Good Concepts to Follow When Referring to Specialists – Avoiding Personal Liability and Vicarious Liability

Good Concepts to Follow When Referring to Specialists – Avoiding Personal Liability and Vicarious Liability

Having a process for when and how to refer patients for complicated cases can help protect your dental practice from potential litigation. Here are some tips for building out a trusted network of specialists and avoiding vicarious liability risks.

By Dr. Ty Galvin, D.D.S., and Dr. Mike Gile, D.D.S.

There is a fine line between when to refer to a specialist for a complicated procedure and when to perform the work yourself. Knowing your strengths and limitations — and those of your network of specialists — can help ensure that you make the best decision for your patients and your practice.

Consider the case of the dentist who worked on a patient’s implants for a bone density issue. The dentist used the wrong size implants, they didn’t integrate properly, and they were not solid in the bone. After the dentist spent more than a year trying to get them fixed and adjusted, the patient still had to have them removed and redone by another provider, which led to an $80,000 claim against the first dentist.

While the dentist in the above case should have referred the patient to a specialist familiar with bone density issues, referring a patient to a specialist’s office for a procedure or condition can also bring risks for the referring dentist. The greatest of those risks is a vicarious liability claim against the general dentist if something goes wrong with the specialist’s treatment. For this reason and more, it is important to select your specialists carefully.

The true costs of a vicarious liability lawsuit — or any other for that matter — lie in the often long and invasive litigation process. It can involve getting publicly served with the lawsuit at work and having documents from discovery available online that detail income, past lawsuit history, and other uncomfortable details. Not only is this embarrassing, dentists could lose work and face increased insurance rates and the potential for non-renewal in the future.

3 Steps for referring to specialists

Patients often trust their dentists’ recommendations when a referral is needed. Having a trusted team of specialists and a process for referrals can set you, your patient and the specialist up for success. Here are three steps to achieve just that:

  1. Know when to do the work and when to refer it out. Working with specialists allows a general dentist to focus on their own practice so they can perform procedures that best match their preferences and skill sets. If a procedure is not within your level of knowledge, technical skill, your office’s equipment, or lab and staff support, it is best to refer your patient. If you are unsure of what to do, evaluate whether or not the procedure has an inherent high risk of complications. Some scenarios you may want to consider referring out to a specialist include:
  • Third molar extractions
  • Implant fixture placements
  • “All-On-Four” prosthetic restorations
  • Intravenous sedation

A specialist’s office would more likely be set up for success and management of problems, should they occur.

  1. Develop a relationship with your specialists. Check their credentials, look at State Board disciplinary actions, listen to feedback from your own patients and meet the provider(s) before recommending that your patient visits him or her. Determine if they meet the following criteria, through referrals from your peers, past patient experiences and more:
  • High quality of work
  • Respectful to patients
  • Good bedside manner
  • Office works well and communicates effectively with your office

Maintain independence so you can ethically choose the best fit specialist as needed. Avoid having specialists buy you lunch or gifts that could have an air of impropriety. Know that kickbacks are illegal, whether they are box seats at a baseball game or a split fee.

  1. Communicate with the specialist and relay the information to patients. Take time to speak with the specialists who your patients will ultimately use. Have a conversation with the specialist to discuss the patient’s case, get their opinion and discuss the approach to care before referring them or doing the job yourself. This simple step can help prevent issues and resolve any potential problems more quickly.

Remember to convey that information to your patient so they know what to expect. Take time to explain why they are being referred, detail the procedure to be completed, and what they should expect. Educating patients will help them be better prepared for their visit and help avoid miscommunication.

Considering adding a service to your practice?

Many dental practices now are providing additional services such as Botox. Before offering a new service know what is required beyond initial training and certification. Determine how many annual continuing education requirements need to be met. In addition, put protocols in place to keep yourself and staff up to date on industry trends. Even though it is a new service for you, you are still held to the same standard of care for that procedure as other providers who are experts. Consider additional training to have more experience before offering new services to patients.

