• 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
  • 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
     

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    business-interruption
  • 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
  • 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
  • Keeping podiatry chairs safe

    Not all podiatry claims are directly related to treatment; Guild Insurance regularly receives claims for injuries arising from podiatry chairs.  No one sets out to have someone injured in their care.  When it happens it can be distressing for you and your client.  People come to you for help; they don’t expect to be injured.  If they have a bad experience, they may never return to your practice and are likely to tell others of their misfortune.

    The following cases highlight how easily incidents can happen.

    Case 1

    A man fell from a podiatry chair when he bent forward to remove a shoe.  At the time the chair was raised to its maximum height, altering the centre of gravity.  The chair tipped and the man fell from a height of approximately one metre, landing on his left shoulder.  He suffered a fracture and as a result, could not work for an extended period. 

    Case 2

    An elderly woman attempted to move off the chair as the podiatrist was lowering it down.  She stumbled and fell, sustaining a laceration to her ankle.  Due to a long history of diabetes and peripheral vascular disease, the wound took many months to improve. 

    Case 3

    A client fell to the ground when the back rest of the chair suddenly gave way without warning.  The man landed on his head, suffering bruising and  serious lacerations.

    Reducing the risk of injuries

    Working with clients

    • Don’t assume clients will act safely on or around the chair, it’s not uncommon for clients to behave in a way you wouldn’t expect.
    • Ensure the chair is positioned at the lowest setting before clients enter the room.
    • If you leave the room, instruct them not to attempt to sit on the treatment chair, or the podiatrist’s stool, until you return. Have a conventional chair available.
    • Supervise people getting onto and off the chair. Instruct them not to attempt to reach out or get off the chair without your help.
    • Consider how a client’s size and weight may impact the stability of the chair, particularly when the chair height is raised.
    • Don’t let children play on, or under, the chair.
    • Consider the benefits of using signage to further alert clients to the dangers of not following safety instructions.
    • Ensure all staff have been educated about the risks of using podiatry chairs and how to use them safely.

    Maintaining or purchasing treatment chairs

    • 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.
    • Think about the age and suitability of your current chair(s).Is it suitable for safely treating obese or elderly clients?
    • Anchor the chair to the floor if possible.
    • Adhere to the manufacturer’s instructions. Obtain another copy of the manual if the original has been misplaced.
    • Regularly clean and service the chair according to the manufacturer’s guidelines.
    • When purchasing a new chair, consider the:
    • maximum weight it can safely accommodate
    • degree of stability the chair maintains as the height is raised, or if weight is transferred to the foot plate
    • ease with which arm rests can be retracted to help clients safely get on and off the chair
    • infection control risks and the ease with which it can be cleaned
    • importance of securely anchoring the chair to the floor
    • other safety considerations relevant to your practice.
    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 in early learning

    Excursions run by an early learning centre can have many benefits for the children involved.  It’s a change in their usual routine at the centre and can create unique learning opportunities.  However removing children from the relatively stable and secure environment of an early learning centre creates additional risks for the service to identify and manage.  Thorough planning is essential!

    Additional risks may exist when on an excursion because:

    • You’re in an unfamiliar environment and it may be difficult or impossible for you to alter or control the environment in terms of safety factors.  For example – if there is no fence around a lake in a park, you won’t be able to erect one to reduce the risk of a child entering the water.
    • Transportation will be required.  It may be in a vehicle such as a bus or it may be on foot if walking to the location.  Regardless of the mode of transport used, this transport will present risks not present when in a centre.
    • You’ll possibly be in the presence of members of the public.  This can create a number of risks such as children getting lost in a crowd or wandering off with other people.

    Tips for planning a safe excursion:

    • Be sure your insurance will provide the right cover for your excursion.
    • It’s a requirement under the Education and Care Services National Regulations that a risk assessment be carried out prior to the excursion. You need to note the risks which have been identified and assessed and how you intend to manage them. An excursion risk management plan template is available from the Australian Children’s Education & Care Quality Authority (ACECQA).Your risk assessment is not limited to but must include the following:
      • The proposed route and transport for the excursion
      • Water hazards
      • The number of children and adults attending and any special skills required from the staff
      • The proposed duration of the excursion and activities to be undertaken
      • Items to be taken, such as a first aid kit and emergency contact details
    • Consider actually visiting the site whilst planning and conducting your risk assessment. This will provide you with a better understanding of how safe the site is and what the risks are.
    • Obtain written authorisation from a parent or another person named on the child’s enrolment record as having this authority.This is to be done after the risk assessment has been completed. Be sure the authorisation contains the required information as set out in the National Regulations.
    • Adhere to the required educator to child ratios. Whilst there is no requirement to increase this ratio whilst on an excursion, following your risk assessment you should consider if additional staff or volunteers may be warranted. If the activity involves potential high risk activities, such as water based activities, additional staff may help to reduce the risks.
    • Create a plan for how you’ll verify attendance numbers at various stages throughout the excursion.
    • The National Regulations require all early learning centres to have a policy regarding excursions. Be sure all of your staff are aware of this policy and refer to it when planning an excursion.

    ACECQA and state based regulatory authorities provide a great deal of information to assist services understand and adhere to regulations.  For further information please visit acecqa.gov.au or acecqa.gov.au/contact-your-regulatory-authority.

    accidents

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