• Notifying Guild Insurance of a claim - your requirements

    Imagine if… you are advised by AHPRA that a patient has complained about the treatment you provided, suggesting it was performed negligently. As you’re sure your treatment was appropriate, you immediately reply to AHPRA informing them of your version of events. Some time after you hear from AHPRA again stating that they still have questions about your treatment and will be investigating further.

    Guild Insurance’s Liabilities policies state that as soon as 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 has noticed a worrying trend where practitioners are responding to complaints on their own without first notifying Guild. This can have a number of consequences for these practitioners 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 AHPRA has notified you of a complaint from a patient or other person and AHPRA has asked you to reply with your version of events.
    • 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 solicitor or law firm representing a patient has requested access to your clinical records.
    • If a patient 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 such as AHPRA.
    • Any other circumstance where you have an uneasy feeling about an incident or situation; when in doubt, notify!

    When to notify Guild

    Practitioners 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 replying to AHPRA following an allegation, when there is a request for patient records from a solicitor or funding provider or when there is an allegation of the patient suffering harm following treatment. However, when a patient complains directly to you, this is when you need to use your judgement. If the patient has simply informed you that they didn’t respond as hoped to treatment following their previous appointment 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 patient, 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 practitioner. When a practitioner handles a matter themselves without the support of Guild, that stress is compounded as the practitioner will be dealing with a process they’re unfamiliar with.

    Guild has seen many cases where a practitioner’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 practitioner 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 practitioner 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

    Disclaimer

    Guild Insurance Limited ABN 55 004 538 863, AFS Licence No. 233 791. This article contains information of a general nature only, and is not intended to constitute the provision of legal advice. Guild Insurance supports your Association through the payment of referral fees for certain products or services you take out with them. RHQ21092 Notifying Guild Insurance of a claim 01/2019

    accidents
  • Your work health and safety obligations

    Every workplace has legal requirement to ensure a safe environment for everyone.

    Your work health and safety obligations

    Here are some simple points to remember.

    GLD3552_Obligations_Diagram_012016

    accidents
  • Commenting on other dentists' work

    Generally, dentists will treat a patient who has had work carried out by another practitioner at some point in their career. During this time, you may have an opinion regarding the standard of work undertaken or the outcomes of treatment provided.

    It is important that you remain professional at all times, no matter what your opinion is. Unprofessional comments or uninformed opinions can also reflect poorly on you as a practitioner and the dental profession as a whole.

    If you find yourself in this position, here’s some tips to help you maintain your professionalism:

    1. Avoid making ‘off the cuff’ comments or judging others work. Even the smallest comment could lead to a complaint about the other dentist or a request for compensation.
    2. If the treatment provided does not appear to have reached the desired outcome, do not assume that the other dentist is at fault.
    3. If you have concerns about the treatment provided, it is good practice to request permission from the patient to you speak to the other dentist involved.
    4. When sending patients back to the referring practitioner, don’t rely on the patient to communicate any clinical information. Always provide written documentation outlining the full diagnosis and treatment provided.
    5. Always ensure your clinical records are maintained. If your work is questioned by a patient, another dentist or AHPRA, clinical records will act as evidence to support your decisions.
    6. Further treatment can be very expensive. Always be very clear and upfront about the costs involved.
    7. Avoid offering free or discounted treatments. This may imply that the initial treatment was ineffective or performed poorly.

    For more information, contact your local ADA branch or call 1800 810 213.

     

    Disclaimer
    Guild Insurance Limited ABN 55 004 538 863, AFS Licence No. 233791. This article contains information of a general nature only, and is not intended to constitute the provision of legal advice. 

     

    accidents
  • What would happen if you can’t operate your business? Part 2

    The threat of storms and fire are obvious threats to any business; however it’s often the seemingly harmless incidents which can severely affect a business’s operations. Events such as prolonged unforeseen power outages, burst water pipes or a sewage leak can all wreak havoc on your business.

    However, there are ways you can attempt to minimise the effects of interruptions to your business.

    1. Identify ways in which your business may be vulnerable to an interruption.

    > For example, conduct regular building inspections and ensure preventative maintenance programs are in place.

    2. Develop a critical tasks checklist to follow in the event of a major disruption.

    > Include items such as diverting phones, photographing damage, securing stock and other assets.

    3. Maintain a list of critical contacts to call when an interruption events occurs.

    > Include staff, landlords, contractors, security providers, local council, suppliers and details of your insurance provider.

