We know, insurance can be tricky to understand. Unfortunately, it’s not as clear as 1s and 0s when working out what cover you need to ensure you’re meeting your professional and contractual requirements. That's why our partner Guild Insurance has provided some insight into the importance of having the right insurance policy by developing common scenarios based on claims trends for the IT consultant profession below:

Scenario one – Expectations can be hard to meet

Despite best efforts, sometimes things don’t end the way intended. Whether that’s due to expectation management, perceived skill or capability, or it's just a bad day, there's a range of reasons that an employer can feel they've been left exposed, feeling vulnerable or worse, have experienced a financial loss. In this case, they may seek retribution by way of seeking compensatory damages.

Scenario two – Differences in scope of work after commencement of contract

It is not uncommon for claims to arise due to cost variation involving a contract. The variation could occur for a range of reasons, including but not limited to the contract taking longer than initially planned, or the discovery that the project is far larger and more complicated than first anticipated. If this results in a dispute of work/cost, things can and often do get messy if not communicated well.

Scenario three – Mistakes in high risk industries

Developing software for aerospace applications can come with challenges. Even the smallest mistake in this sector could have enormous consequences. Like the aerospace industry, segments such as health, utilities, medical or defence, among others, can come with significant risk if an accident occurs, and can result in major claims.

Scenario four – Proof of insurance and maintaining cover

Employers may ask for evidence of professional indemnity and public liability insurance as a condition for working for them. However, it is imperative to maintain your professional indemnity insurance policy after the contract ends, as claims may arise days, weeks, months even years after the services were performed. If you don't have a current policy, then you may be left exposed for claims or allegations made against you.

The ITPA partners with Guild Insurance to ensure the unique needs of your profession are covered. And they do this by providing a policy that bundles professional indemnity, products and public liability all in one.

To learn more about the features and benefits of Guild Insurance’s IT consultant policy, visit guildinsurance.com.au or call 1800 810 213.

 

 

Disclaimer

Insurance issued by Guild Insurance Ltd, ABN 55 004 538 863, AFSL 233791 and subject to terms, conditions and exclusions. This information is of a general nature only. Please refer to the Product Disclosure Statement and policy wording for details. Guild insurance supports the ITPA through the payment of referral fees. For further information, contact us on 1800 810 2013.

Implants: a step in the tooth life cycle, not the end.

Media and consumer interest have heightened demand and expectations for implants as a solution to tooth loss. As a result there are an increasing number of implants being placed but, with less than satisfactory treatment planning and case assessment there are also increasing complaints about failures. When an implant fails it usually means that the super structure also fails, making any substantiated claims costly to the PI insurer and therefore to everyone via increased premiums. By not adequately assessing and planning cases dentists are not acting to protect their own interests or those of the profession.

 Emerging issues in implant complaints:

There are two emerging issues (leaving aside the issue of implants placed overseas for another article): firstly, patient driven treatment, where the patient refuses a removable option yet is biologically unsuitable for fixtures, can lead to placement of implants without adequate risk analysis and therefore a higher risk of failure. Secondly, a number of practitioners and most patients believe the treatment to be permanent and at low risk of failure. This is not the case according to dental literature.

Failure risks can be considered as restorative and surgical/periodontal. The prosthetic part of the treatment must be governed by first principles of occlusion and load, and because of the ease of machined components it is more predictable and if the occlusion is right, there is less risk of mechanical failure that conventional crowns and bridges. When implants fail, they are less amenable to treatment than natural teeth. There is reference in the literature to “failing” and “ailing” implants and it is recognised that there will always be implants which fail in the short term, but with time it is expected [and demonstrated in the literature] there will be more biological and technical issues resulting in increasing loss of implants.

Risk of failure

It appears that an increasing number of implants are being placed with no heed to the biological risks of failure. There is already (as well as emerging) published literature on this point but many dentists continue to place implants in cases which, given evidence based research, are at high risk of failure. As dentists we are used considering a risk hierarchy of factors for periodontal disease and caries. There are also risk factors to be considered when planning implants. There is well regarded literature which shows increasing loss or failure over time, and some cases of “spontaneous” failure with no known risk factors.

Emphasis in many planning cases is on the type of fixture and restoration and not on basic triage of suitability. In overlooking this foundation of treatment planning the result is increasing failures, complaints and therefore costs to the profession and the insurer.

High risk factors for peri-implantitis are:

1. Present active periodontal disease
2. History of past periodontal disease
3. Poor oral hygiene
4. Smoking (evidence showing it is less ranking than with periodontitis but still significant)
5. A small amount of literature identifies osteoporosis and Diabetes as risk factors but there is not enough evidence to rank them.

In summary

Every dentist should know the limitations and complications which arise from implant placement and advise the patients of these. The dentist should conduct a risk assessment on the likelihood of failure and add this to the general discussion of implant treatment. Expectations of patients should be aligned with this risk profile prior to embarking on treatment.

Although this is a now ageing article, I recommend the excellent review article by Drs Gary Greenstein and John Cavallaro: JADA 145(8) August 2014. In this article they cite the following recommendations to help reduce failures.

1. Treat any periodontal or peri-implant pathosis before implant placement
2. Fully assess medical history
3. Make sure there is adequate bone height and width: if not augment
4. Follow strict surgical protocol
5. Construct a proper super structure
6. Instruct patients in good oral hygiene and the absolute necessity for maintenance
7. Over engineer cases where parafunction is obvious

Performing  and recording a risk analysis and then informing  patients of any heightened risk of failure is good risk management for you, not to do so is potentially negligent and can give rise to a basis for an expensive claim, usually involving a costly remedial treatment plan. Disregard for considering evidence based research would also result in a potential unprofessional conduct finding if the matter was taken to AHPRA, as would practicing beyond the scope of an individual’s formal training.

Dr Eryn Agnew

Community Relations Manager/ Professional Consultant

Dental Implants - Success or Failure pdf

Chiropractors regularly deal with challenging situations and are continually required to make difficult decisions.  However, these decisions don’t always relate solely to the clinical care they’re providing their patients.  Unfortunately, sometimes chiropractors will face other difficult situations with their patients and knowing how to manage these isn’t always easy or obvious.

The information below highlights three challenging scenarios, which are not uncommon in chiropractic, with tips on how they could be managed.