Review your liability insurance coverage with your agent to ensure it includes the additional services you want to provide. Adding new services or an additional office location to your policy may cost an additional fee.

Whether deciding to refer out to a specialist or to perform the work yourself, or considering adding a new service, keep in mind that the highest standard of care for your patients should guide you to the best approach.

For more information on protecting your practice, contact The Professional Protector Plan® for Dentists @ 800-922-5694, or through the website: protectorplan.com.

This information is intended for informational purposes only. Nothing contained in this publication is, nor is intended to be, legal or dental advice. Professional Protector Plan for Dentists is not liable for any injury, loss, damage or expense arising out of or in connection with the use of this information.


Protector Plans Executive Liability launches primary product offering

Protector Plans Executive Liability launches primary product offering

Protector Plans Executive Liability has launched a primary product offering. The Protector Plans Executive Liability insurance program now offers D&O liability, employment practices liability, fiduciary liability, employed lawyers, crime and miscellaneous professional liability coverage for private and not-for-profit risks. Coverage is available for risks up to $750 million in revenue and assets or 2,500 employees with limits up to $5 million per coverage section.

Backed by an insurance carrier with an AM Best Rating of A XV, all coverage includes duty to defend, no hammer clause and non-rescindable coverage. Coverage enhancements designed specifically for professional firms and healthcare are also available. 

Professional Plans Executive Liability supports dozens of industries, including oil and gas, healthcare, hospitality/restaurants, technology, software, consulting, engineering, biotech/pharma and more. When it comes to Miscellaneous Professional Liability, the program specializes in advertising services, event planning services, medical billers, printers, property management, travel agents and fulfillment firms. 

Jeffrey S. Grange, president of Protector Plans’ Tampa Programs division, stated, “The addition of the primary product offering supports Protector Plans’ vision to be the leading preeminent full-service delegated underwriting platform for specialty lines in the MGA/MGU channel. We provideproprietary insurance products and solutionstailored to the risk management needs of ourcustomers as a talent-led organization committed to specialization.”

Working with the Protector Plans brands provides customers access to custom insurance solutions for commercial and retail products, extensive underwriting knowledge and fast quote turnaround. We work to simplify the insurance experience, build trust and reduce uncertainty. Protector Plans’ website will be updated regularly with news, blogs, business activity, new product offerings and events. For a full list of policy features and coverage appetite and to submit, email [email protected].

About Protector Plans Executive Liability/B&B Protector Plans

Protector Plans Executive Liability Program provides coverage for all your business insurance needs. The program offers D&O liability, Employment Practices Liability, Fiduciary Liability, Employed Lawyers, Crime and Miscellaneous Professional Liability coverage for private and not-for-profit risks with up to $750 million in revenue and assets or 2,500 employees. Limits are up to $5 million per coverage section.

Brown & Brown Protector Plans, Inc. (“Protector Plans”) is a national administrator of property and casualty insurance solutions whose reputation for innovation and customer service is based on a 40+ year history of meeting the complex insurance needs of professionals. Protector Plans’ fundamental distinction is grounded in insurance product innovation. Protector Plans is a wholly owned subsidiary of Brown & Brown, Inc.

About Brown & Brown, Inc.

Brown & Brown, Inc. (NYSE: BRO) is a leading insurance brokerage firm, delivering risk management solutions to individuals and businesses since 1939. With 15,000+ teammates in approximately 500 locations worldwide, we are committed to providing innovative strategies to help protect what our customers value most. For more information or to find an office near you, please visit bbinsurance.com.

Full Press Release: Protector Plans Executive Liability launches primary product offering (prweb.com)


GL and PL Together Reduce Coverage Gaps for Dentists

GL and PL Together Reduce Coverage Gaps for Dentists

While purchasing your Professional Liability and General Liability insurance from separate carriers is common, purchasing both from one carrier with a single claims team helps reduce gaps in coverage and enables a quick payout of claims.

By Sean Gleason, Cornelius Briscoe and David Simonson

As a dentist running a successful practice, you need multiple types of insurance to cover your risks and liabilities. This includes Professional Liability (PL) insurance — also known as medical malpractice insurance — to cover treatment related injury and medical negligence claims, and General Liability (GL) coverage to protect you if a bodily injury or third-party property damage claim occurs.

