Dentists fighting to get insurance payouts because office closure seen as ‘voluntary’

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Thousands of Canadian dentists who followed industry recommendations to shut down their practices nearly two weeks ago because of the COVID-19 outbreak have still not received insurance payments despite taking out business interruption policies that include pandemic coverage.

The industry-wide policy – sold to dentists and dental specialists by CDSPI Advisory Services Inc. and underwritten by Aviva Canada – is called TripleGuardTM Insurance and covers policyholders for fire, theft, liability and practice interruption, including special circumstances such as earthquakes and pandemics.

Now, two weeks after the Royal College of Dental Surgeons of Ontario (RCDSO) “strongly recommended” dental clinics in the province immediately suspend all non-essential and elective or routine services for patients, thousands of dentists – including many outside Ontario who have also suspended their services – have yet to receive a single payout.

Dr. Michael Duchnay, an oral medicine specialist in Toronto, filed his claim on March 15, a few hours after receiving the RCDSO recommendation. Two days later, an insurance adjuster called to tell him it was “highly unlikely” his claim would qualify as the office closure was seen as “voluntary" and a public-health official did not “prohibit” the staff from entering the office.

The lag in insurance payouts for dentists follows a growing number of cases in the insurance industry in which the coronavirus is being declared as uninsurable for certain business interruption policies. In the U.S, legislative officials are now requesting insurers recognize financial losses related to COVID-19, regardless of certain exclusions.

After not hearing from Aviva about whether or not her claim would be processed, Dr. Andrea Johnstone, a periodontist in Toronto, began an online petition, along with her colleague Dr. Sue Chincholi. The petition asked that CDSPI, a financial-service provider for dental professionals, take action.

“Dentists have been paying into these policies in good faith believing that in the time of need, we will be covered by our insurers,” said Dr. Johnstone. “Now that there is a bona fide pandemic on our hands, our claims are being delayed.”

More than 18,000 dentists across the country have so far signed the petition to fight the delay in getting a decision on an insurance policy that was intended to begin paying out within 24 hours of business interruption due to a pandemic.

The insurance policy says it is intended “to help offset” income loss during a pandemic outbreak. Automatically, policyholders have practice interruption coverage up to $1,000 a day after the first 24 hours (up to a $20,000 aggregate annual limit) when they are prohibited from entering their office by an order from a civil authority or public-health official.

For an extra premium, policyholders can increase pandemic outbreak coverage up to $2,500 a day (up to an annual limit of $50,000) or up to $5,000 a day (up to an annual limit of $100,000).

In an e-mail to The Globe and Mail, Aviva Canada said it is working “relentlessly" to provide CDSPI with clarity, but it does "require time to clearly understand individual coverages and operational issues.”

In the meantime, dentists are struggling to maintain overhead costs such as building rental payments, and some have had to layoff staff. Many are still waiting to see if they qualify for government assistance.

Dr. Duchnay, the Toronto oral medicine specialist, said “it was a real shock" to hear from an adjuster that his insurer did not consider there had been “a physical disruption” to his practice.

"Had I kept my clinic open and disregarded the directive given by the RCDSO, not only would I have put the community, my patients and staff at risk due to potential spread of COVID-19, I would risk revocation of my licence and, in turn, potential loss of my business. Now, I have no insurance and no revenue, and could potentially lose my business anyways,” Dr. Duchnay said.

Some dental offices are allowed to remain open for medical emergencies – and can provide medical advice to patients over the phone, including providing prescriptions for pain management or antibiotics.

But many – including Dr. Duchnay and Dr. Johnstone – are unable to keep offices open to perform emergency surgeries owing to the lack of appropriate personal protective equipment, such as N95 face masks, as well as the temporary staff layoffs.

“As a result of this [recommendation] I had no choice but to close my clinic,” said Dr. Duchnay. “I had every intention of paying my staff when the insurance money came in, but that was weeks ago.”

Many dentists who have signed the petition are also publicly asking CDSPI for their premiums back. Some have made 30 to 40 years of payments for a product they didn’t need until now, said Dr. Johnstone.

CDSPI told The Globe it is working closely with Aviva to ensure “they have the information they need regarding the various provincial government and regulatory announcements and recommendations issued over the past few weeks.”

In an e-mail sent to Aviva clients on Sunday night, CDSPI president Ed Dermit said the company was continuing “to press” Aviva to pay the TripleGuardTM pandemic claims.

“Aviva had assured us numerous times over the past weeks that they were 'days away’ from a decision, but now those days have turned into weeks,” he wrote.

In the e-mail, CDSPI says it met with Aviva Canada CEO Jason Storah and anticipates Aviva will announce a decision by the end of this week.

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