Patient requesting specific treatment

Some patients will attend their chiropractic appointment with what they believe is an understanding of their condition and how they should be treated.  These patients will often request, maybe even demand, a particular type of treatment.  This information may be based on how they’ve been treated by a chiropractor in the past.  Sometimes it will be based on information non-clinically trained people, such as friends, have shared with them or even information they’ve read online.

Chiropractors must be sure all patients are assessed thoroughly regardless of what the patient tells them about their condition; the chiropractor as the health professional needs to be sure.  Following the assessment, the chiropractor may determine that the treatment being requested isn’t appropriate for that patient based on their current clinical situation. 

When the treatment the patient has requested isn’t ideal for them, they may not be happy with the decision to not provide this.  This requires the chiropractor to explain to the patient what treatment is recommended and why.  Chiropractors must be sure they don’t allow themselves to be coerced into providing treatment against their better judgement and they need to be sure all treatment they provide is clinically justified.  If there is a poor outcome following treatment and the choice of treatment is questioned, stating that the patient demanded that treatment isn’t a justification for it being provided.

In many cases, the patient will accept the chiropractor’s treatment recommendation.  However, chiropractors need to be prepared for the possibility that some patients won’t agree with this recommendation and may leave the appointment disappointed.  Unfortunately, it’s not possible to please all patients. 

If the situation above occurs, it’s vital that the patient’s request is noted in the clinical record so there is a full history not just of what treatment was provided but of all conversations regarding the treatment.

Patients seeing multiple practitioners

Some patients will choose to visit multiple practitioners for the one condition.  A common reason for this that they aren’t satisfied with the treatment outcome from one practitioner, so they try others hoping for a different result.  They may choose to see different chiropractors, or they might see different types of practitioners such as osteopaths and physiotherapists as well as a chiropractor.

In most cases, a patient seeking a different opinion shouldn’t be cause for concern.  However sometimes a patient who has seen numerous practitioners and has been unhappy with them all may be a patient who’s difficult to please and chiropractors should be mindful of how they manage this situation.

In cases where a patient presents criticising the treatment provided by another practitioner, it’s important that chiropractor doesn’t also criticise this treatment.  The chiropractor doesn’t have the full story of how the patient presented to the other practitioners, what treatment was provided and why.  Criticising the work of other practitioners is not only unprofessional, it can also encourage, even if unintended, the patient to make a formal complaint about that practitioner.

Quite often patients are unhappy with their treatment outcome due to them having unrealistic expectations.  Assisting a patient to form realistic expectations about treatment requires effective communication before treatment starts.  Therefore, be sure that with all patients the likely and realistic treatment outcomes are discussed with them prior to any treatment being performed.  And this conversation needs to be had using language they’ll understand so avoid clinical jargon.

If a chiropractor has a very uneasy feeling about a patient due to it appearing difficult to meet their needs, the chiropractor can decline to provide treatment.  However, the chiropractor needs to acknowledge that not providing treatment could upset the patient.  Therefore, this discussion needs to be planned and worded in a way unlikely to cause offence.  Exactly what is said will vary depending on the situation, however it would be reasonable to let the patient know that due to the patient not getting benefit from previous treatment similar to what would be provided, the chiropractor may not be the most appropriate person to provide further treatment.  The patient could be advised to see another health professional such as a medical practitioner.

Blurred boundaries

The relationship between a patient and chiropractor is a professional relationship.  However, at times the behaviour of patients and chiropractors can blur the boundaries of this relationship and it can start to seem more of a personal relationship which isn’t appropriate.

Chiropractors need to remember that their patients are just that, patients.  They aren’t friends and shouldn’t become friends.  There are a couple of simple rules to follow to avoid this change of relationship.

Chiropractors should avoid socialising with patients.  Sometimes a chiropractor will treat a patient and their family for many years which leads to them getting to know each other quite well.  This can lead to chiropractors being invited to family birthdays and other events.  While it may seem impolite to decline these invitations, accepting them can complicate the professional relationship. 

With the continually increasing use of social media, there can be a temptation to connect on social media with a large number of people.  If a chiropractor has a professional social media account, only used for professional communications, it’s okay to connect with patients through this account.  However, chiropractors shouldn’t connect with patients on a personal social media account.

Chatting to patients during consultations is a great way to seem more personable and make patients feel relaxed.  However, if there is too much personal chatting the chiropractor is possibly not spending enough time discussing the treatment being provided.  Also, there have been occasions when personal conversations have been misinterpreted by the patient and they’ve felt uncomfortable with the chiropractor discussing information not related to treatment.

Unfortunately, keeping clear boundaries can be a little challenging for those chiropractors practicing and living in small towns or communities where many people know each other.  In these situations, the chiropractor needs to ensure that if they are treating someone they know, they maintain their professional standards during consultations and not treat these patients differently to others. 

Managing difficult chiropractic situations

Managing complaints in dentistry

There has been a steady increase in errors reported to Guild Insurance involving the wrong route of administration.  These errors occur when a pharmacist dispenses a medication that has been manufactured for administration via a different route.  For example, the pharmacist dispensed ear drops instead of eye drops, or the patient was prescribed injections, but was given tablets.  Errors also include pharmacists directing customers to take the correct medication, but via the wrong route.  For example, a customer was prescribed oral capsules, but the pharmacist labelled the medication to be used as a suppository.

These errors can and do happen, even to experienced pharmacists who’ve never made a mistake before.  They can happen to you and they can have serious consequences for you and your customers.

Cases

An infant was prescribed Egozite scalp lotion to treat a skin condition.  On the same script, it was recommended her parents also obtain Infacol drops to help treat infant colic.  However, during the dispensing process, the labels were transposed and as a result, the Egozite lotion was given orally and the Infacol drops used topically.

 A pharmacist inadvertently dispensed Ciloxan ear drops instead of Ciloxan eye drops.  While the customer didn’t suffer harm, the same error with a different medication may have resulted in serious consequences.

Reduce the risk of dispensing errors        

• Adhere to the PDL ‘Guide to good dispensing’ every time.Don’t be coerced into rushing or cutting corners.When errors occur, pharmacists often say “if only I’d taken the time to…”
• Display posters or reminders in the dispensary to promote compliance with dispensing procedures.
• Use barcode scanning every time.
• Seek help if you are feeling intimidated or uneasy about contacting the prescriber to clarify a script.
• Consider placing flags or warnings in the dispensing basket when handling a script for a different route of administration.For example, a simple card stating ‘RISK WARNING – injection’ could reduce the chance of you automatically selecting an oral dose.
• Make use of the safety features available in your dispensing software.Set up different alerts to remind people to perform certain tasks.Likewise, make use of advanced scanning features that automatically print a barcode on the dispensing label.
• Promote a culture where all staff are confident to point out risky practices when they occur.
• Reducing distractions when a pharmacist is dispensing is everyone’s responsibility.Agree to strict rules for minimising interruptions and distractions in your pharmacy.
• When handing medications to a customer, point out all warnings and directions on the label and packaging.This not only helps with counselling but serves as a final check against any dispensing error.

