Learnings from dental prosthetist claims.

Guild Insurance spends time analysing claims and/or complaints relating to treatment provided by dental prosthetists. This involves complaints made directly to the practitioner or practice as well as complaints to a regulatory body, such as Ahpra. This analysis helps Guild better understand several key details such as:

  • what the complaint or allegation is about
  • the factors that may not be mentioned in the complaint yet have contributed to the incident and therefore the complaint occurring
  • what could have been done differently to possibly avoid the complaint from occurring

This information is then used to develop risk messages for the profession, which are tips and strategies to reduce the likelihood of complaints being received. It’s important to understand that risk management can’t guarantee a poor outcome or complaint won’t ever occur. However, by adhering to the following messages, dental prosthetists are taking positive steps to reduce the likelihood.

Key risk messages

1. Ensure you make communication a key feature of your work

Guild’s claims analysis suggests that poor communication is a feature in almost all treatment-related complaints. Patients don’t often complain specifically about poor communication. However, when an incident is investigated, poor communication is quite often a factor. Practitioners must continually focus on their communication with patients, patient’s families where relevant, colleagues and other health professionals. Good clinical skills alone aren’t enough to make someone a safe and effective practitioner.

2. Manage patient expectations

It’s common to hear from patients who are unhappy with the look, feel and comfort level of a denture. It’s therefore important that patients have realistic expectations, as unrealistic expectations are rarely met. Unmet expectations will often lead to patients being dissatisfied and more likely to complain. It’s the responsibility of the practitioner to support the patient to have realistic expectations. Practitioners must remember that in most cases, patients won’t have the clinical knowledge and understanding they have. They should never assume a patient’s understanding regarding wearing a denture; there must be a conversation to ensure this.

3. Ensure assessments are thorough and treatment plans are appropriate

Thorough assessments seem like an obvious step. However, it’s not uncommon to see claims where the assessment hasn’t been thorough enough, leading to a treatment plan and prosthesis that isn’t ideal. Assessments shouldn’t be rushed, and details of the assessment, findings and treatment plan are to be recorded in the clinical record. Practitioners must be sure they don’t make assumptions or fall into routines. Remember, poor assessment usually leads to poor outcomes.

4. Be sure patients have given their informed consent to treatment

Patients must be given the opportunity to provide their informed consent to treatment. Informed consent requires a conversation between the treating practitioner and patient about recommended and alternate treatment options as well as the benefits and risks for each of those options. Informed consent should include informed financial consent which is a discussion about the expected costs of treatment. Details about the consent discussion need to be recorded in the clinical record.

5. Maintain adequate clinical records

Clinical records are a history and evidence of what took place, and they serve numerous purposes. They assist with ongoing clinical care, as no practitioner can remember how they’ve treated every patient in every consultation. They also assist as evidence, if a practitioner’s treatment is questioned by a patient, regulator, or private health insurer. And finally, they’re necessary for meeting the expectations of the Dental Board of Australia.

6. Know and adhere to all Ahpra requirements

As a health professional registered with Ahpra, it’s a dental prosthetist’s responsibility to make themself aware of what’s required. This means making the time to seek out and read the numerous codes and guidelines found on the Ahpra website (ahpra.gov.au). Some of these documents detail what’s considered best practice, while some information refers to the law. Not knowing this information is no excuse for not adhering to it.

7. Behave in a professional and appropriate manner

Complaints don’t always focus on clinical outcomes; they can also relate to the behaviour of the practitioner. These complaints include, among others, allegations of speaking rudely to patients, not listening to the concerns of a patient and blurring professional boundaries by having inappropriate conversations or interactions with patients. Practitioners must always be very mindful of their professional behaviour. They also need to understand, and adhere to, the professional standards set out in their Code of Conduct, which can be found at ahpra.gov.au/Resources/Code-of-conduct/Shared-Code-of-conduct.

