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Vicarious liability is the responsibility of a superior for acts committed by a subordinate. As a dentist or dental practice owner, if your employee causes harm through an error or through negligence, you can be held liable for their mistake and named in a claim or lawsuit. There is no insurance coverage type called “vicarious liability.” Instead, it is a type of risk that can occur in a variety of situations. Therefore, there are a variety of insurance coverages that respond to different types of vicarious risk. The challenge is that vicarious liability is often an invisible risk, so it is important to have regular or in-depth conversations with your insurance agent or broker. They can help you identify vulnerabilities in your practice that you may not see. When Might a Dentist Experience a VL Exposure? In malpractice, there are a number of ways you can open yourself to a vicarious liability claim. Some of these include: Creating a corporate entity Opening a practice Hiring associate dentists as employees or contractors Bringing a specialist to your office, such as an anesthesiologist or oral surgeon Creating a corporate entity, even if you are a sole practitioner: If you are an independent contractor who works on a 1099 basis, chances are your accountant has suggested that you form a corporate entity to be paid through, for the tax benefits, instead of accepting payment as an individual (E.g. Jane M. Doe DDS LLC). If you have an incident with a patient during clinical care that leads to a malpractice claim or lawsuit, the chances are good that the plaintiff’s representation will name your corporate entity in the action in addition to yourself. If you do not have insurance coverage for that corporate entity, your malpractice policy will respond to your defense but will not respond to defend the corporation, and you will experience a gap in coverage. Fortunately, this type of gap is easy to close. Most insurance companies have the ability to add Shared Limits Entity Coverage to your individual malpractice policy with little or no additional premium. That is because, in this scenario, the corporate entity and the doctor are basically one in the same. “Shared Limits” means that the per-occurrence and aggregate limits of liability found in your policy will extend over yourself and your corporation. Opening a practice where you employ dental assistants and hygienists: As soon as you open your own dental practice, you run the risk of a vicarious liability. Any dental assistant, hygienist, or dental technician treating patients is doing so under your supervision. If they have an incident, you are liable. If you are the only doctor practicing in your office, the Shared Limits on your malpractice policy may suffice. However, if you have associate dentists working with you, Shared Limits will not be enough. In this case, you will need a separate Entity Policy . More on this in the next section. Bringing on other associate dentists as employees or contractors: An Entity Policy is essentially a malpractice policy for your corporation. It covers your practice for the actions of the doctors working there. In this scenario, you would carry your own malpractice. You would also carry the Entity Policy that defends the corporation. And each of your associates would carry their own individual malpractice policies. This is key. An Entity Policy covers your practice for the actions of the doctors working there, but it does not cover those doctors. They still need to maintain their own malpractice coverage. The premium cost for a separate Entity Policy would be about 10% of the cost of your individual malpractice premium. When a specialist treats patients at your office: Many dentists believe that, when they have an outside specialist visit the office, such as an anesthesiologist or oral surgeon, that specialist is responsible for their own malpractice, and leave it at that. However, just because a visiting specialist is not your employee, that does not mean you cannot be held responsible for their actions. When that specialist attends to your patient, it is understood that they are doing so at your request and within a course of treatment you have prescribed. If you work with an attorney or dental consultant, they may advise you to have all your associates, contractors, and specialists add your practice to their own individual malpractice policies as an Additional Insured . This advice is part of a movement within the dental sphere to push risk downstream. The argument here is: if your employee or contractor makes a mistake, why shouldn’t they be held liability instead of yourself? With the Additional Insured provision, their policy would respond to your practice’s defense if they make an error. However, while helpful, there are several limitations to this approach: The Additional Insured provision puts the onus on the employee to defend the owner, which many associates consider an unfair re-distribution of the risk. If you rely on this strategy, you are also relying on your employee to open the claim. It’s not your policy, so you cannot do it yourself. Yes, you may have some protections, but you are also relinquishing control of your own defense. Even if your employee adds you as an Additional Insured, that may not prevent you from being named in a claim or lawsuit. Why run the risk of having a gap in coverage