Dispensing errors – wrong route of administration

There are an increasing number of dental services available which are direct to the consumer, meaning the consumer hasn’t consulted directly with a registered dental practitioner.  While the convenience of these services is obvious, they aren’t without risk for both the consumer and any registered dental practitioner involved.

These direct services are available for several dental treatment areas such as orthodontic aligners, splints and sleep appliances.  These services can be initiated by the consumer creating their own impression using materials and information provided to them.  In other cases, the patient may have a digital scan carried out by the service provider at a designated location (shopfront or pharmacy), often by someone who is not a registered dental practitioner.  Following this, a treatment plan is developed and the device(s) required will then be provided to the patient for use.  Some of these services also offer mechanisms for remote supervision of treatment progress by a dental professional.

One of the concerns with this type of treatment model is that other dental issues, not directly related to the appliance, may not be detected due to the patient not being regularly assessed and treated in-person by an appropriately registered dental practitioner.  There are also concerns about how patient suitability (or standard of care case selection) is determined.  While some companies providing these services do have a process of assessing the suitability of the appliance for each patient, this is often done by the patient completing an online assessment form themselves; therefore, there is no assessment for suitability by a registered dental practitioner.

There may be occasions where a dentist, who isn’t involved in this treatment model, has a patient ask them about their views on it or asks them for support in completing forms required to purchase one of these devices.  Dentists should be aware that if they provide clinical advice, they are involved in the treatment.  It’s therefore recommended that dentists contact their ADA Peer Advisor (NSW/ACT) or Community Relations Officer (Victoria, South Australia and Tasmania) if they find themselves in this situation so they can obtain advice on how to best manage this situation.

Dentists who choose to participate in these treatment models need to understand and appreciate their level of responsibility and possible liability.  Regardless of whether or not a dentist has seen or consulted with the patient themselves directly, involvement in design of such appliances or other aspects of their provision and use may be deemed by regulatory bodies to be provision of a dental service.  Registered practitioners, when providing a dental service, must ensure their professional obligations are always being met. 

If a consumer is dissatisfied with the outcomes of their treatment and they’re aware of a registered dental practitioner who was involved in their treatment in some capacity, they have the same rights as other patients to formally complain to regulatory authorities or make civil claims about the treatment provided by this practitioner.  To defend against allegations of wrong-doing, this practitioner would need to show that:

• the treatment and/or advice they provided was to the professional standard expected;
• they are appropriately qualified and experienced to be providing that treatment and/or advice;
• the treatment and/or advice was clinically justified;
• the patient was aware of the risks, expected outcomes and limitations of the treatment; and
• detailed clinical records have been maintained, showing exactly what was done and why.

It is therefore strongly recommended that any registered dental practitioner choosing to become involved in any capacity in providing treatment through this direct model considers the risks involved and be certain these risks will be appropriately managed.

Download PDF here

Building workplace relationships in early learning

Bullying in the workplace is a serious work health and safety issue which affects all workplaces, including early learning centres.  Guild Insurance regularly manages workers compensation claims where there are allegations of staff members being bullied.   Bullying negatively impacts both employees as well as the business they work for; therefore, it’s something all businesses should be aware of and be consciously working towards eradicating

What is and isn’t bullying?

Bullying is repeated unreasonable behaviour directed towards workers.  Bullying can occur in many forms; it may be physical or psychological, it can be direct and obvious or indirect and subtle.  Examples of bullying are:

• Behaving aggressively
• Teasing or practical jokes
• Pressuring someone to behave inappropriately
• Excluding someone from work related activities or events
• Abusive or offensive comments
• Belittling or humiliating comments

Sometimes workers believe any behaviour or action in the workplace which makes them feel uncomfortable is bullying.  However, this isn’t the case.  Actions carried out by management, such as disciplinary action or feedback about poor performance, isn’t bullying when done reasonably.  Disagreements are also generally not bullying when they’re handled reasonably. There are other workplace behaviours, such as discrimination and sexual harassment, which while completely unacceptable, won’t necessarily be considered bullying depending on the circumstances.

Bullying doesn’t just occur in a face to face physical setting.  More and more cases are being reported of bullying occurring online using social media.  This online behaviour can be easier to hide and often won’t occur during work hours, yet the consequences for employees and employers are just as severe.

Consequences of workplace bullying

There can be many consequences, both for individuals and the workplace, when bullying is taking place.

Firstly, it is the responsibility of all employees to create and maintain a safe work environment.  If a workplace isn’t taking reasonable steps to prevent and manage bullying, this may be seen as a breach of WHS laws.

Bullying can lead to serious physical and psychological harm with people suffering from depression, stress, anxiety and emotional exhaustion.  It is well recognised that workers suffering from physical or psychological harm are more likely to take sick days and not be as productive as they would hope to be when at work.  Bullying can also lead to a level of staff resignations.

Preventing and dealing with bullying

There are numerous ways employees, employers and workplaces can reduce the likelihood of bullying occurring.  There are also many resources available to support this.

1. Workplace culture

To create and maintain a workplace where bullying doesn’t exist, it’s important to start by addressing the culture of that early learning centre.  Managers and senior staff need to be sure they’re leading by example in the behaviour they demonstrate and expect of their staff.  All staff should be expected to treat their colleagues fairly and with respect, and this behaviour must start with those most senior.

It is also vital that a culture is created where staff feel comfortable speaking up if there is something they’re unhappy about.  If a staff member feels they’re being bullied by a colleague, it’s ideal that they speak to their manager first before considering making a formal complaint against the centre.  Yet for this to happen, this openness and willingness to discuss concerns needs to be supported and encouraged.

A key step an early learning centre should take to prevent bullying occurring is to be sure no one thinks it won’t happen in their workplace.  Bullying behaviour unfortunately can occur in any workplace.  However, if a manager thinks their centre is immune, it’s possible they won’t put in place the necessary process to prevent this which could place them at greater risk.

