The OMS Malpractice Claims Process: What to Expect

Malpractice claims can be overwhelming and confusing for oral and maxillofacial surgeons. However, knowing how to navigate the process ahead of time can help you better prepare to manage a claim. Let’s break down the malpractice claims process so you can practice with greater confidence.

The malpractice claims process for OMS

A malpractice claim arises from an accusation that care provided by an OMS failed to meet the standard of care–which is the direct cause of an injury or injuries–and is typically brought forward by a patient, a patient’s family, or a patient’s attorney. Claims are usually handled between the two parties through the oral surgeon’s malpractice insurance carrier and the complainant.

Choosing a trustworthy malpractice insurance carrier with a strong claims team is one way you can prepare for any future claims made against you. It’s also helpful to know what to expect, so you understand the steps to take in the event of a claim. The process described below is what you can expect to occur when facing a malpractice claim.

1. Reporting a claim to your malpractice insurance carrier

Notice of a claim can come from either a patient or their attorney. In both scenarios, you should report it to your malpractice insurance carrier immediately.

2. Delegation of a claim

Once a claim is reported, it will be assigned to a claims consultant. Depending on the particularity of a claim, an attorney may be assigned to assist with the claim.

3. Initial contact with claims consultant

You will be contacted by a claims consultant who will go over the case with you, gather more information, and verify that your policy covers the claim.

4. Preparation for the claims process

In preparation for your involvement in the claims process, there are some things you can do.

• Gather all your documents/records about the treatment of the patient. Never alter your records – that includes adding, removing, or changing any information.
• Avoid speaking about the claim to others. Only speak to representatives from your insurance carrier and any involved attorneys about it.
• If you or your practice receives any further communication from the patient, let your insurance carrier know immediately. Advise the patient that communications need to go through your malpractice insurance carrier.

5. Investigation and evaluation

Your claims consultant will speak to the patient or their attorney and will request from the patient all the relevant information to evaluate the claim, including:

• Dental and medical records from prior and subsequent medical or dental providers
• Any information they have to support their claim against you

6. Discussion of available options going forward

After the claims consultant has received all the patient’s records in support of the claim, they will evaluate the strengths and weaknesses of the claim being made against you. They will discuss the claim with you and will help you decide how to proceed from there.

MedPro Group helps OMS navigate claims with confidence

In the event of a claim, MedPro Group will be with you every step of the way. Our industry-leading claims team has a trial win rate of 95% and closes 80% of claims without payment.

It’s important to know that your insurance carrier will be there for you when it matters most. By understanding the claims process, you can feel more prepared should you ever be faced with a claim.

For more information about claims, connect with our team today.

All data is derived from MedPro Group records and calculations; claims data range is 2013-2022 unless otherwise indicated. MedPro Group is the marketing name used to refer to the insurance operations of The Medical Protective Company, Princeton Insurance Company, PLICO, Inc. and MedPro RRG Risk Retention Group. All insurance products are administered by MedPro Group and underwritten by these and other Berkshire Hathaway affiliates, including National Fire & Marine Insurance Company. Product availability is based upon business and/or regulatory approval and may differ among companies. © MedPro Group Inc. All Rights Reserved.