|Year : 2014 | Volume
| Issue : 2 | Page : 44-48
Professional indemnity insurance used among graduated and post graduated dental surgeons in Mumbai city, India
Dhaman Gupta, Susan Thomas, Rushabh Dagli, Jitender Solanki, Geetika Arora Bhateja, Rajeev Mahajan
Department of Public Health Dentistry, Vyas Dental College and Hospital, Jodhpur, Rajasthan, India
|Date of Web Publication||4-Feb-2015|
S-1141, Ashiyana Amarbagh, Pali Road, Jodhpur, Rajasthan
Source of Support: None, Conflict of Interest: None
Aim: To determine the utilization of dental indemnity insurance among oral health professionals in Mumbai city. Materials and Methods: A cross-sectional survey was conducted in February 2014. A total of 306 dental practitioners were selected as the study population by simple random sampling technique. The dental practitioners were visited by a single examiner and all the available and willing participants were given the close-ended questionnaire on the day of visit. The widely used questionnaire by "GLOBAL CHILD DENTAL FUND" for professional indemnity insurance was obtained from its website (www.gcdfund.org) and was modified according to the results of a pilot study. Chi-square was used to find the association of use of dental indemnity insurance by dental practitioners with age, gender, education, working sector, years of practicing dentistry, and whether dental practitioners know about dental indemnity insurance or not. Results: Significant association was found for dental indemnity insurance with increased age, education, years of practicing, private sector working dentist, and level of knowledge for indemnity insurance. 35.6% dentists felt it was not mandatory for each and every dentist, whereas 13.6% felt there was no need dental indemnity insurance. Conclusion : Most of the oral health practitioners in Mumbai city do not have dental indemnity insurance. So, there is a need of spreading knowledge and awareness to dental practitioners about the uses and benefit of dental indemnity insurance.
Keywords: Clinical practice, dentists, insurance, liability insurance, malpractice
|How to cite this article:|
Gupta D, Thomas S, Dagli R, Solanki J, Bhateja GA, Mahajan R. Professional indemnity insurance used among graduated and post graduated dental surgeons in Mumbai city, India. J Health Res Rev 2014;1:44-8
|How to cite this URL:|
Gupta D, Thomas S, Dagli R, Solanki J, Bhateja GA, Mahajan R. Professional indemnity insurance used among graduated and post graduated dental surgeons in Mumbai city, India. J Health Res Rev [serial online] 2014 [cited 2019 Dec 9];1:44-8. Available from: http://www.jhrr.org/text.asp?2014/1/2/44/150798
| Introduction|| |
The term "indemnity" means reimbursement or to compensate. The principle of indemnity is strictly observed in liability insurances. These insurances are designed to provide the insured person protection against the financial consequences of legal liability. 
An indemnity insurance is a contract of insurance by which the insurer promises to indemnify the insured on the occurrence of a defined event or events or against defined losses. The insurer will not necessarily be obliged to pay or indemnify the insured; unlike an investment life assurance, the obligation to indemnify will arise only if the event or the risk which is insured against occurs. If the insured event occurs and the insured suffers a defined loss, the insured must prove the loss because the principle of indemnity means that insured should be indemnified only to the extent of the loss. 
Prior to 1980s, the primary type of dental indemnity insurance was occurrence policy, but in the late 1970s and early 1980s, the claim-made policy proved to be a better option for the insurance companies. Today majority of the policies are on claim-made basis.
There are two types of professional indemnity insurance policies. The first type of indemnity insurance is the occurrence policy coverage type, in which all malpractice incidents are also covered. Even if the claim is reported after the policy has expired, the insurance company must still defend the insured and pay any judgment awarded by the court that does not exceed the policy limits, and the policy covers those incidents forever. The second type of dental indemnity insurance is the claims-made policy which requires the malpractice incident to occur and be reported while the policy is in force. For most policies, a claim is not considered to have been "made" until the insured notifies the insurance company of a potential malpractice situation. It is a means of improving the predictability of loss experience. This is accomplished by limiting the time frame over which rates must be projected, thus reducing the risks arising from inflation, evolving standards of professional care, and changes in the civil justice system. 
The Indian Dental Association launched the first professional indemnity insurance at the 65 th Indian Dental Association Conference held at Mumbai on 1 February 2012. This insurance covers legal liability arising from errors and/or omissions on the part of Registered Dental Practitioners while rendering professional service. The policy indemnifies any act committed by the insured, who shall be a Registered Dental Practitioner, giving rise to any legal liability to third parties. The insured includes the policy holder and his qualified assistants or employees as named in the proposal form.  The Indian dental insurance sector is in its nascent stages and currently only a handful of insurance companies are providing professional indemnity insurance, such as "The New India Assurance Company Limited", " The Oriental Insurance Company Limited", "National Insurance Company Limited with the Indian Dental Association", etc.