    4. Produce an essential items kit of things you might need in an emergency.
    > A site map of your premises showing the location of electrical switchboards, hot water service, water and gas shut-off valves and emergency exits.

    > Instructions for restoring IT systems and hardware.

    > Instructions for accessing updates from key government agencies such as CFA, SES, Bureau of Meteorology.

    > Emergency provisions such as a torch, mobile phone charger, and a battery operated radio.

    5. Maintain an accurate list of current assets.

    6. Regularly back-up electronic records and ensure a copy is securely stored offsite.

    7. If an event does occur, record evidence of any damage before beginning the clean-up.

    If you would like information on how Business Interruption cover can help you, simply contact Guild Insurance on 1800 810 213 or visit guildinsurance.com.au
     

    DOWNLOAD AS PDF

     

     

     

    business-interruption
  • Dealing with a claim - an early learning perspective

    A personal text message from the daughter of one of our claims consultants led to the safety of a childcare centre – all before the centre had even contacted us.

    At Guild it’s about getting you back up and running as soon as humanly possible – at the heart of all that we do is you our customers. But don’t just take our word for it – learn more about the Guild difference when making a claim.

    claims
  • Dealing with a claim - a fitness centre perspective

    When a mirror was accidentally cracked by a member at Gideon’s gym, he immediately rang Guild Insurance… and that’s where we kicked into high gear.

    At Guild it’s about getting you back up and running as soon as humanly possible. At the heart of all that we do is you – our customer. But don’t just take our word for it, learn more about the Guild difference when making a claim.

    claims
  • Making a claim following a major disaster

    When Tropical Cyclone Debbie hit the east coast of Australia in 2017, she undoubtedly brought with her devastation to local residents and businesses across the state of Queensland.

    Then her aftermath of flooding across both Queensland and New South Wales made the damage of this ongoing catastrophe even more acute. However, that was just the beginning of our story…

    At Guild it’s about getting you back up and running as soon as humanly possible – at the heart of all that we do is you – our customer.  Learn more about the Guild difference when making a claim.

       

    claims
  • Poor clinical records can make you an easy target for complaints

    Keeping up-to-date and accurate records plays a vitally important role in providing care.
    Clinical records improve the level of treatment provided as well as providing evidence against any complaints or allegations of wrongdoing.

    Below are four simple tips for good record keeping.

    Clinical records engagement infographic

     DOWNLOAD AS PDF

    clinical-records
  • AHPRA, advertising and breaches: be safe not sorry

    Breaches of National Law are serious and Australian Health Practitioner Regulation Agency (AHPRA) are very active in ensuring that registered health professionals are compliant.

    Any breach of section 133 can have far-reaching consequence’s ranging from fines and penalties to prosecutions.

    This document explains what avenues are available to AHPRA for advertising breaches, and provides some real life examples of how and why some practitioners have been found to be in breach by the regulator.

    Download now

    advertising
  • Poor clinical veterinary records can make you an easy target for complaints

    Keeping up-to-date and accurate records plays a vitally important role in providing veterinarian care.
    Clinical records improve the level of treatment provided to an animal, plus provide evidence against any complaints or allegations of wrongdoing.

    Below are four simple tips for good record keeping.

    Vets clinical records engagement infographic

     DOWNLOAD AS PDF

    clinical-records
  • How nurses can avoid gaps in cover

    As a Nurse, you deserve to be safe in the knowledge that your reputation is protected with your own individual cover. Find out how taking your own policy out can ensure that you stay in control, no matter what your individual circumstances are.

    claims
  • Do you have the right insurance for your fitness business?

    Sally began her career as a personal trainer in 2012. With high hopes and wanting to make sure she did the right thing Sally purchased an exercise professional liabilities policy. Her hard work and focus paid off and a few years later Sally opened the doors to her very own fitness studio. Sally didn’t think to change her individual policy to a fitness centre business insurance policy and continued to renew her insurance annually.

    In February 2016, a personal trainer at Sally’s gym put down a barbell behind another client who wasn’t aware that it is was there, the client tripped over it, hit her head on the floor and was knocked unconscious.

    The personal trainer immediately called 000. After the paramedics arrived, the client was taken to hospital and underwent emergency spinal surgery.

    Two months later, Sally received a letter from the client’s lawyer requesting reimbursement for the ambulance, medical expenses, loss of earnings and pain and suffering. The letter also recommended that Sally should contact her insurer. Taking this advice, Sally informed her insurer and began the claims process.

