Frequently Asked Questions
If I call to report a problem or seek advice, does TDIC automatically file a claim?
If I fill out the online claim form to report a claim, do I have to do anything else?
Can I use my own attorney to help defend my claim?
When, if ever, should I supply a copy of the patient's records related to a claim?
Will I have any input as to whether or not to settle my claim?
If I am sued and end up paying a patient, is that an admission of liability?
If I experience a claim, will my premium increase?
Can TDIC suddenly drop my coverage, without prior notification or discussion?
I received a survey about my recent claims experience. How will this information be used?
As an employer, what is my responsibility in reporting injuries?
I suspect an employee is not actually hurt and is faking an injury. What do I do?
Are there Workers’ Compensation posting requirements or forms for my workplace?
Can my employees designate a physician instead of going to one in your Medical Provider Network?
How long after a workplace injury occurs does the employer have to respond?
How do I check on the status of an open Workers’ Compensation claim?
If I call to report a problem or seek advice, does TDIC automatically file a claim?
A call to TDIC does not constitute the reporting of a claim. Some professional liability carriers automatically file a claim any time an insured contacts them with a concern or issue. TDIC takes a different approach. Whenever you have a question or concern about potential claims stemming from patient or employee situations, contact TDIC's Risk Management Advice Line. You will receive the necessary education, support and preventative counsel to avoid or minimize a potential claims situation.
Should the situation warrant reporting a claim, the analyst will work closely with you and the claims department to ensure a smooth transition.
If I fill out the online claim form to report a claim, do I have to do anything else?
TDIC prefers to take a personal, hands-on approach when it comes to the claims process. Reporting the claim is just the first step. This can done using our online form or by telephone or fax. Next, we will assign you a claims representative. This person will be your contact throughout the claims process and will help guide you through every step, until your case is closed.
Can I use my own attorney to help defend my claim?
The attorneys used by TDIC are well-versed in dental issues and malpractice law. When a case requires representation, we will provide you with a knowledgeable and informed attorney that complements the team approach in defending your claim.
When, if ever, should I supply a copy of the patient's records related to a claim?
For details on when and to whom to release patient records, visit What to Expect if You Are Sued.
Will I have any input as to whether or not to settle my claim?
TDIC's claims department remains committed to representing policyholders through the claims process, not just in resolving claims quickly. Many other liability carriers have what is known as a hammer clause, which means the company retains and exercises the right to force the policyholder to settle a claim. The TDIC professional liability policy does not have a hammer clause, but rather includes an unconditional consent-to-settlement provision, which makes you the policyholder a partner in deciding the case development and outcome.
Our team of trained experts provides guidance and support through every step of the process. If you experience a claim while with TDIC, you and your claims representative will discuss all alternatives, evaluate the impact of settling the case versus going to trial, and then make a mutual decision at the appropriate time about how to proceed. TDIC will not settle a professional liability claim without your consent.
If I am sued and end up paying a patient, is that an admission of liability?
Paying a patient because of a lawsuit or claim is not necessarily an admission of liability. There can be many reasons why an offer of settlement is considered.
Some policyholders weigh the option of pursuing the case through litigation versus the time and expense of being away from their practice. In some instances, the settlement demand is within a range that is considered acceptable to the policyholder and TDIC, given all of the variables in a particular case. Standard release language also contains wording that states that the settlement is not an admission of liability.
Regardless of the reasons that you may consider a settlement, professional liability matters are never settled without your written consent.
If I experience a claim, will my premium increase?
Your individual claim activity has no bearing on your premium. Premium rates are determined each year, based on your entire state's activity, not your personal experience.
Can TDIC suddenly drop my coverage, without prior notification or discussion?
TDIC rarely nonrenews policyholders. When it does happen, it is usually due to extreme circumstances—extraordinary claims activity, evidence of misconduct or actions that affect licensure—and the policyholder is an active participant in the process long before any final action is taken.
Each year, a subcommittee of the TDIC Board of Directors reviews policyholders being considered for possible nonrenewal. Policyholders who are denied renewal at that time may then appeal. Appeals are presented to TDIC's Underwriting Committee, comprised of practicing dentists, for a final decision.
I received a survey about my recent claims experience. How will this information be used?
At the conclusion of each case, the policyholder receives a claims service evaluation, encouraging a candid evaluation of how the claims staff and defense counsel handled the claim. The feedback collected helps TDIC evaluate and provide enhancements to its claims process.
We take great pride that in 2006 an outstanding 99 percent of survey respondents rated their service for both professional liability and property claims as excellent.
As an employer, what is my responsibility in reporting injuries?
California employers are required to report all work-related injuries. Failure to do so is a violation of the law and can result in substantial penalties. Report all employee workplace injuries to 877.890.8123 for triage and, if necessary, further medical referral. If the employee requires medical assistance, the triage nurse will partially complete the 5020 form for the employer.
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I suspect an employee is not actually hurt and is faking an injury. What do I do?
Follow the protocol described in the answer to question #1. Once the employee is assessed and a recommendation made, the triage nurse will notify a representative who will contact you. You may advise him or her of your suspicion at that time.
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Are there Workers’ Compensation posting requirements or forms for my workplace?
Yes. All required forms and postings are contained within this claims kit.
Required forms:
• DWC 1 — Injured employee completes.
• 5020 — Once the triage nurse determines the employee requires medical attention, he or she will partially complete the 5020, then forward it to the employer, who finishes filling it out. The employer is responsible for submitting the completed form via thedentists.com.
• “Time of Hire” pamphlet — Provide to each new hire and injured employees.
Required posting:
• DWC 7
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Can my employees designate a physician instead of going to one in your Medical Provider Network?
Yes, employees may predesignate a physician if:
• the employer currently offers group health coverage and the employee is an established patient of the physician he or she chooses within the plan,
• the physician is predesignated prior to an injury occurring,
• the physician agrees to the Workers’ Compensation fee schedule.
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How long after a workplace injury occurs does the employer have to respond?
The labor code mandates that the employer provide access to medical treatment within 24 hours of the injury. By reporting workplace injuries to the toll-free dedicated triage line, the employer will ensure that the triage nurse assesses and refers the employee for appropriate medical treatment.
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How do I check on the status of an open Workers’ Compensation claim?
Information for all claims made on or after April 1, 2011, is available at thedentists.com. Select your state, then click the Workers’ Compensation link. If you have an existing claim prior to April 1, 2011, contact your previous carrier.