UNDERWRITING GUIDELINES
(Editorial Revision 4/30/2014)
Underwriting Rules 4/18/79
Standard #1. The insured must be a licensed member of his profession in good standing with any review board appointed by his profession.
Standard #2. An applicant who has knowingly misrepresented any information on an application shall not be insured without approval of the Board of Directors.
Standard #3. The insured shall be a resident of the state of Utah
Standard #4. The insured must be licensed to practice his profession by the state Regulatory Agency responsible for licensing.
Standard #5. No policy shall be issued to a potential insured with a previous suit or claim without first having the policy approved by the Board of Directors.
Standard #6. The parties to the contract must be legally competent. Insane or intoxicated parties are not considered competent.
Standard #7. If the potential insured has not participated in any continuing education program within the last five years, his application must be reviewed by the Board of Directors. The Board will make a determination as to the potential insured’s competency.
Standard #8. Any professional that is not using standard acceptable procedures shall not be insured until application is reviewed by the Board of Directors. (Any experimental procedure or experimental instrument shall be considered as a deviation from standard acceptable procedures.)
Standard #9. Any “yes” answer to questions #9e, f, g, h, i, j, or k or #20 on the application shall be justification for a review of insurability. The applicant shall not be issued a policy until reviewed by the Board of Directors.
Underwriting Rules Revisions and Amendments
1. Dentists specializing in oral surgery shall not be covered, unless their practice is limited to those procedures that are performed by general dentists, such as third molar extractions, etc. 1/12/82
2. Specialists, including orthodontists, periodontists, pedodontists, endodontists, prosthodontists, and general dentists shall be covered in Class I if general anesthetics are not used by these practitioners. 9/22/82
3. Hygienists administering local anesthetics who are employees of the dentist may be covered under the dentist’s policy if they are certified to give local anesthetics and if the dentist pays and additional premium. Class I dentists will be given the new classification of Class I-H. Class II dentists will get the new classification of II-H. 3/27/86
4. Prior acts coverage shall be offered for prior years up to a period of four years. Rates are determined as per schedule filed with the Utah State Insurance Department. An additional requirement to be imposed shall be a signing by the prospective insured of an Affidavit stating that he/she has no knowledge of any pending claim or potential claim that will be brought against him/her for the time period for which prior acts coverage is being offered. 10/1/87
5. Beginning August 5, 1990, all professional liability policies for optometrists will be not be renewed upon the anniversary dates. Effective immediately, no new applications for optometrists will be accepted. 6/28/90
Entities, Group Practice, Moonlighting. 4/7/93
Professional Insurance Exchange Mutual, Inc. will not provide malpractice coverage for dentistry performed under the auspices of any profit or non-profit health care delivery organization such as FHP, University Hospital, or other comparable organization.
We will not provide malpractice coverage for dentistry performed by dentists acting as employees for the Public Health Service, Veterans Administration, or any other government managed entity that provides their own liability coverage.
We will not indemnify any group practice; we will provide malpractice insurance on an individual basis to each member of any partnership or group practice who pays their premiums in accordance with Policy rules.
We do not provide malpractice coverage for dentist employees of another dentist or organization under that individual or organization’s policy; every insured member of P.I.E. must purchase his/her own coverage and have in his/her possession an individual Policy.
Professional Insurance Exchange Mutual, Inc. does not indemnify affiliate organizations, eg. Sears, ZCMI. But we can provide individual coverage to dentists practicing within such facilities if they provide a signed statement certifying that they acknowledge that Professional Insurance Exchange does not indemnify the entity or employees of the employing entity for any occurrence.
Professional Insurance Exchange Mutual, Inc. does not indemnify any non-profit organizations, eg. Donated Dental Services Clinic or Salt Lake Community Health Center, for which Policyholders are employees or within which the Policyholder does volunteer work. Our malpractice policy will not indemnify the employees of such organizations, eg. dental assistants, hygienists, etc. The dentist employee is not responsible for the acts of any other employees under his or her supervision. The non-profit organization is responsible for providing liability insurance to cover property and acts of the entity or employees.
Professional Insurance Exchange Mutual will require a written statement (Refer to Indemnification Agreement) from any profit or non/profit organization for which an insured dentist acts as an employee or volunteer that certifies that the individual dentist is not responsible for any acts of that facility or its employees or any other personnel. We are responsible to indemnify only for the acts of the individual dentist who has purchased our policy.
If a dentist member of Professional Insurance Exchange Mutual, Inc. provides volunteer services to community service organizations, eg. Donated Dental Services Clinic or Salt Lake Community Health Center, P.I.E. coverage will apply only in the event that the service facility lacks any liablity coverage of its own. In this instance, Professional Insurance Exchange Mutual, Inc. coverage will still apply only to individual dentists but will not indemnify the clinic entity or any acts of its employees.
If a dentist employee of a for-profit or government entity desires to “moonlight” and seeks to obtain malpractice coverage through Professional Insurance Exchange Mutual, Inc. to cover the private practice of dentistry on weekends, etc. such coverage shall be made available provided that the dentist returns a copy of a document signed by his/her employer certifying that coverage obtained from Professional Insurance Exchange will not apply to any acts performed by the employee dentist in the entity setting, and provided that the dentist meets other underwriting criteria.
Temporary License Considerations 4/7/93
Professional Insurance Exchange Mutual, Inc. will not provide malpractice liability insurance to any dentist holding a temporary license to practice in the state of Utah.
Proof of Licensure 4/1/98
Any dentist applying for malpractice insurance through Professional Insurance Exchange Mutual, Inc. must furnish proof of licensure. The license number must be given at the time of application and a copy of the Utah state license may be requested at the time of application.
Dentists acting as Anesthesiologists 4/1/98
Any dentist applying for coverage shall be informed that coverage does not extend to provision of I.V. sedation by an insured to patients of record of another insured. If a dentist wishes to act as a dental anesthesiologist, he or she must obtain coverage intended for anesthesiology.
Recent Graduates 1/9/98
Recent graduates, eg. dentists who were graduated within five years of submitting an application for coverage must complete the “Supplemental Questions for Recent Graduates” form as part of their application. Examination or course failures will be taken into consideration as part of the application
REINSTATEMENT POLICIES 9/1/91
1. A dentist who cancels coverage for retirement, education, etc. who wishes to reinstate his or her policy may do so under the following guidelines:
- If the dentist canceled less than one year from the time reinstatement is requested, he or she may not be required to fill out a new application. However, in such cases the applicant for reinstatement may be asked to complete a renewal form. The applicant may also be requested to sign a new subscription agreement.
- If a tenured dentist wishes to restore the tenured rate (for more than four years of membership), he or she must pay a $100 reinstatement fee, regardless of the time interval since the policy was canceled.
- If a non-tenured dentist wishes to restore credit toward the tenured rate (for more than four years of membership), he or she must pay a $100 reinstatement fee, regardless of the time interval since the policy was canceled.
- If a tenured or non-tenured dentist wishes to apply coverage retroactively as of the cancelation date, the $100 reinstatement fee shall not be assessed.
- If a dentist is canceled for non-payment of premium, he or she may not be subject to reinstatement or being granted a new policy.
- If a dentist paying a surcharge cancels his or her policy for any reason prior to discharging the surcharge obligation, the surcharge rate will remain in force should the dentist apply for reinstatement. Assessment of the $100 reinstatement fee shall be handled per guidelines B, C and D.