Professional indemnity insurance (BAV) for a dental hygienist
As a self-employed professional you treat in other people's chairs, sometimes on instructions and sometimes on your own indication. Who carries which mistake depends on that relationship and on what you can demonstrate.
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In brief
Your daily practice has two positions. In the first you work on instructions from a dentist. The Wet BIG then requires the person instructing you to satisfy himself that you are competent and requires you to follow directions. You remain responsible yourself for whether you can carry out the procedure. In the second you work on your own indication, within what your registration allows. A claim almost always starts with the question which of the two applied and whether that was recorded. Arrange it in writing at the start of every collaboration, together with the agreements on record-keeping and referrals.
The loss itself is rarely purely financial. Nerve damage after an anaesthetic, injury to the mucosa, a damaged crown or bridge, or a periodontal situation that deteriorated in your hands: that is personal injury and sometimes damage to property. Many standard variants of professional indemnity insurance are written for advisory professions and cover only pure financial loss. So ask for the healthcare variant and have it confirmed on the policy schedule that damage to teeth and to existing restorations falls under it.
The standard you are measured against is that of the good care provider in Article 7:453 of the Dutch Civil Code. Dental hygienist is an Article 34 profession under the Wet BIG: a protected qualification title, no disciplinary tribunal of its own, complaints handled through the Wkkgz. If you work with your own patients, your own treatment room and staff, further questions about the class of insured persons arise; those are set out under the dental hygiene practice.
This page deals with one situation. The full overview is on Compare professional indemnity insurance (BAV).
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We report the claim and monitor how it is handled. In urgent cases you can reach us on the emergency line.
What to look out for
Four points that determine, for a self-employed dental hygienist, where the bill ends up.
Competence is your own responsibility
An instruction from a dentist does not make you competent to do something you have not mastered. You may refuse, and sometimes you must. Keep a record of the training you have followed and which procedures you carry out routinely. In a claim about, for instance, anaesthesia the first question is how recent and how frequent your experience of that procedure was.
Consent for vulnerable patients
If you treat in nursing homes or at people's homes, the patient is by no means always able to decide for himself. Ask the representative for consent as Article 7:465 of the Dutch Civil Code requires and note who that was. Treatment without valid consent can be challenged even where there is no complication, and that is an allegation you cannot put right afterwards.
Other people's equipment and your own instruments
If you damage the unit or equipment of the practice where you work, that is damage to property and not a professional error. It belongs on public and employers' liability insurance, where the care, custody and control exclusion plays a part for property in your keeping. You insure damage to your own portable equipment through business contents insurance.
What falls outside the policy
Excluded are, among others: liability accepted under contract under a broad indemnity in your agreement; intent and wilful recklessness (Article 7:952 of the Dutch Civil Code); fines and penalty payments; and repayment of your own fee or redoing free of charge a treatment the patient is dissatisfied with.
What does your premium depend on?
- Annual turnover: the usual basis for a sole practice
- Procedures carried out: anaesthesia and X-rays weigh more heavily than cleaning and instruction
- Workplaces: established practices, institutions or treatment at home
- Patient groups: frail older people and medically compromised patients are taken into account
- Sum insured per claim: set by injury and remedial costs, not by your hourly rate
- Retroactive and run-off periods: damage to teeth often only comes to light at a later check-up
Insurers weigh these details differently. That is where your saving is.
What is covered
| Situation | AVB | BAV |
|---|---|---|
| After your anaesthetic a patient has a numb lip for months | No | Provided that |
| A patient with a prosthetic heart valve is not given prophylaxis and is admitted with an infection | No | Provided that |
| You do not report an abnormality of the oral mucosa to the dentist and the patient's treatment is delayed | No | Yes |
| A patient incurs costs at another practice to have your work done again | No | Yes |
| Your ultrasonic device leaks and damages the flooring of the practice where you work | Yes | No |
| The income you lose because the practice ends the collaboration after a complaint | No | No |
A complaint is not yet a claim. The policy only comes into the picture once someone claims compensation from you.
Frequently asked questions
This is what people ask us most.
I work on the dentist's instructions. Is he liable then?
Not automatically. The person instructing you must satisfy himself that you are competent and arrange supervision where necessary, but you remain responsible for carrying out the procedure. When a claim arises, that division is assessed case by case. So record what instruction you received, what information came with it and what you established yourself before you started.
I damaged a crown during cleaning. Is that covered?
That depends on your form of policy. Damage to an existing restoration is damage to property and not pure financial loss. A policy limited to financial detriment leaves it outside the cover. So ask for the healthcare variant in which damage to property and injury arising from professional practice are included, and check that section word for word on the policy schedule.
I also treat in a nursing home. Does that change anything?
Yes, report it when you apply. Different circumstances, a different patient group and treatment outside a regular unit are assessed separately. If such an extension goes unreported, the insurer can rely on Articles 7:928 and 7:930 of the Dutch Civil Code and adjust payment. Also make written arrangements with the institution about record-keeping, consent and consultation with the dentist.
I am stopping next year or taking a job. What do I arrange?
Run-off cover, before you end the policy. Under a claims-made policy the moment of notification counts and not the moment of treatment, while complaints about periodontal care or damage often only arise at a later check-up. If you take a job, your employer's policy covers only what you do there, not your earlier years working for yourself.
Every situation is different. For these situations we have a separate page.
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