Manipulation · informed consent · contraindications
Professional indemnity insurance (BAV) for a chiropractor
Chiropractic applies force to a spine. If it goes wrong, it involves injury, and then the question is whether your policy covers more than financial loss alone.
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Deze pagina in het Nederlands: Beroepsaansprakelijkheidsverzekering voor een chiropractor.
The calculator and the quote form below are in Dutch. Prefer to do this in English? Email info@finassverzekert. nl or call 072 - 509 24 56 and we will take it from there.
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A premium indication, not personal advice. Prefer to talk it through? Call 072 - 509 24 56.
In brief
The claims in this field are recognisable. A cervical manipulation followed by neurological deficits, a rib fracture during a thoracic correction, a herniated disc made worse, or symptoms in a patient who takes anticoagulants, has osteoporosis or had an accident shortly before. Alongside that is the allegation that you continued treating for too long while the symptoms pointed to something else and referral was called for. Each time this is injury, not an accounting loss.
That is why your policy must cover personal injury caused in the course of your profession. Professional indemnity insurance written only for advisory professions leaves precisely the risk you face uninsured. The standard against which your conduct is measured is that of a good care provider under Article 7:453 of the Dutch Civil Code. In the Netherlands chiropractic is not a profession with its own register under the Wet BIG (the Dutch act on healthcare professions); complaints run through the complaints procedure and disputes body required by the Wkkgz, and if necessary through the civil courts.
Do not underestimate the duty to inform. Article 7:448 of the Dutch Civil Code requires you to inform the patient about the nature of the treatment and the risks, and Article 7:450 DCC requires consent. In a claim after a neck manipulation the first question is always whether the conversation about the risks took place and whether it is in the file. For a practice with several practitioners there are further questions. Those are set out on the page about the chiropractic practice.
This page deals with one situation. The full overview is on Compare professional indemnity insurance (BAV).
What to look out for
Four points that turn out to be decisive in a chiropractic claim.
Recorded consent for high-impact techniques
With manipulation of the cervical spine, insurers expect you to discuss the risks and to record that. A note in the file with the date, the risks discussed and the patient's response is worth more in a claim than a general leaflet in the waiting room. Without that record your position is weak, even if you did have the conversation.
Intake, screening and red flags
Contraindications such as anticoagulation, osteoporosis, recent trauma or neurological signs must appear from your intake. Treating without screening, or continuing treatment when there is no result, is the most common allegation. Record when you referred the patient to the GP; that is evidence that you stayed within your own expertise.
Declared techniques and patient groups
If you treat infants and children, use dry needling, or take X-rays yourself, declare that when you apply. These elements are assessed separately and are sometimes excluded or subject to conditions. Undeclared activities can, under Articles 7:928 and 7:930 of the Dutch Civil Code affect the payout.
What falls outside the policy
The following, among others, are outside the cover: intent and wilful recklessness (Article 7:952 of the Dutch Civil Code); fines and penalty payments; supplements, insoles or other products you sell, because that is product liability; and repaying your own fee or redoing a course of treatment free of charge.
What does your premium depend on?
- Annual turnover from treatments: the usual basis for the premium and the sum insured
- Techniques used: high-impact manipulation weighs more heavily than mobilisation alone
- Patient groups: treating children or older people is assessed separately
- Training and registration: recognition by a professional body is often a condition of acceptance
- Retroactive period: determines whether treatments from before the start date are included
- Sum insured and excess: injury claims add up, so look beyond the lowest amount
Insurers weigh these details differently. That is where your saving is.
What is covered
| Situation | AVB | BAV |
|---|---|---|
| A rib fracture during a thoracic correction | No | Yes |
| Neurological symptoms after a neck manipulation where the risks were not discussed | No | Yes |
| Dry needling in which a patient suffers a collapsed lung | No | Provided that |
| A complaint from parents after treating an infant, which you had not declared when you applied | No | No |
| A patient tears his coat on a protruding screw of your treatment couch | Yes | No |
| A supplement you sell alongside the treatment causes stomach problems | Provided that | No |
Techniques and patient groups that are not in your application are not in your cover either; have them appear on the policy schedule or a clause sheet.
Frequently asked questions
This is what people ask us most.
A patient still has symptoms after a neck manipulation. What do I do first?
Report it to your insurer, even if there is no notice of liability yet. Article 7:941 of the Dutch Civil Code requires you to notify as soon as you reasonably know that a claim may follow. Record the course of events, refer the patient to the GP if necessary and do not admit liability. An expression of regret is not an admission. A promise of compensation is.
I also treat babies. Is that automatically included?
Not as a matter of course. Insurers assess the treatment of infants and young children as a separate risk, because the symptoms are different there and the consequences weigh more heavily. State it when you apply and have it appear on the policy schedule or in the clause sheets. If it is not mentioned, do not assume it is included.
Where does professional liability end and business liability begin?
Along the type of event. Injury arising from your treatment belongs on professional indemnity insurance with healthcare cover. A patient who steps off the treatment couch and trips over a bag, or a coat damaged by a leak, is an ordinary accident on your premises and falls under the public and employers' liability insurance.
What if I close my practice?
Arrange run-off cover before you cancel. Under a claims made policy the moment of notification counts, and complaints about a treatment often come later. Without run-off cover you are uninsured for work you did over many years. Also bear in mind the twenty-year retention period for patient records in Article 7:454 of the Dutch Civil Code: that file is your defence in a late claim.
Read more
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