However, you may not be aware that many common claims can overlap across these two coverages, creating a potential nightmare when filing claims, dealing with multiple claims handlers simultaneously, uncovering coverage gaps, collecting payments from different carriers… and more!

Consider these three true claims scenarios and lessons learned:

1. A friend designs your website and uses copyrighted photos.

Many dentist practices hire professionals to create their websites. However, some turn to friends — with problematic results. In one case, the dentist’s friend unwittingly used a copyrighted image, which carried an $800 a day fine for each day it was on the website. Fortunately, the practice had coverage for copyright infringement under both its PL and GL policies.

    Take-away: Advertising coverage may be offered under both policies, but with different wording or coverage options. Having PL and GL in one package enabled the claimant to work with one claims team and have all their options for coverage reviewed and handled appropriately.

    2. A patient is injured by falling plastic.

    A patient sued his dentist, claiming he had suffered a concussion and cuts to the skin that caused scarring when a piece of plastic lens from the dental light broke off and hit him in the head and face. The incident happened when the dental practitioner was moving the light into place. Was the equipment defective (a GL claim), or was the practitioner negligent (a PL claim)?

    Take-away: There could be an overlap in coverages. If the practice has both coverages with one carrier, the claims team can manage the claim from both perspectives, investigating what the source of the falling plastic was; i.e., the equipment or the practitioner.

    3. A sedated patient falls in the bathroom.

    A sedated patient needed to use the restroom in the middle of treatment. The dental assistant helped him to the bathroom entrance. While inside, the patient fell, hit his head on the toilet and suffered a brain injury. The patient later sued, claiming he fell because he was over sedated, triggering a PL claim.

    Take-away: The claims team was able to investigate the fall to determine if the accident qualified as a PL claim due to malpractice, or a GL claim because the fall was caused by something else. As a result, the team could ensure that the appropriate coverage kicked in.

    Beware of potential gaps and exclusions

    It’s important to know where there may be gaps in coverage between PL and GL policies. An in-house claims team familiar with both will have critical insight into:

    • Concurrent policy limits that could affect coverage. Dental GL is an occurrence-based policy where claims that occur during the policy period are paid regardless of when they’re filed, versus a claims-made policy that only considers claims filed during the policy period. This can get tricky if there is an incident that continues for years or there are multiple claims that cross policy periods where there were different limits.
    • Restrictions on the number of facilities PL will cover. A dentist might practice in multiple facilities — one they own and another they practice in — but their PL could restrict their coverage to only one facility. This leaves only Dental GL to cover the exposure if PL is insured on another policy.
    • Restrictions on intellectual property. A company’s most important asset is frequently its intellectual property, covered under advertising injury coverage in a GL policy. Some GL policies may restrict coverage for personal injury, libel, slander and defamation. For example, if one dentist disparages another and is sued.
    • Issues arising from treating non-dental problems. A dentist getting involved in diagnosing an issue such as sleep apnea that should have been referred to an associate could pose a coverage gap between PL and GL insurance.

    Protect yourself and your practice

    Every dentist has either experienced or worried about these or other troubling scenarios.

    What will you do if faced with such a claim? Do you understand the coverages you have and where there may be overlaps or gaps? Are you confident you will get the support you need with the carriers you have?

    If not, look for another way. Consider a carrier that offers both PL and GL coverage.

    For more information about using one carrier for both your Professional Liability and General Liability coverage needs, contact PPP Risk Management.

    This information is intended for informational purposes only. Nothing contained in this publication is, nor is intended to be, legal or dental advice. Professional Protector Plan for Dentists is not liable for any injury, loss, damage or expense arising out of or in connection with the use of this information.


    How to Hire and Retain Dental Staff for the Long Term

    How to Hire and Retain Dental Staff for the Long Term

    Finding and keeping quality employees can be a challenge for dental practices in the post-pandemic world. Adjusting your approach to staffing and personnel management can yield positive results.