    After reviewing her cover, Sally found that she held the incorrect policy and unfortunately wasn’t covered for any of the costs arising from the accident. This meant that Sally was held personally responsible for all expenses incurred – the costs nearly ruined Sally’s business. She has since purchased a Guild Fitness business insurance policy to suit her new circumstances, but is still to this day recovering financially from the incident.

    You can learn from Sally’s mistake. Keep in mind if you do change from being an individual fitness provider to a business owner, you need to make sure you’ve got the right cover.

    Not sure if you’re on the right policy for you, call us on 1800 810 213. We’d be happy to help.

    The above case study is based on general claims scenarios and do not reflect any particular claim. Names are fictitious and any resemblance to a real person is purely coincidental.

    accidents
  • Do you understand your dispensing obligations?

    Over time, we all develop our own way of doing things and the workplace isn’t any different. Good and bad habits can be passed on to new staff, sometimes without even considering if the practices are still relevant and appropriate. Every year we work with many concerned pharmacists who have been reported for breaching laws. They are often unaware that their behaviour may have led to disciplinary action. Below are four common scenarios that might surprise you.


    Download Full PDF

    claims
  • Avoiding children's fingers getting caught in doors

    Children are curious by nature and too often that curiosity can end in tears. Unfortunately, little fingers can easily get caught in everyday objects like doors and hinges.

    Although finger injuries are easily preventable, they can have serious consequences, including fractures, stitches and even amputation!

    Here’s five simple things your centre can do to lower the chances of little fingers getting stuck in doors.



    accidents
  • Can podiatry chairs be a workplace hazard?

    Reducing hazards in your workplace not only protects you and your staff from injury, but also your patients.

    At Guild Insurance, we continue to receive claims for injuries arising from the use of podiatry chairs and other equipment and furniture in treatment rooms.

    Claims are made by patients who may have fallen down stairs, tripping over an unsecure electrical cord, or even falling off the furniture – the list goes on.

    This can be a shock to both you and the patient since people come to you for help; they don’t expect to be injured.

    Whilst much care is taken by you to keep your office safe for everyone who visits, there are always more ways to ensure the safety of staff and patients alike.

    Educate your staff and colleagues about the risk of injury when using patient chairs.
     

    Maintaining a safe environment is everyone’s responsibility:

    • Ensure the chair is positioned at the lowest setting before a patient enters the room.
    • Consider how a client’s size and weight may impact the stability of the chair, particularly when the height is raised.
    • Do not allow children to play on, or under, furniture and equipment in the office.
    • Reduce clutter in and around the treatment area. Keep equipment or other objects away from the chair’s foot switch to avoid accidently activating the pedal.

    Remember, accidents do happen but it’s always best to be prepared for what may happen.

    accidents
  • Tripping out: Reducing hazards in the workplace

    Reducing hazards in your workplace not only protects you and your staff from injury, but also your patients.

    At Guild Insurance, we continue to receive claims for injuries arising from the use of practice chairs and other equipment or furniture in treatment rooms.

    Claims are made by patients who may have fallen down stairs, tripping over an unsecure electrical cord, or even falling off the furniture – the list goes on.

    This can be a shock to both you and the patient since people come to you for help; they don’t expect to be injured.

    Whilst much care is taken by you to keep your office safe for everyone who visits, there are always more ways to ensure the safety of staff and patients alike.

    Educate your staff and colleagues about the risk of injury when using patient chairs.
     

    Maintaining a safe environment is everyone’s responsibility:

    • Ensure the chair is positioned at the lowest setting before a patient enters the room.
    • Consider how a client’s size and weight may impact the stability of the chair, particularly when the height is raised.
    • Do not allow children to play on, or under, furniture and equipment in the office.
    • Reduce clutter in and around the treatment area. Keep equipment or other objects away from the chair’s foot switch to avoid accidently activating the pedal.

    Remember, accidents do happen but it’s always best to be prepared for what may happen.

    accidents
  • How rushing affects dispensing processes

    Meet Kim.

    Kim recently took over a busy pharmacy in outer Melbourne. Just like any new job, it took Kim a few weeks to settle into her new role.

    When rush hour leads to rushed processes

    At 5.30pm on a Friday afternoon Kim was the only pharmacist left in the dispensary. A customer arrived with her repeat script and was eager to pick up her Enablex 7.5mg script and catch her train home.

