodontics as any procedures defined by The Australian Schedule of Dental Services as orthodontics (items 811-881), costing $1,500 or above per treatment plan, no matter the number of procedures completed. If as a General Dental Practitioner, you intend to perform these procedures in the next 12 months, you should select "yes" to undertaking this defined procedure.

What do you consider to be endosseous implants for the purposes of defined procedures?

We define endosseous implants as the surgical insertion of an implant made of biocompatible material in the bone of the maxilla or mandible, not including restorative work. If as a General Dental Practitioner, you intend to perform this procedure in the next 12 months, you should select "yes" to undertaking this defined procedure.

How much does defined procedures cost?

If you nominate cover for defined procedures, we will include this as a factor in the calculations of your total premium. There is no fixed dollar amount that is charged in addition to your standard premium.

Why do you charge for defined procedures?

Our claims analysis has identified that endosseous implant insertion and General Dental Practitioner orthodontic treatments lead to significantly more claims than other treatment types. Not necessarily because the treatment is poorly performed, but the nature of the treatment is such that complications can arise and become costly to rectify. Our claims data shows that claims for these defined procedures have increased in both frequency and severity in recent years, which is reflected in the premium calculation for practitioners who undertake them.






Practitioners with business entities and/or employees:

What cover is available if I operate a business entity?

When you tell us that you operate a business entity, with or without employees, our policy protects your dental practice in the event proceedings are brought against your dental practice rather than against you personally as a dental practitioner.

Why do I need this cover?

A claim could be made against the dental practice (entity) for various situations including:

When do I need to cover my business entity?

Our policy automatically provides cover for proprietor dentists who have told us, and we have named on the Schedule, that they operate a business entity. This cover will protect their business from liabilities arising against the dental practice as a result of the proprietor’s own actions, or from liability arising from the actions of the employees or other principals of the dental practice and vicarious liability from contractors, consultants and/or agents.

It’s important to note that the intent is to ensure we provide cover to the individual dental practitioner who is listed on the Schedule and to extend the protection to their own dental practice. All registered practitioners engaged by the practitioner should have their own professional indemnity insurance.

How do you charge to cover my business?

The premium is charged in addition to your individual premium if your business entity has more than one registered practitioner engaged in your business other than yourself. We provide premium relief to proprietors that are part owners in the business.

Another part-owner's policy includes coverage for the business; do I still need coverage? Do I need to pay a premium? 

We recommend that you include coverage on your policy for your own protection, so you will know that there is coverage in place. We provide premium relief to proprietors who are part-owners in the business.

What if I only work part-time, how will the cover impact my premium?

When you have covered your business entity, work part-time and employ any registered practitioners, a minimum premium will apply. This is on the basis your practice is open even when you're not working.