2. Business policies

Early learning centres all have an extensive list of policies for their business.  There are many policies which are required from a regulatory perspective.  However, all centres should consider what other areas they should develop policies for beyond those required; bullying is an example of this.  A policy on workplace bullying should include information about what a staff member should do if they’re experiencing bullying and how the centre will respond to this.  Workplaces should also have a social media policy which sets out appropriate social media behaviour for both personal and professional use.

The benefit of having a policy, rather than just stating what’s required, is that it formally sets the standard that all staff are expected to abide by and can be continually referred to.  However, for policies to be effective they need to be known about and be accessible for all staff.  This means centres need a process for making sure staff are aware of the policies they need to adhere to.

3. Performance management processes

Performance management discussions can unfortunately lead to staff confusing feedback with bullying.  This confusion can often occur due to the way the performance appraisal is delivered.  It’s incredibly important that managers are undertaking their role in a reasonable manner so that it doesn’t cross that line and become bullying.  

Addressing poor performance shouldn’t be put off until an official staff feedback or review discussion.  Doing this means that a staff member’s poor performance will continue for some time without them being aware.  Receiving this unexpected feedback only at review time can be viewed as unfair and unreasonable by staff members.

When discussions are had regarding performance issues, staff should be encouraged to have a support person there with them.  This person can provide them with moral support during the meeting as well as afterwards.  A record of these discussions should be made so there is a history of what was said by all parties and what was agreed to.

The Fairwork Ombudsman provides resources to assist with managing underperforming staff members, this information can be found at www.fairwork.gov.au/how-we-will-help/templates-and-guides/best-practice-guides/managing-underperformance.

4. Additional resources

Preventing and managing bullying is not easy; therefore there are resources available to assist workplaces with this challenge.  For assistance with understanding what bullying is, how to prevent it and what both employees and employers should do if it does occur, refer to the follow sites:

www.fairwork.gov.au/employee-entitlements/bullying-and-harassment

www.fwc.gov.au/disputes-at-work/anti-bullying

www.safeworkaustralia.gov.au/bullying

Workplace bullying in early learning

It may surprise you to know that complaints about orthoses are a common source of podiatry claims to Guild Insurance. 

Common allegations include:

1. The orthoses caused the client to suffer a new injury, such as a hip or lower back problem.
2. The orthoses exacerbated the client’s existing or underlying condition.
3. The orthoses failed to resolve the client’s presenting problem.

Any claim against you, whether substantiated or not, can be distressing.  Your good reputation may be damaged leading to undue criticism from other healthcare providers and reduced client referrals.  Furthermore, complaints to agencies such as AHPRA may take many months to resolve resulting in a prolonged period of uncertainty.

Managing client expectations through effective communication is central to avoiding claims against you.  Key issues to discuss with clients include, but are not limited to:

• Discuss the range of options available to treat the individual’s condition. Take the time to discuss the pros and cons of each option, including costs and risks.Ensure the client understands the difference in expectations between pre-formed and custom-made orthoses.
• Make sure the client understands what outcomes he or she can realistically expect to achieve with the orthoses. Remember, what is obvious to you may be completely foreign to the client.However, don’t just ask them if they understand, as in many cases they’ll say yes even if they don’t.It’s better to ask the client to tell you what they’ve understood from the discussion.
• Where suitable, use visual aids such as diagrams and models to help explain the information.
• Allow clients adequate opportunity to ask questions and weigh-up their options, including the financial implications of their choice.Give them time to make their decision, they shouldn’t be expected to decide at the appointment where they were given the information.They may wish to think about it for a few days.
• Provide clear instructions about how the orthoses are to be used, including choice of footwear and any prescribed exercises or stretches.Carefully explain the implications of not following your instructions.
• Remember to discuss the expected life span of the orthoses and any instructions for ongoing care.
• Emphasise the importance of attending all follow-up appointments and contacting you immediately if they have any concerns.Remember to outline the early warning signs of any complications and urge the client to contact you as soon as any issues arise.
• Where possible, provide clients with written information for them to take away and read in their own time.Sometimes people are not able to absorb everything they’re told during an appointment.However, written information should only be used to re-enforce what was discussed, not as a replacement for the conversation.

Finally, remember to clearly document your discussion and the outcomes in the client’s clinical notes.  Good clinical notes are invaluable in the event of a complaint against you.

Orthoses - Managing Expectations

Incidents involving pharmacists selecting the wrong medication or the wrong strength are the most common dispensing errors reported to Guild Insurance.  Not surprisingly, a number of these errors involve look-alike, sound-alike medications. 

Despite awareness raising campaigns, errors still occur.  While a person could suffer harm if given any medication in error, the likelihood of serious clinical effects increases significantly when the medication involved has a narrow therapeutic index.  These errors can and do happen, even to experienced pharmacists who’ve never made a mistake before.  They can happen to you and they can be fatal to your customers.

Cases

A patient was admitted to hospital with unexplained abdominal bleeding.  On investigation he was found to have an abnormally high INR, even though he had never been prescribed anticoagulant therapy.   His elevated INR was eventually attributed to a dispensing error.  The pharmacist had inadvertently made a selection error and dispensed 5mg Coumadin instead of 5 mg Coversyl as prescribed.

Due to a pharmacist’s selection error, the cytotoxic medication Hydrea was dispensed instead of the prescribed antihypertensive Hydopa.  The young woman happened to be pregnant and claimed the error resulted in her suffering a miscarriage.

A customer successfully claimed for ‘loss of income’ when she was unable to work for an extended period after a dispensing error.  Although the customer had been prescribed Lamictal 25mg, the pharmacist inadvertently dispensed 200mg tablets.  The customer subsequently took the higher dose for a number of months and suffered liver damage.  While the pharmacist said she usually used ‘barcode scanning’, she failed to do so on this occasion.