    To speed up the process, the dispensary assistant grabbed the medication off the shelf and handed both the script and the drug to Kim. Just like any other day, Kim scanned the barcode on the script, checked the label against the packaging and gave it to the customer.

    Why did AHPRA get involved?

    Nearly three weeks later, she received a letter from AHPRA notifying her of a complaint. An error was made when the original script was first dispensed, but because Kim didn’t check the repeat against the original, she didn’t notice the previous error and made the same mistake – Effexor 75mg was accidently dispensed.

    What happened next?

    Worried about any adverse effects for the customer and what it meant for the long term implications to her career, Kim contacted Guild Insurance immediately. As she had her pharmacy Business Insurance with Guild, the team was able to support Kim throughout the process and helped her formally respond to the complaint.

    Satisfied with the response, AHPRA did not take further action, but insisted Kim undertake additional training.

    The above case studies are based on general claims scenarios and do not reflect any particular claim. Names are fictitious and any resemblance to a real person is purely coincidental.

    accidents
  • Caught in the middle of feuding parents?

    Avoid being caught in the middle

    Generally, people under the age of 18 years are capable of consenting to health treatment if they understand the nature, consequences and risks of the treatment. Whether the child has capacity to consent will depend on the age, maturity and intelligence of the particular individual and the nature and seriousness of the treatment.

    Where the health practitioner concerned is of the opinion that the child is not capable of consenting, then either of the parents (or guardians) may consent to treatment, unless there is a Parenting Order to the contrary.

    In most instances, it will be the parent and not the child who is paying the costs of treatment. For this reason, in cases where there may be disagreement about the course of treatment to take and who will cover the costs, it is good practice for practitioners to draw up a treatment plan setting out the proposed treatment, the estimated costs, and who will be responsible for payment. The treatment plan can then be signed by the consenting parent and kept on the file.

    Practitioners should keep in mind that even where only one parent has consented to the treatment, both parents have the right to request access to the child’s clinical records (absent any Parenting Order to the contrary). By having a written treatment plan to hand, you can demonstrate to another parent (or guardian) who disagrees with the approach to treatment, that valid consent to the treatment has been given.


    This article contains information of a general nature only, and is not intended to constitute the provision of legal advice.

    claims
  • Funding provider audits and clinical records

    Funding providers are looking to investigate over-servicing and poor records can make you an easy target. Give yourself the best chance to avoid a claim being made against you.

    claims
  • Planning an excursion? There are some important tips to follow.



    Excursions offer many benefits for children attending early learning centres.

    They’ll be able to experience new sights, sounds and smells, as well as unique learning opportunities. However, there are risks associated when planning early learning excursions.

    What are the risks?

    Unfamiliar environment

    You’re in control of the environment at your early learning centre, however the same cannot be said when you venture outside of the centre.

    For example, you are visiting a park and there isn’t a fence around a lake. You won’t be able to easily prevent a child entering the water.

    Transport

    Regardless of the type of transportation used (i.e. walking, driving), there will certainly be associated risks that you need to be aware of.

    For example, crossing the street if walking and traffic hazards if driving.

    General public

    It can be quite easy for a child to get lost in a crowd, as well as a child wandering off with a stranger.

    Planning is essential

    Firstly, it is imperative you have the right insurance to protect you, your business and the little ones you care for.

    There is an extensive list of what you need to plan for prior to any excursion you organise, including but not limited to:

    • Written permission from the parents/guardians of the children in your care;
    • Ensure you have adequate educator to child ratios, possibly even consider additional staff/volunteers;
    • Schedule for checking attendance throughout the excursion; and
    • Ensure all staff and volunteers are aware of health and safety procedures.

    It’s the law

    The Australian Children’s Education and Care Quality Authority (ACECQA) has prescribed a set of National Regulations regarding early learning, including extensive risk assessment guidelines for excursions.

    It is a requirement to carry out a risk assessment prior to the excursion you are organising.

    State-based regulatory authorities also provide a great deal of information to assist early learning centres with their obligations.

    For further detail on the National Regulation, and to download the ACEQUA risk assessment template, visit www.acecqa.gov.au/regulatory-authorities1/contact-your-regulatory-authority.

    For more information on Guild Insurance and how we can help you, simply contact 1800 810 213.
    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.

    accidents

Similar Articles

Exception occured while executing the controller. Check error logs for details.