when you can take steps to help ensure your own defense? Consider a Group Policy. If you are a practice owner with associates, employees, and specialists, you may want to consider a Group Policy . This option tends to provide the most comprehensive coverage for a practice with multiple doctors. In this scenario, a majority of the doctors at your office would work with a single insurance company, and each would carry comparable coverage with the same limits. The corporation would also have its own Entity Policy. There is no need for an Additional Insured provision. Your risk is diminished because everyone’s coverage is uniform, and everyone has their own individual limits of liability (including the corporation) without having to share. Other Vicarious Liability Risks Faced by Practice Owners Practice owners can face vicarious liability risks from other angles besides malpractice, including some of the following: An employee uses their personal vehicle to run a work-related errand and has a car accident. That employee is operating within their job duties; therefore you may be held liable. If your Business Owner’s Policy includes Hired and Non-Owned Auto coverage , your practice would be covered if named in a lawsuit due to that employee’s accident. It’s important to note that your Business Owner’s Policy would not defend the employee. They still need to carry their own personal auto policy An employee gets into an altercation with, or bullies, a stranger while wearing a shirt with your practice logo on it. In a legal action, an attorney would be only too glad to claim you have liability for the violator’s actions. As a business owner, you are a juicy target (far more than one individual employee). The liability coverage inside your Business Owner’s Policy may respond to your defense. An employee uses a photograph they found on the internet in your marketing materials or on your website, only to discover that it is owned by a stock photo company. That stock photo company then sues your practice for Copyright Infringement. The employee made an error while working within the scope of their employment, therefore you are liable. The liability coverage inside your Business Owner’s Policy may respond to your defense. If you have any questions or concerns about your coverage, or if this article has exposed a vicarious liability risk that you are facing, now is the time to contact your agent for their assistance. They want to help you. And your insurance company wants you to avoid gaps in coverage. Written by: Eric Harper
When you hear someone say “Dental Malpractice,” where does your mind go first? Do you think about the premium you pay for insurance? Do horrific stories of patient allegations fill your mind? For me, I remember a conversation I once had with a mentor. “What do you think causes most malpractice lawsuits?” she asked. I began thinking of a long list of complex procedures that often make the headlines when it comes to high payouts. “Is it anesthesia? Surgical placement of implants? Third molar extractions?” My mind raced, but her simple answer surprised me: “Bedside manner.” The Common Defense If you ask an insurance professional how to defend against malpractice claims, they’ll likely say “Risk Management.” This is a good starting point. Within the context of dental malpractice, risk management strategies often involve controls like patient consent forms, advanced patient charting, and medical history reviews. These mechanisms are meant to solidify a dentist’s defensibility when a complaint or lawsuit is filed. Another answer you will likely receive is “Professional Liability Insurance” (aka dental malpractice coverage). This is the invisible armor every practitioner wears - a necessary safety net designed to catch them if a root canal goes south or a crown doesn't seat. But here is the twist: while malpractice insurance is a legal and financial necessity, it is fundamentally a reactive tool. It is the "break glass in case of emergency" option for when the patient complaint has already been launched. But what if the best way to keep that glass from breaking isn't found in a thicker insurance policy or more complex risk management strategies? How can a lawsuit be prevented from gaining traction in the first place? Is this possible, or just a pipe dream? Perhaps the answer can be found by first investigating the evolving nature of patient complaints. The evolution of the dental chair For decades, patient perception of whether a dentist was a “good dentist” could be determined with a single question: “Did it hurt?” But as we navigate the second decade of the 21st century, the narrative in the dental chair has shifted. The modern patient isn't just worried about the needle; they’re worried about the vibe. They’re concerned about the "upsell," and whether their dentist is a clinician or a salesperson in scrubs. From clinical fear to financial friction If you browse through communities like Reddit, Quora, or other popular forums, a common refrain isn’t "It hurt." Instead, it’s: "Is my dentist scamming me?" Patients walk in for a routine cleaning and walk out with a $4,000 treatment plan involving procedures they never knew existed. Social media has become a breeding ground for these frustrations, with users frequently sharing photos of their X-rays to crowdsource second opinions from strangers online. In a 2024 legal review, a patient (referred