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

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