8. Adhere to advertising requirements

Ahpra’s expectations regarding advertising are explained in the Guidelines for Advertising Regulated Health Services document which can be found at ahpra.gov.au/Resources/Advertising-hub. There are numerous complaints continually being lodged with Ahpra alleging health professionals are breaching these guidelines. Practitioners need to be aware that these guidelines specify what’s required under the National Law and non-compliance is a criminal offence for which hefty fines can be imposed.

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Don’t go it alone

Guild Insurance Limited ABN 55 004 538 863, AFS Licence No. 233 791. Guild Insurance supports your Association through the payment of referral fees. This article contains information of a general nature only, and is not intended to constitute the provision of legal advice. For more information call 1800 810 213. DEP576022 Learnings from Dental Prosthetist Claims RA 05/2026

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    While making your way through emails one evening, you come across one from Ahpra (Australian Health Practitioner Regulation Agency). It informs you that they’ve received a notification about you from one of your patients, alleging your treatment has caused harm. You’re shocked and confused; this has never happened to you before. You immediately notify Guild Insurance, knowing they’re there to support you during moments like this. However, the situation becomes more concerning when Guild informs you that your policy lapsed five months earlier.

    Could this happen to you? It’s easy to think not. However, Guild Insurance has noticed a worrying trend of practitioners failing to maintain instalment payments during the policy period, or to renew their policy.

    Ahpra’s registration standards

    Being covered by a professional indemnity insurance (PII) policy is a registration standard for all health professionals registered with Ahpra. This means that every practitioner must be covered by either their own PII policy or a third party arrangement. Section 129 of the Health Practitioner Regulation National Law states that:

    “A registered health practitioner must not practise the health profession in which the practitioner is registered unless appropriate professional indemnity insurance arrangements are in force in relation to the practitioner’s practice of the profession.”

    Section 130 of the National law details relevant events where, if they occur, a practitioner is required to notify their relevant Board within seven days after becoming aware of the event. PII arrangements no longer being in place is one of these events.

    It’s recommended that all practitioners review their Board’s Professional Indemnity Insurance Registration Standard which can be found on the Ahpra website: www.ahpra.gov.au.

    Implications of having no PII

    No cover for an investigation or complaint

    Most PII policies provide cover on a claims-made basis. This means that, regardless of when the alleged event occurs, if the practitioner doesn’t have a policy at the time they become aware of the complaint, they won’t be covered for that claim. Without a PII policy, the practitioner won’t have the support of a claims manager or lawyer, instead having to respond to the claim or complaint themselves, or pay a lawyer to do this for them. By not having a PII policy, this would also mean the practitioner has to self-fund any compensation payable to the patient, which can be quite costly.

    Breach of professional requirements

    As already mentioned, not being covered by a PII policy is a breach of Ahpra’s registration standards. Further to this, it can lead to practitioners making a false declaration at the time of registration renewal. At renewal, practitioners are asked to declare that they won’t practice without PII. If they continue practicing when there’s no longer a PII policy in place, this may mean they’ve made a false declaration. There are possible registration consequences for practicing without PII. This can include conditions placed on the registration, refusal of an application for registration renewal or suspension of registration.

    What can be done to prevent this?

    The team at Guild do all they can to make customers aware when their policy is due for renewal, or if the policy is going to be lapsed or cancelled due to non-payment of the premium. However, ultimately, the responsibility for maintaining PII cover sits with each individual practitioner.

    PolicyHub – Guild Insurance has an online self-service platform called PolicyHub where customers can access their insurance information. If you aren’t sure when you last paid your insurance premiums and you want to check when it’s due, logging onto PolicyHub is an easy way to keep yourself informed. This can be accessed via Guild’s website – guildinsurance.com.au/policyhub.

    Reliance on a third party – if a practitioner doesn’t hold their own PII policy and is instead covered by a third party’s policy (e.g. your employer’s), this doesn’t mean the practitioner isn’t responsible for ensuring they’re appropriately covered. Practitioners should discuss the policy with the third party to ensure, first and foremost, that they have a policy, but also that the level of cover is appropriate for the practitioner’s requirements.