to as Bobby) took advantage of a $59 "First-time patient special." After the initial evaluation, the dentist proposed an extensive treatment plan. Bobby later filed a lawsuit, alleging the "special" was a fraudulent lure designed to trap patients into high-cost procedures once they were in the chair [1]. A decade of change The complaints of yesteryear were simpler, more mechanical. If we look back a decade or more, the data paints a different picture of patient dissatisfaction. Research from 2010–2015 indicates that while clinical treatment was always a top concern, "Charging and Cost" was a much smaller slice of the pie, often hovering below 10% [2]. By 2025, cost-related complaints and confusion over "In-network vs. Out-of-network" have surged, occasionally doubling in frequency [3]. When patients stop viewing their treatment as healthcare and start seeing it as a sale, trust evaporates. The high cost of silence It would be incorrect to say that clinical concerns are a thing of the past. Almost all malpractice lawsuits are hinged on allegations of procedural error. But these “errors” are often exaggerated by a lack of communication . In a 2025 malpractice analysis, a patient with a history of diabetes sought dental implants. Allegedly, the dentist proceeded without documenting a discussion of the high risks associated with the patient’s health history. When the implants failed, the patient sued not just for the failure, but for the lack of warning . The expert review highlighted that 25% of patients who seek a new practitioner do so because of "poor communication about expectations" [4]. The anatomy of a relationship If you spend enough time scrolling through social media, a pattern emerges: people don't just sue because of an error; they sue because they felt disrespected . A landmark study published in the Journal of the American Medical Association (JAMA) remains one of the most powerful insights into this phenomenon. It found that the leading indicator of a malpractice suit wasn't medical negligence at all—it was the doctor’s communication style [5]. In fact, doctors who had never been sued spent an average of just three minutes longer with their patients (18.3 minutes vs. 15 minutes). Those "no-claim" doctors were more likely to use humor, ask for the patient's opinion, and orient them on what to expect. On social media, this plays out in real-time. Popular advice for finding a "good" dentist rarely mentions technical credentials or schools. Instead, users point to things like: Make the invisible visible: As one Reddit user recalled when his dentist used an intraoral camera: "When he showed me the crack on the screen, I stopped feeling like he was being a salesman and started feeling like he was a partner" [6]. Cost Transparency: The "blind bill" is a common complaint. Providing a written estimate before a single tool is touched and using a "No Surprises" approach could be more effective at preventing lawsuits than any signed consent form [7]. Humor and Humanity: Patients who describe their dentists as "funny" or "warm" are statistically less likely to file a complaint, even when complications occur [5]. The reality, as confirmed by both data and the court of public opinion, is that you don’t sue a friend . Only 1% of patients who experience an actual negligent error end up filing a claim [5]. Why? Because they like and trust their doctor. They see the person behind the mask. It seems my mentor was right about bedside manner. The Golden Rule as the Gold Standard I understand—there are numerous cases of unreasonable patients, frivolous allegations, and downright ridiculous lawsuits. You can’t always choose who enters your office. But we have reached a point in modern healthcare where we must recognize that the most effective risk management tool in existence isn't a consent form or an insurance policy. It is respect . Building rapport is the ultimate insurance. When a dentist practices the Golden Rule, the entire dynamic of the office shifts. Formal protections like charting, consent, and malpractice insurance are the bare minimum required to operate. They are the floor. But relationship-building is the peak of professional excellence, effectively the ceiling. You can have the most bulletproof paperwork in the state, but if you are dismissive or cold, you are inviting a complaint. Conversely, a dentist with a warm heart and a listening ear can survive almost any clinical complication because the majority of their patients know, beyond a shadow of a doubt, that their dentist was on their side. In the end, the most important tool in the operatory isn't an iTero scanner; it's the ability to look a patient in the eye and make them feel like their humanity matters more than your wallet. Footnotes [1] Professional Solutions: Case Studies in Dental Billing Red Flags (2025). [2] General Dental Council (GDC): Trends in Written Complaints 2010-2024. [3] Dental Update - MAG Online Library: "What Makes a Patient Complain?" (2025).[4] The Doctors Company: MPL Case Analysis on Inadequate Informed Consent (Summer 2025). [5] Wendy Levinson, JAMA: "Physician-Patient Communication: The Relationship with Malpractice Claims" (Study 1997; verified meta-analysis 2024). [6] Reddit r/Dentistry: "Community Consensus on Trust Indicators" (2026). [7] My Social Practice: "Reputation Management and the Impact of Transparency" (2026). Written by: Matthew Christy