Reduce the risk of dispensing errors

• Adhere to the PDL ‘Guide to good dispensing’ every time.Don’t be coerced into rushing or cutting corners.When errors occur, pharmacists often say “if only I’d taken the time to…”
• Display posters or reminders in the dispensary to promote compliance with dispensing procedures.
• Use barcode scanning every time.
• Make use of the safety features available in your dispensing software.Set up different alerts to remind people to perform certain tasks.Likewise, make use of advanced scanning features that automatically print a barcode on the dispensing label.
• Introduce measures to differentiate between look-alike or sound-alike medications:
  • Use separators, stickers or flags
  • Avoid positioning these medications in strict alphabetical order.For example, storing Coumadin under ‘W’ for Warfarin, limits the chance of inadvertently selecting Coumadin instead of Coversyl which has similar packaging.Consider storing other high-risk medications separately.
• Promote a culture where all staff are confident to point out risky practices when they occur.
• Seek help if you are feeling intimidated or uneasy about contacting the prescriber to clarify a script.
• Be careful with zeros and abbreviations.Transcription or interpretation errors involving a zero, decimal point or abbreviation are common causes of serious dispensing errors.For example, 6U of insulin could easily be interpreted as 60 units.
• Reducing distractions when a pharmacist is dispensing is everyone’s responsibility.Agree to strict rules for minimising interruptions and distractions in your pharmacy.
• Review the dispensary layout to ensure workflow supports each step of good dispensing.
• When handing medications to a customer, point out all warnings and directions on the label and packaging.This not only helps with counselling but serves as a final check against any dispensing error.

Pharmacy Dispensing Wrong Medication or Strength

Receiving a complaint is often an unexpected part of running any business, including a chiropractic practice.  No business is immune from receiving a complaint, regardless of how successful it is or how customer focused staff are.  There can be a tendency to see a complaint as a personal criticism rather than constructive feedback.  However, there can be positive outcomes when the situation is managed appropriately. 

Why do people complain? 

There are many reasons why patients might complain about your practice and the treatment or service they’ve received.  Sometimes a complaint will almost be expected following an incident; sometimes it will take you by complete surprise.  Understanding why people may complain can assist with managing a complaint if it occurs and potentially reducing the likelihood of further complaints.  The following are some of the reasons why people may feel the need to complain.

High expectations – consumer expectations are increasingly high when engaging professional services.  Your patients pay for your service and will most likely see you as a highly trained and qualified professional.  This view can influence their expectations about the service and outcomes they anticipate. 

Unrealistic expectations – it’s possible that patients may have unrealistic expectations about what they can reasonably expect from chiropractic treatment.  Their high expectations may at times surprise you.  It’s therefore important to remember that most patients will not have the clinical knowledge you do and what’s obvious or common sense to you may not be to them.  A practice must assist patients to be clear and fully informed about the treatment being provided and the outcomes they can realistically expect.  This requires ongoing discussions with patients and, where possible, written information to assist their understanding. 

To inform and be heard – patients may wish to make a complaint about an incident or poor outcome just so they are sure you and your staff are aware of what’s occurred and how they feel.  They may wish to complain simply to be listened to and acknowledged, especially if they have been adversely impacted.  Not all complaints will lead to a formal demand for compensation. 

Belief that someone is responsible – when something goes wrong we often try to determine who’s responsible.  Sometimes someone is obviously responsible, sometimes it’s hard to determine who’s responsible and other times there is no one person responsible but it’s just an unfortunate set of circumstances.  If a patient thought something had gone wrong and this led to them being harmed, it’s quite possible they may complain with the intention of holding someone responsible and possibly liable. 

The importance of managing complaints 

There may sometimes be a temptation to ignore a complaint and hope it’ll just go away.  Maybe the patient won’t follow up.  Maybe the incident won’t occur again.  This is a very short-sighted way to run any business as there are clear benefits when complaints are managed appropriately. 

• Patients will generally expect to see their complaint dealt with quickly and fairly.  When this doesn’t happen it’s possible that further complaints will follow and the issue or concern could become a much greater one.  Complaints may also escalate to AHPRA or another regulatory body. 
• Managing complaints should be seen as good ‘customer service’.  You rely on patients to keep your business afloat.  When patients are unhappy with a service they’ve received, they can talk with their feet by not returning to the practice.  Keeping patients happy and satisfied is more likely to see them continue to use your service and recommend your practice to others. 
• Complaints can provide a practice with an opportunity to review and improve their service.  Receiving a complaint may highlight an issue which the practice had not been aware of.  When investigating and dealing with the complaint, the practice may wish to consider a change in a procedure to avoid that issue arising again in the future. 

How to manage complaints

It’s advisable that every chiropractic practice has a complaints policy.  This means that the practice will have an agreed-to process which allows for all complaints to be dealt with in a fair and consistent manner.  It also means staff know what to do which is important as managing complaints can be challenging.

A key aspect in dealing with any complaint is listening to the person.  Where possible, make time to sit down in a quiet space and give them time to express their concerns.  Make the effort to hear what they have to say and take on board what they have told you.  You may not agree with all they are saying, however it helps if you can try to understand the situation from their perspective.  You may wish to ask them to document their concerns so you both have an accurate record of the matter.  Avoid being defensive or taking the complaint personally as this may inflame the situation.

With low level complaints you may be able to offer a solution there and then.  However, this won’t always be the case.  With more serious complaints you should provide the person with an assurance that you’ll investigate the matter and get back to them with a response at a later date.

Guild Insurance expects those insured with us not to admit liability (or name someone else as being at fault), or to offer any compensation without contacting us first.  However, this doesn’t prevent you from apologising or showing sympathy for any pain or inconvenience the person may be experiencing.  Contact Guild Insurance on 1800 810 213 as soon as you’ve received a complaint; don’t wait till it escalates to a claim for compensation.  We will provide advice and support to assist you to deal appropriately and professionally with what can be a challenging and possibly upsetting situation.  This support can be the difference between sorting a problem quickly and it escalating to a serious claim.  

Managing complaints in Chiropractic

Guild Insurance regularly analyses claims information to understand factors which may contribute to claims and complaints occurring.  This analysis has highlighted a trend where claims involve treatment by at least two dentists.   

Evaluating another dentist’s work

All dentists will at times treat a patient who’s had dental work carried out by another practitioner.  And you may have questions about that treatment, such as when:

• the work may not seem to be up to the standard expected of a dentist;
• the treatment selected may not appear the be the ideal or obvious choice given the clinical situation or
• it may seem as though the treatment provided has not led to the intended or expected outcome

Dentists must be very mindful of how they handle these situations and what they say to or in front of the patient.  It’s understandable that to provide treatment the dentist will want a complete understanding of prior treatment.  However, conversations about another practitioner’s treatment, if not conducted appropriately, may contribute to the patient lodging a complaint against that other dentist.

What can go wrong?

Not all situations where a dentist questions previous treatment will lead to issues arising.  However, the following case examples highlight how easily complaints can occur.