The Indian Dental Association with the National Insurance Company proposed premium for different specialties under different schemes. For a practicing general dentist, the premium is Rs. 600(Approx. 10 USD) + ST annually, which provides coverage of Rs. 3 lakhs (Approx. 5000 USD). For a specialist dentist (doing implant, major surgeries, high-end dental treatment, etc.), there are two types of insurance coverage: One type is the Professional Indemnity Insurance which provides coverage of Rs. 4 lakhs(Approx. 6667 USD ) with a premium of Rs. 800 (Approx. 14 USD) + ST annually and the second type has coverage of Rs. 5 lakhs(Approx. 8334 USD) with a premium of Rs. 1000 + ST paid annually. 
Patients today have become very much aware of their rights and are far more likely to question due to the Consumer Protection Act (CPA) of 1986, which was enacted for better protection of the interests of the consumers and to provide simple and quick access to redress consumer grievances.  The government has made the CPA more stringent than in the past years. The Medical Council of India launched its annual report on 30 May 2013 for the year 2012 and the report shows that the Medical Council of India received a total of 423 new complaints in 2012, representing a 12% increase from 2011.  These figures show an alarming situation and indicate the need for the all the practicing oral health professionals to get insured with the dental indemnity insurance.
In the ever-changing dental world, the role of dental indemnity is to assist, support, and protect dentists in the various challenges and threats that they face during their professional career. Any profession has two sides like that of a coin. It can bring fame or criticism as well. Often dentists start their practice at a young age without even knowing the complications that they can face in their career. It is only after going through years of their practice that they come to know this dark side of their profession. In fact, it takes a while before new dentists actually grasp the concept of dental indemnity insurance.
Dentist need to be aware of the various professionals' insurance policies currently available in the market, as to how and where to acquire these policies, the purchase cost, when to avail the policy, and various measures of safety and protection at the level of professional, personal, and financial disaster.  There have been very few studies on this issue, and hence, the present study was undertaken to find out the utilization of insurance policy among oral health professionals in Mumbai city.
| Materials and methods|| |
A cross-sectional survey was conducted in February 2014 to determine the utilization of dental indemnity insurance among oral health professionals in Mumbai city, Maharashtra state, India.
The total number of dental practitioners in Mumbai city was 5000. The subjects were selected by simple random sampling technique and all those who fulfilled the inclusion criteria became the study population, which numbered 306.
- Those who were qualified as BDS (Bachelor in Dental Surgery) or MDS (Master in Dental Surgery) were included in the study
- Those who were practicing dentistry in either government or private sectors were included.
- Those who were not willing to participate were excluded
- The clinics that were closed on the day of visit were excluded.
Ethical approval was taken from the ethical clearance committee of Vyas Dental College and Hospital (Jodhpur, India). The aim of the study was clearly explained to all the subjects and their informed consent was obtained.
Collection of data
The data were collected using a close-ended questionnaire on the day of visit. The widely used questionnaire by "GLOBAL CHILD DENTAL FUND" for professional indemnity insurance was obtained from its website (www.gcdfund.org) and was modified according to the results of a pilot study which was conducted on 30 subjects. It included questions on personal information, dental indemnity insurance, insurer, premium paid, compensation, and about maintaining patient records by the dentists.
The dental practitioners were visited by a single examiner and all the available and willing participants were given the questionnaire on the day of visit. The participants were asked to respond to each item according to the response format provided in the questionnaire. The examiner was available throughout the filling of the questionnaire to explain the question to the participants. Dental practitioners' identities were kept confidential.
Data were analyzed using SPSS version 17.0 software (SPSS Inc., Chicago, IL, USA). Chi-square test was used for the statistical analysis.
| Results|| |
The total sample size of the study was 306 and the response rate was 100%. There were no drop-outs.
[Table 1] shows that 59.1% of the study subjects were in the age group 55 years or older and were having professional indemnity insurance, whereas dentists who were of younger age group (18-24 years) were not keen on having professional indemnity insurance. The mean age of the study population was 43.5 years. In this study, 63.7% were male and 36.2% were female. Based on the level of education, 47.6% of those who had completed post graduation were insured, as compared to 10.3% of graduates. It was also found that 19.9% of the private practitioners were insured, as compared to government practitioners. There was a significant relationship of utilization of indemnity insurance with respect to increase in age, increased level of education, and the professionals in working sector.
|Table 1: Distribution of study subjects by age, sex, education, type of practice, and use of dental indemnity insurance|
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[Table 2] shows that 79.4% of the dental practitioners did not have dental indemnity insurance and 35.6% of the subjects felt that it was not mandatory to have professional liability insurance. Among those who had professional indemnity insurance, 11.4% dental practitioners came to know about the dental indemnity insurance through their friends and about 9.8% dental practitioners are paying a premium of Rs. 700-1400 annually.
|Table 2: Distribution of dental practitioners according to the knowledge of dental indemnity insurance|
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[Table 3] shows that 55.2% of the subjects knew about professional indemnity insurance and 29.4% of the dentists were of the opinion that it is mandatory only for those working in private set-up. In this study, 61.4% of the dental practitioners were of the opinion that Rs. 10,000-50,000 compensation should be paid to the patient for any unintentional mishap. Maintenance of patient record before and after treatment was done by 93.5% of the study subjects.