    By Dr. Ty Galvin, D.D.S., and Dr. Mike Gile, D.D.S.

    When someone utters the phrase about good help being hard to find, many dentists will agree.

    The recent COVID-19 pandemic created staffing issues for dental practices as administrative personnel and hygienists may not have returned to work once pandemic restrictions were loosened or eliminated. This phenomenon has dentists looking at hiring and retention efforts in a whole new light.

    According to a study by the American Dental Association Health Policy Institute, the labor crunch within the industry has caused an 11% reduction in dental practice capacity. Approximately 40% of all dental practices surveyed responded that they were either currently or recently recruiting dental assistants, while 36% were currently or recently recruiting hygienists. About one-third also revealed that appointment schedules are not full, due in part to inadequate staffing.

    With the staffing landscape changing, dentists recognize that changes are needed to find and retain new employees, since new hires may view a current position as a steppingstone, moving on when the opportunity to earn more money arises.

    Hire slowly, fire swiftly

    Not only is employee turnover disruptive to your practice, but it’s also costly. Recruiting and hiring a new employee can cost up to $4,700 on average.[1]

    Consider top-line dollars in the equation as well: Hygienists can generate as much as $150,000 annually in revenue for your practice. So, being short-staffed isn’t just a problem of a lack of bodies to help; it can also be an indicator of a weaker bottom line.

    As a result, you want to build a staff that exhibits three principal qualities as a whole:

    1. Stability. A busy practice needs employees who will perform tasks and duties consistently in the office. While work/life balance should be emphasized, issues like absenteeism and presenteeism must be addressed.
    • Competency. Employees need to excel in patient care and the technical aspects of their jobs. Job hopping may indicate that these skills are lacking.
    • Loyalty. New hires who readily adopt a patient-centric mentality will tend to be more engaged and focused on a long-term career. It’s essential to identify who among your staff may not be team players. 

    To minimize turnover and maximize long-term employees, take your time and consider adopting the following hiring practices:

    • Leverage multiple recruiting sites. About 25% of dental practices use recruiters.[2] Consider a standardized application and link it to job listings on Indeed, Zip Recruiter, Craigslist or publications that have wide local circulations.
    • Seek referrals from trusted sources. You may have employees, family or friends who know qualified candidates for employment. Offer a referral fee to help drive activity.
    • Create detailed job descriptions. Well-written job descriptions reflecting benefits packages may help attract top talent while dissuading unqualified prospects who take up time and resources.
    • Use a temp service. Temp agencies can help pre-screen applicants, so you have a good sense of whether the person is a fit. Fees for this service pale in comparison to lost revenue from understaffing.
    • Beware of hiring other dentists’ employees. Poaching employees from others could harm your reputation in the professional community.
    • Connect with local training facilities. You can find a steady stream of prospects through college or trade school programs conducted near your office.

    If an employee is not working out, it’s best to terminate the relationship quickly. Here are some signs that an employee is not the right fit:

    • A general feeling. While running a practice and working alongside many types of people, you often instinctually know if a specific employee is not meeting your expectations. We need to give employees a chance, but if they aren’t a fit, don’t let them linger.
    • A lack of chemistry. You’re in an industry in which “people skills” resonate. Employees who clash with fellow employees and/or patients likely won’t work out in the long run.
    • Poor job performance. You have quality standards for services, procedures and outcomes. If performance falls short of those standards, it’s another indication that termination may be necessary.

    Use probationary periods to set a time during which a new hire’s performance will be assessed. A 30-60-90-day probationary period can give you enough time to gauge whether an employee will work out, while allowing quick removal if they are not performing.

    3 reasons hygienists and dental assistants leave your office

    According to the ADA, there are three main reasons hygienists and dental assistants leave a job:

    • workplace culture
    • insufficient pay
    • being overworked

    Awareness of these issues can help you implement measures to prevent quality employees from leaving.[3]

    Since you spend so much time with your employees, it’s imperative to create an office culture that strives for an optimal level of work-life balance. Learning about your employees’ personal lives not only improves employee engagement, but results in greater production levels, reduced training costs and higher patient retention ratios in the process. In addition, verbally recognizing hard work and creating a comfortable office atmosphere helps increase employee satisfaction.