A patient had received many years of dental treatment from Dentist A.  Whilst happy with the treatment provided, the patient began seeing Dentist B when she moved to a new house.  During a consultation, Dentist B commented on the file fragments which had been left in her tooth, assuming she was aware.  When she appeared surprised, Dentist B explained that he had detected small fragments of a file which had been left in a tooth following RCT.  Dentist B was openly critical of Dentist A for what he described as ‘sloppy treatment’ and told the patient she should have been informed at the time when the file broke.

Whilst away for a weekend, a patient felt a tooth break whilst eating.  He decided to see a local dentist who was available to provide emergency treatment.  When he returned home he went to see his regular dentist to receive further treatment to that tooth.  His regular dentist was quite surprised with and critical of the treatment provided by the other dentist.  She informed the patient that due to the poor work she was going to have to replace what was done, therefore costing the patient more than he had anticipated.

Impact of comments made

Making negative comments about the work of another dentist can reflect poorly not just on that dentist but the dental profession.  If the entire situation surrounding treatment is not understood, the comments may be incorrect and presumptuous.  This can unfairly damage the reputation of a dentist as well as cause unnecessary frustration for the patient.

It’s therefore very important that when dentists find themselves in a situation where they have questions about the work of another dentist, this is handled appropriately.

Tips for managing these situations

• Don’t make off the cuff comments to a patient judging or criticising the treatment another dentist has provided.Making even what you see as a small or insignificant comment to a patient regarding the choice and quality of treatment provided by another practitioner could be enough to encourage that patient to make a complaint or a demand for compensation.
• If your patient has received treatment which doesn’t appear to have been the most preferred for their clinical situation, don’t assume this is an error on the part of another dentist.Sometimes patients choose a different course of treatment to that recommended by their dentist, often due to financial restraints.
• Avoid making assumptions.If you have concerns or questions about the treatment your patient has received from another dentist, consider seeking the patient’s permission to contact that dentist to find out more about the treatment provided and reasons behind their clinical decision making.It’s possible that the clinical situation you’re seeing is not the same as what the first dentist saw.
• When sending a patient back to their referring practitioner, provide a letter for that practitioner outlining your diagnosis, the treatment you provided and why that treatment option was selected.Don’t rely on the patient to convey this information.
• Documentation is vital.If your work is being questioned by a patient, another dentist or AHPRA, you’ll need your accurate clinical record to act as the explanation and evidence behind your clinical decision making.
• Patients can become frustrated with ongoing treatment costs.If replacement work is required, be very clear and upfront about the cost of this further treatment.
• Avoid offering free or discounted treatment when replacing work.This may further suggest that the initial treatment was ineffective and therefore a waste of money.Also, the patient may expect that discounted or free treatment will continue beyond what you had anticipated.Always contact your local ADA branch or Guild Insurance before offering any form of discounted treatment to a patient.
• And finally, always maintain a high level of professional behaviour, both when treating patients and anytime you’re communicating and interacting with them.This not only reflects well on you, it can also improve the public perception of dentistry as a profession.

Commenting on another dentist's work

Guild Insurance (Guild) undertakes regular reviews of the claims managed by them to understand trends and themes within those claims.  Recently Guild has identified an increase in the frequency and severity of fitness related claims being reported.  The nature of the incidents which lead to these claims suggest that some fitness professionals are not recognising the risks within their work, or they aren’t being proactive enough to properly manage those risks.

The following information will assist fitness professionals in understanding the risks they face in their day to day work and what they need to do to reduce the likelihood of these risks becoming a reality.

Don’t underestimate the importance of communication

Guild’s claims experience shows us that poor communication is a factor in almost all complaints from fitness clients.  In some cases, clients will allege the communication from the fitness professional was poor and this led to an incident, such as the explanation for how to perform an exercise was too brief and this resulted in the client injuring themselves.  In other cases, the client may not mention anything about communication when lodging their complaint, yet when the incident is investigated it’s found there has been a communication breakdown between the fitness professional and the client.  Fitness professionals need to focus not only on their technical knowledge but also their communication skills when communicating any information to clients. 

Don’t underestimate the risk of poor exercise selection and prescription

Exercise has the potential to provide a great deal of enjoyment whilst also providing health and fitness benefits.  However, Guild’s experience in managing fitness claims provides evidence that there are also significant risks attached to exercise; clients can suffer life changing injuries.  Yet this doesn’t mean we should stop exercising, it means we need to pay closer attention to the risks of exercise and put in place risk mitigation strategies to reduce the likelihood of these injuries occurring.  Hoping a client won’t be injured isn’t enough.  The risk of exercise needs to be understood and mitigated.

Work within your scope of practice

Fitness professionals need to be sure they understand, and work within, their scope of practice.  This means knowing what they’ve been trained to do and are competent in.  Giving advice outside this scope will potentially be creating a risk for the client which in turn becomes a risk for the professional.  Fitness professionals need to be sure that regardless of what information or program the client has requested, they only plan and deliver exercise programs within their scope.  If the client’s needs or requests are outside of this, the professional needs to seek assistance or refer the client to someone else.  Fitness professionals need to remember they’re responsible for all professional advice and guidance they provide, so they should never allow themselves to be coerced into doing something they know they shouldn’t.

Keep records of sessions

It’s important to keep a record of your sessions with clients.  This means maintaining an accurate and detailed history of what exercises your client has performed and the specifics of those exercises in terms of weight, height, sets, repetitions etc.  It also means you have details of how successfully the client performed those exercises and if there were any issues such as injuries.

Records of your sessions with clients serve two key purposes:

1. Continuity of service – this means you don’t have to rely on your memory to recall what took place in previous sessions, you have a documented history which will help guide you and your client in future sessions.
2. Defence of an allegation – if there is an allegation against you of wrongdoing, your records will assist in your defence as they provide evidence of what actually took place.

Balance encouragement and pushing too far

It’s quite common to hear clients allege their trainer pushed them too hard when they had told the trainer the exercise was beyond their capability and this led to them suffering an injury.  But where is the line between encouraging a client to challenge and improve their fitness and pushing too far that it becomes a risk?  Unfortunately, this line isn’t always obvious.  Therefore, fitness professionals need to be sure they’re tailoring all they do to each individual client and watch for signs that the client is struggling to a point of potential harm.

