According to MedPro, a leading medical malpractice insurance company, the average dentist gets sued at least once in their career. This means that a dentist will eventually go through the claims process and should understand what that process looks like. Over multiple articles, we are going to discuss that process. Today’s article is the first in that series; we are going to look at when to report a potential dental malpractice claim, because calling your insurance company to report a lawsuit or a potential claim is always the first step.

What Counts as a “Claim” vs. an “Incident”

A claim is usually easy to recognize: a written demand for money, a summons and complaint, a formal demand letter from an attorney. Nobody debates whether to report on those.

The gray zone is the incident, sometimes called a “potential claim” or “circumstance.” This is any event or communication that a reasonable dentist would recognize might lead to a claim later, even though no demand has been made yet. Your policy almost certainly contains language requiring or permitting you to report these, and this is where dentists get into trouble by underestimating what qualifies.

Will calling make my insurance premiums go up?

One question I get from dentists all the time is, “Will calling my insurance company cause my premiums to go up?” The answer is no. You will not be punished for reporting an incident. It’s what happens after the report, like a settlement or a judgment payment, that determines whether your premium rises. The report itself costs you nothing, so don’t let that fear keep you from picking up the phone. I wanted to address this early because it is a common misconception I hear from dentists.

The Triggers

As I mentioned earlier, the first step in the claims process is calling your insurance company. If there is an incident or a lawsuit, make that call as soon as possible. This is very important, so let’s go over the triggers that would warrant picking up the phone.

A lawsuit

The most dreaded trigger is a lawsuit being served to you. When you call your insurance company, they will take this very seriously and jump into action immediately, assigning a claims staff member to your case along with a defense attorney. These two members of your new team will guide you on what comes next as you navigate the lawsuit.

Adverse Clinical Outcome

This next trigger comes before a lawsuit or complaint is ever made against you. This is when an adverse clinical outcome happens, like extracting the wrong tooth or severing a nerve. When this happens, you know it will likely turn into a claim, so retain all records and documentation immediately, do not change anything, and call your insurance company to let them know what happened. They will get the process going so you are ready when that complaint or lawsuit arrives.

A patient threatening to sue

Throughout your career, a patient will likely threaten to sue you multiple times. This is just one of the risks of being a dentist. When this happens, even if the threat is meritless, you still need to call your insurance company and let them know what happened. If you don’t call and report it, the insurance company may refuse to defend and indemnify against the claim later. This reporting requirement is a feature of every malpractice policy, and it applies even when there is no lawsuit, just a threat.

A records request from an attorney
This trigger is the most common early warning sign that a claim is coming. When a request for a patient’s complete chart arrives from a law firm, or comes with an attorney authorization attached, there is a good chance a lawsuit is already being evaluated. Many dentists treat these requests as routine paperwork and mail the records off without telling anyone. Do not make that mistake. Before you send anything, call your insurance company and let them know about the request. They will guide you on how to respond and start preparing in case a lawsuit follows.

A demand letter
This trigger is the step between a threat and a lawsuit. A demand letter is when an attorney sends you a letter demanding money or a settlement before filing suit. Under most malpractice policies, this is considered an actual claim, not just a potential one, so this call is not optional. Some states also require a pre-suit notice of intent to sue, and that notice works the same way. If either one lands on your desk, call your insurance company right away and do not respond to the attorney on your own.

A state dental board complaint
This last trigger is a little different because it is not a malpractice claim, but it still warrants the phone call. Board complaints sometimes run alongside a lawsuit or come before one. The good news is that most malpractice policies include license protection or regulatory defense coverage, and calling your insurance company is how you activate it. The same phone call that starts a malpractice claim also unlocks this coverage, so do not try to handle a board complaint by yourself.

What to Do (and Not Do) When a Trigger Hits

1. Secure the record as is. Do not alter, supplement, or “clean up” the chart after the fact. Altered records are the fastest way to turn a defensible case into an indefensible one.
2. Don’t admit fault or negotiate on your own. Expressing empathy is fine and often wise; statements like “I made a mistake,” or unilateral refund offers with no release are not. Get guidance first.
3. Notify promptly and in writing. Call your carrier’s claims or risk-management line, then follow the written notice procedure in your policy. Include the patient’s name, treatment dates, a factual description of the event, and why you believe a claim may result.
4. Loop in your agent. We can help you frame the report, confirm what your policy requires, and make sure related coverages are being used properly.
5. Report before you switch or renew. If you’re changing carriers or your renewal is approaching and there’s anything simmering, report it under the current policy first. This is non-negotiable.

The Takeaway

Reporting a potential claim is not an admission that you did something wrong. It is how you activate the protection you have been paying for. The dentists who get burned are rarely the ones who reported too much. They are the ones who waited, hoped it would go away, and gave their insurance company a reason not to stand behind them. If any of these triggers happen to you, make the call. And if you are ever unsure whether a situation rises to that level, call your agent. A ten-minute conversation now is always better than a coverage problem later.

Now that you know when to report, the next article in this series will walk through what happens after that phone call, from the moment your claims team is assigned to how a claim gets resolved. Stay tuned.

Insurance by dentists specializes in insurance for dental practices and DSOs. If you have a situation you’re unsure about, or want a second set of eyes on your current malpractice policy’s reporting requirements, contact us.