    Hosting team-building events outside of the office such as dinners or sporting events also gives everyone a chance to socialize and bond. Make it a point to recognize employee birthdays and work anniversaries as well to increase employee engagement.

    On the business side, actions like supporting a hygienist who may be running behind can help build loyalty. This might involve providing a sample to a patient or finding another staff member to help turn over a room. Employees are much less likely to seek employment elsewhere if they are part of a team. Wages and benefits packages also should be competitive with other practices in the area.

    Finally, management style should reflect gentle accountability. Avoid micromanaging your employees. Instead, empower them to make decisions withing the practice and encourage them to make contributions that might fall outside their designated roles. Most important, stay calm and professional while deescalating office dramas and avoiding micromanagement.  

    For more information on finding and retaining ideal employees, contact PPP Risk Management.


    [1] Society for Human Resource Management “The Real Costs of Recruitment,” April 11, 2022.

    [2] American Dental Association, “Dental Workforce Shortages: Data to Navigate Today’s Labor Market,” October 2022.

    [3] American Dental Association, “Dental Workforce Shortages: Data to Navigate Today’s Labor Market,” October 2022.

    This information is intended for informational purposes only. Nothing contained in this publication is, nor is intended to be, legal or dental advice. Professional Protector Plan for Dentists is not liable for any injury, loss, damage or expense arising out of or in connection with the use of this information.


    The Critical Role Of Employment Practices Liability Insurance

    The Critical Role Of Employment Practices Liability Insurance

    Just as important as professional liability coverage, EPLI protects a business against rising claims of discrimination, harassment, retaliation and wrongful termination.

    By Ben Young, Christie Vu and Gregory Boornazian

    An employer can do everything right and still be served an Equal Employment Opportunity Commission (EEOC) notice.

    Alleged discrimination charges under Title VII of the Civil Rights Act of 1964 accounted for 61% of the EEOC cases filed in 2021.[1] Employment Practices Liability Insurance (EPLI) helps protect against liability from false allegations just as much as accurate ones. Claims that aren’t legitimate or don’t hold up in court still cost business owners real money to defend.

    EPLI is a business’s main protection against claims of discrimination, harassment, retaliation and wrongful termination, and with such claims on the rise, it is just as important as professional liability coverage. Broad form EPLI will cover a business for defense costs, indemnity and third-party claims. Added benefits often include “duty to defend” language and 100% defense cost allocation.

    Smaller businesses often argue that their staff is one big happy family, but the reality is this is simply not true. Employees have certain expectations of their employers, and even long-term, reliable employees can seize an opportunity for personal gain.

    Knowing and complying with employment laws is a business owner’s first defense against certain fines and penalties. When mistakes are made, employers can rely on strong legal counsel, but ignored and unreported errors will only escalate matters over time.

    Consider the following real claims scenario:

    An employer in the Midwest was summoned by the U.S. Department of Labor for Fair Labor Standards Act violations due to a timekeeping discrepancy and a misunderstanding of U.S. overtime policies by the company’s management. Engaging the injured parties, paired with the fast action and cooperation of their legal team, saved the employer from a criminal investigation and punitive fines. The employer paid the owed back wages, but without proper insurance provided by a reliable company with an experienced claims team, the consequences of their mistake could have been a lot worse!

    Business owners have a lot on their plates and managing an EEOC claim can be a stressful and costly expense. Utilizing EPL coverage through a highly rated carrier is an efficient risk transfer for this exposure. Engaging expertise, particularly in the event of frivolous allegations, can save a business valuable time and money.

    For more insight on today’s changing employment landscape, check out Protector Plans’ eBook.


    [1] Seyfarth “EEOC-Initiation Litigation,” 2023.

    This information is intended for informational purposes only. Protector Plans Executive Liability is not liable for any loss or damage arising out of or in connection with the use of this information.