    Set reminders – a common explanation for not maintaining insurance is that the practitioner has a poorly-managed inbox and doesn’t stay up-to-date with reading emails, meaning some are missed. If this might happen to you, think about how else you can be sure you won’t miss that renewal date. Setting a reminder in a calendar is one simple way to do this.

    Setting a reminder in your calendar is one simple way to help not miss your insurance renewal.

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    Responding to the statements on this checklist will help you evaluate your record keeping practice. ‘No’ answers are opportunities for reflection on and improvement of your processes.

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    Stay on the right side of Ahpra’s advertising requirements

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    These advertising requirements are set under Section 133 of the Health Practitioner Regulation National Law. Therefore, breaching an advertising requirement is a criminal offence for which prosecution and financial penalties can apply. For an individual, there may be a penalty of up to $60,000 per offence and $120,000 for a body corporate.

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    It’s incredibly important that all health practitioners and health practices who advertise a regulated health service make themselves fully aware of these requirements and what they need to do to comply.

    The information in this article summarises the key requirements, yet it’s important to refer to the information provided by Ahpra to be fully informed, which can be found at ahpra.gov.au/Resources/Advertising-hub.

    Within the hub, you’ll find the document titled Guidelines for advertising a regulated health service, published December 2020, which provides a wealth of information and guidance.

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    Ahpra defines advertising as ‘all forms of verbal, printed or electronic public communication that promotes a regulated health service provider to attract a person to the provider (practitioner or business).’

    This includes all forms of advertising such as websites, social media, flyers, billboards, signage and business cards.

    What’s not allowed?

    There are five advertising requirements regarding what’s not allowed in advertising according to the National Law (listed below as (a) through to (e)).

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    This requires advertising to be honest and factual, with consideration for the audience and their level of understanding. The information should be detailed as partial information has the potential to be misleading. The information also needs to be based on “acceptable evidence”; an explanation of this can be found in the Guidelines document.

    • (b) offers a gift, discount or other inducement to attract a person to use the service or the business, unless the advertisement also states the terms and conditions of the offer

    The terms and conditions need to be clear, not misleading and in language that can be understood by the intended audience. Details of price, and the services to be provided, must be easily understood.

    • (c) uses testimonials or purported testimonials about the service or business

    A testimonial, in this instance, refers to a positive statement about the clinical aspects of a regulated health service. Testimonials aren’t allowed as they’re often biased, subjective and misleading and won’t apply to all patients and their unique clinical situations.

    • (d) creates an unreasonable expectation of beneficial treatment

    Patients need to have realistic expectations regarding treatment outcomes. This means not making unsubstantiated scientific claims or overstating the potential benefit of treatment. It’s also important to not minimise the risk of harm by declaring treatment to be safe or risk-free, as all healthcare treatment carries some level of risk.

    • (e) directly or indirectly encourages the indiscriminate or unnecessary use of regulated health services

    Advertising shouldn’t encourage the public to buy or use a regulated health service they don’t need or is of no benefit. It’s important to not create a sense of urgency or encourage regular appointments when not clinically indicated.

    Use of titles

    Accuracy and detail in titles when advertising is important to be sure the public understand the qualifications and registration type of a health professional. And this information doesn’t have to be false to be misleading.

    All registered health professions regulated by Ahpra are protected titles under the National Law. Therefore, those titles can only be used in advertising by professionals qualified and registered under that profession.

    The use of protected titles extends to specialist registration. It’s considered that if a practitioner doesn’t hold specialist registration, using words such as ‘specialist’, ‘specialises in’, ‘specialty’ or ‘specialised’ may be misleading or deceptive and therefore in breach of the guidelines.

    “Doctor” (or “Dr”) isn’t a protected title and can be used by various types of health professionals. However, as the public have historically used this term to refer to medical practitioners, it could be misleading in advertising. Therefore, if the use of “Dr” doesn’t refer to a medical practitioner, it must be made clear the type of health professional it’s referring to.

    What you’re responsible for

    Health practitioners are responsible for compliance with advertising requirements when they have control over that advertising. This means that, for example, if a testimonial is posted on a practitioner’s social media page, they’re able to remove it and must do so; to leave it would be in breach.

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