[Table 4] shows that 8.2% of the study subjects selected the insurer based on their friends' suggestions, and that 11.4% of the dental practitioners had opted for professional liability insurance for less than 5 years and 1% was insured for more than 10 years. The study shows that 8.8% of the dentists had insurance coverage of 3 lakhs and 4.6% had taken coverage of more than 3 lakhs. This study also shows that only 0.7% of the dental practitioners had to pay compensation for treatment negligence. Anticipation of post-treatment consequences is one of the major reasons that 7.5% of dental practitioners were willing to opt for professional liability insurance.
|Table 3: Distribution of dental practitioners regarding the awareness of dental indemnity insurance|
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|Table 4: Distribution of dental practitioners according to use of dental indemnity insurance|
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| Discussion|| |
This is the first study to present information about dental indemnity insurance in India. In the past, dental professionals were unaware of professional indemnity insurance. Therefore, no previous data is available to compare with the findings of this study. Not updating the professional knowledge leads to increased risk of failure in dental treatment and legal issues. In addition, the expanding patient population is becoming more knowledgeable and aware of their rights through electronic media in rapidly developing countries such as India. In many professions, it is a matter of concern that every year, the number of claims against professionals is on the rise. Earlier clients used to hesitate to sue their professional advisers for negligence, but today such hesitancy no longer exists as the public are more aware of their rights.
The findings of this study show a significant association found between use of dental indemnity insurance with increasing age and professional experience, as most of the budding practitioners were not aware of professional indemnity insurance. They start to understand the advantages of having professional insurance as they progress through years of dental practice, whereas experienced dental practitioners are aware of all the benefits and measures of safety to safeguard their profession and themselves. The utilization of professional indemnity insurance was significantly related to the educational level and the type of working sector. However, gender wise, no significant difference was found in the utilization of insurance coverage.
In our study, the total number of insured dental practitioners was 63. Among those who were not insured, two claims of treatment negligence were made against the oral health professionals. In one of the claims, an oral maxillofacial surgeon had to pay 10 times more compensation to the patient as the subject was not insured for professional liability insurance. After this incident, the surgeon purchased dental indemnity insurance. In the second claim, the study subject had to compensate with double the charges for root canal failure to the patient as the study subject did not update his insurance premium payment since 2 years. In a study conducted by Clark et al. in the US (1970), it was found that 1219 claims were made against dental professionals, out of which 990 claims were closed and only 229 claims remained pending, and the total number of insured dental personnel was estimated to be 1054. 
In this study, 55.2% of surveyed dental practitioners were aware of professional liability insurance while 44.8% were not having much knowledge of it. The study also shows that majority of the post graduate practitioners were insured, as compared to graduate practitioners. This is confirmed by the statistical significance (P < 0.001). In another study conducted by Scurria et al. in Italy, it was found that 33% of the surveyed professionals were unaware while 27% had a very poor knowledge of the professional liability insurance coverage subscribed. Their study showed that the medical specialists had a better knowledge of the insurance coverage in their contract. This is confirmed by the statistical significance (P value is 0.02). 
Dental records are an essential component serving as an information source for dentists in medico-legal, administrative, financial functions within the general practice, for quality assurance and audit. With the increasing awareness among the general public of the legal issues surrounding health care, in forensic purposes, and with the worrying rise in malpractice of insurance claim cases, a thorough knowledge of dental record issues is essential for any practitioner. The findings of the present study show that 93.5% of the oral health professionals were maintaining patients' records before and after treatment. Astekar et al. conducted a study in Rajasthan and observed that a very low percentile (about 38%) of the surveyed dentists maintained records. 
The limitation of the study was that there are high chances that many of the study subjects might have underreported cases for compensation as they were hesitant to be exposed.
| Conclusion|| |
Public awareness of dental negligence in on the rise. The importance of professional indemnity insurance as a preventive measure helps to avoid litigation and provide security to the dental professionals. Therefore, oral health professionals need to update their understanding on professional indemnity insurance and its amendments, as well as maintain their patients' records in order to be on a legally safer side.
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[Table 1], [Table 2], [Table 3], [Table 4]