Balance creativity and risky

Like all good business people, fitness professionals are continually looking for new and different offerings for their clients and ways to set themselves apart from their competitors.  However, this ingenuity can create new risks for the business.  The risks of any new offerings need to be carefully considered before being put into place; think about what can go wrong before it does.  Guild has seen many claims where clients have been seriously injured undertaking an activity where it could be argued that the risks of the activity outweigh the likely benefits.

Be proactive with managing risks

Guild has seen numerous cases where the fitness professional has identified a potential risk or hazard, such as a pothole where clients are jogging, or weights being left on the floor rather than on racks, yet they’ve put in very little, if any, effort to manage that risk.  Warning clients to avoid a pothole whilst running is not proactively managing a risk.  Moving the clients away from the area where there is a pothole is going to be much more effective in preventing an injury.  When a risk assessment is done, and this leads to risks being identified, fitness professionals need to be sure they’re taking the necessary steps to reduce the likelihood of that risk eventuating.  Hoping it won’t happen isn’t enough.

And finally…

Don’t think it won’t happen to you.  No fitness professional is immune from the risks involved in training clients.  The more aware a professional is of what could possibly go wrong, the more equipped they are to prevent it.

Fitness professionals and their risks

Guild Insurance is a leading insurer of early learning centres in NSW. The responsible service of alcohol at meetings, fundraising events or social gatherings is something our clients frequently enquire about.

The following information highlights the risks faced by centre managers, committee members and staff when making decisions about the service of alcohol at events. However, if you are unsure about anything to do with the service of alcohol, you should seek legal advice.

Serving alcohol at events held by child care centres

• Guild recommends avoiding serving alcohol at events. If you do serve alcohol, you may be in breach of liquor licencing laws. Importantly, the centre and its committee members could be exposed to personal legal liability.
• The service of alcohol is highly regulated in NSW. To serve alcohol a current liquor licence is required and relevant people must complete an approved responsible service of alcohol (RSA) course.
• If you would like to hold an event that includes the service of alcohol, it is recommended you hold the function at licensed premises.

What if people bring their own alcohol to events?

Guild also recommends you prohibit committee members, parents or visitors from bringing any alcohol to events that have been organised by the centre.

While it might seem a safer option for people to bring along their own alcohol, it certainly does not remove the risk of legal liability attaching to the centre or members of the committee. If a committee member, volunteer or staff member was to be injured, or cause injury to someone else after consuming alcohol, a court may deem the staff and / or committee partly responsible. The court may also see the centre as encouraging a culture of drinking at such an event, or the centre and its committee not taking reasonable steps to avoid the incident giving rise to the injury. Therefore, Guild strongly recommends that you prohibit all alcohol consumption at any centre events, both in and out of business hours.

Early Learning Centres and Alcohol Consumption NSW

Managing Patient Expectations in Dentistry

Dispensing Errors Can Happen To Anyone

 

All early learning centres would be well aware of the expectation and legal requirement for them to provide a safe environment.  But what does this actually mean?  How can anyone be sure their business really is safe?  And what would it mean if your business wasn’t and an incident occurred?

Guild Insurance has been insuring early learning businesses for many years and this experience has provided us with a great understanding about the risks faced when an environment isn’t safe.  Unfortunately, this experience also tells us that despite best efforts, many early learning centres aren’t as safe as they could or should be.

What is a safe environment?

When many of us think about an early learning centre being safe, the first thought is often around the physical environment for children.  There are many obvious physical risks for children and Guild Insurance unfortunately sees numerous claims where children have been physically harmed.  But this is just one piece of the safety puzzle.

All businesses need to be free from dangers and hazards for all people who attend or use the business.  This means that early learning centres have an obligation to children, staff and anyone else who attends, such as parents.  And safety extends beyond physical.

Children need a centre where the likelihood of them being physically injured is low.  They also need to feel happy and nurtured.  They need to be able to learn and develop as they move through their childhood and develop social skills.  They need to feel respected as an individual whilst learning to respect and appreciate others as individuals too.  They need an environment where they can thrive as young people.

Staff also need an environment which is physically safe.  With the physical work required in early learning, injuries to staff are unfortunately not uncommon.  Staff also need a workplace which is supportive and enables them to perform their best.  They need opportunities to develop and grow as a professional and to feel that their contribution to the workplace is valued and appreciated.

It may come as a surprise to learn that visitors, such as parents, have been injured whilst at a centre. Therefore, a safe physical environment is important to them as well.  Parents will also want to be sure that the centre is a safe and secure environment for their child.  They need to feel confident that their child is going to be well cared for and educated.

What can go wrong?

To be able to create a safe environment, you need to start by understanding what can make it unsafe.  This means you need to identify the possible risks and think about what could go wrong before it does.  Below are examples of what can go wrong as seen in claims managed by Guild Insurance.

• The tip of a child’s finger was been amputated when it was caught in a closing door.
• A child fell awkwardly when going down a slide.When landing at the bottom of the slide he suffered a fractured arm.
• A child’s hand slipped whilst climbing a climbing frame.She fell forward and bumped her mouth on the frame, breaking a tooth.
• A parent tripped in a pot hole in the car park and fractured his ankle.
• A staff member injured her back whilst lifting a child and needed a month off work to recover.
• A staff member believed he was unfairly dismissed and therefore lodged a complaint with the Fair Work Commission.

Why do things go wrong?

When trying to understand why an incident has occurred, at Guild Insurance we focus on ‘contributing factors’.  This is because there’s rarely one main cause for an incident but more likely many factors which have contributed to it occurring.  Addressing these factors can assist in reducing the likelihood of incidents occurring.  Below is a list of the common contributing factors identified by Guild Insurance.

• Not knowing or following relevant laws and regulations.There are quite a few laws which relate to operating an early learning centre.It’s vital that all staff, not just owners and managers, know what’s required of them.Centres should have their own policies and procedures for staff to follow, however the law must be reflected in these.Staff should be very familiar with the Education and Care Services National Law and National Regulations.However, it doesn’t end there.Staff also need to be aware of their obligations regarding employment law, privacy and work health and safety, just to name a few.
• Play equipment and furniture.Many injuries occur when children fall off or trip over play equipment and furniture.Furniture can also create a risk for staff and others at the centre.Therefore, it’s important that staff think about the type of play equipment and furniture in the centre, the condition it’s in and where it’s placed.
• Not noticing a potential risk before an incident occurs.If play equipment or furniture looks unsafe, it probably is.By regularly inspecting your centre you’re likely to identify risks before there’s an incident.Don’t wait for a child to suffer an injury; make changes to reduce the risk before this happens.
• Reliance on other people.When there are numerous people working in a centre at any one time, it may be easy for staff to think that someone else, especially someone more senior, will notice and address risks.However, all staff have a responsibility to contribute to reducing risks within their workplace.Therefore, all staff should be encouraged to speak up if they notice something which could potentially create a risk.
• Other children, staff or parents. Other people can contribute to incidents occurring.Children have fallen off play equipment when numerous children are playing on it at the one time.Staff have accidentally lifted a child awkwardly and injured the child.Children have left a centre when a parent has accidentally left the door open.Always be mindful of those around you and the potential risks in each situation.

Unfortunately, all risks can never be eliminated from early learning centres.  And we can’t guarantee that the most effective risk efforts will mean an incident won’t occur.  However, there is a great deal which you and your staff can and must do to create a safe environment and reduce the likelihood of an incident in your centre.

Is your early learning centre a safe environment?

Imagine if…

You receive an angry email from the parent of one of your clients stating they aren’t happy that you declined to provide therapy to their child and they’re considering making a complaint alleging discrimination.  You know you weren’t the most suitably qualified speech pathologist to provide therapy to that child and did the right thing in referring to someone else.  Therefore, you immediately reply to the parent informing them of your version of events.  Some time after this you hear from the parent again claiming they have now lodged their discrimination complaint.

Guild Insurance’s Liabilities policies state that as soon you, as the policy holder, experience a claim made against you or an incident which could give rise to a claim, you are required to notify Guild.  However, Guild is aware that some clinicians respond to complaints on their own without first notifying Guild.  This can have a number of consequences for these clinicians as they’re not receiving the support or guidance their insurance policy may entitle them to.  It can also mean the policy holder is not adhering to the conditions of the insurance policy.

Possible scenarios

The following scenarios are some examples of when you should notify Guild Insurance:

• If a private health insurer, or other funding provider such as Medicare, has requested access to your clinical records as evidence of billing practices.
• If a client has complained directly to you or your practice with a formal demand for compensation or suggested they’ll make a notification to a regulatory body.
• If a solicitor or law firm representing a client has requested access to your clinical records or notified you of a complaint.
• Any other circumstance where you have an uneasy feeling about an incident or situation; when in doubt, notify!
  

When to notify Guild

Clinicians are sometimes unsure whether a matter is serious enough to warrant notifying their insurance company.  There are some occasions where notifying an insurance company is a must, such as when there is a request for client records from a solicitor or funding provider or when there is an allegation of the client suffering harm following therapy.  However, when a client complains directly to you, this is when you need to use your judgement.  If the client has simply informed you that they didn’t respond as hoped to therapy provided previously yet doesn’t seem annoyed or demanding, then this may be a matter which can be sorted by you alone.  Yet if you’re in doubt or concerned about the complaint or allegation from the client or their family, then you should notify Guild.

Will my premium go up if I notify Guild of a matter?

Guild’s premium pricing is influenced by a number of factors.  Notifying Guild of an incident is unlikely to be the cause of a premium increase the following year.  However, as detailed below, not notifying Guild may lead to further stress and complications.  Therefore, the cost of the premium should not be a factor in deciding whether or not to notify Guild.  

Consequences of not notifying Guild

Facing an allegation or investigation of any sort can be an extremely stressful situation for a clinician.  When a clinician handles a matter themselves without the support of Guild, that stress is compounded as the clinician will be dealing with a process they’re unfamiliar with. 

Guild has seen many cases where a clinician’s own response has either not provided the required information, or a response has been written in a way which is likely to inflame or escalate the situation.  This usually leads to further investigations being conducted and Guild being notified after the investigation has begun, inhibiting Guild’s support and influence.

When a clinician doesn’t notify Guild as soon as is reasonably possible of a claim made against them, they may be considered to not be complying with the conditions of the insurance policy.  This can lead to cover under the policy being cancelled or the claim not being paid.

It’s also important to understand that a clinician may leave themselves with out of pocket expenses by not notifying Guild at the beginning.  This may occur if they engage their own legal counsel not approved by Guild and at a rate Guild believes to be exorbitant or if they have offered to settle a matter without Guild’s consent.

The staff at Guild Insurance have a great deal of experience and expertise in managing allegations and investigations and are well aware of what is required when responding to them.  For this reason, it’s of benefit to everyone involved to notify Guild immediately and be sure the necessary support is provided and process is followed from the start.

How to contact Guild Insurance

To notify Guild of an incident, and therefore make a claim against your insurance policy, either call Guild on 1800 810 213 or go to guildinsurance.com.au/claims.

Notifying Guild of a claim - Speech Pathology

We hear it all the time – a disaster has ruined lives and businesses. 

Too often people unfortunately seek comfort in the belief that ‘it could never happen to me’. Yet claims reported to Guild Insurance tell us otherwise. They remind us that businesses suffer losses every day. 

Some business owners have unrealistic expectations about how they’ll cope if the unthinkable happens. Businesses are often surprised at just how much they’re impacted when a disaster occurs. This is why planning for a disaster is vital. Once something happens, the time to prepare has gone. All businesses need to be realistic about what can happen and be proactive in putting risk management strategies in place.

Matters to consider when preparing for a bushfire 

• Understand your risk of a bushfire based on location and current weather warnings 
•  Know the safest route out of your local area > Understand bushfire danger ratings and what they mean > Follow and adhere to bushfire warnings when issued
• Have a plan, and rehearse it, for what to do in the event there is a bushfire. This plan includes but isn’t limited to:
  • Being ready and willing to leave early before you see signs of fire, allowing for how fast fires can travel
  • An evacuation plan which needs to consider not only staff but any clients or other visitors who may be on the premises
  • An emergency items kit which is packed at all times and includes all emergency contact phone numbers, mobile phone chargers and a first aid kit 
  • Shelter options in the event you’re unable to leave
  • Be sure all staff are involved in preparing the business for a bushfire 
  • Understand what you’re insured for in the event of a fire; contact your insurer if this needs updating

Bush fire preparation resources 

Each state’s country or rural fire services have a range of resources to assist business and individuals prepare for and cope with a bushfire. To utilise these resources, visit rfs.nsw.gov.au to ensure you’re as prepared as you can be.

How to Lodge a claim

In the event you need to lodge a claim click here or call us at 1800 810 213 for assistance.

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