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Get guidance navigating risks through the pandemic.

During this unprecedented health crisis, TDIC is making every effort to ease dentists’ burdens and provide information and resources to guide their decisions and reduce risks.

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TDIC continues to receive a high number of inquiries from policyholders on how to assess and manage the risk of potential exposure. The answers below address common questions about navigating uncertain situations.

Workers’ Compensation

Under Senate bill 1159, employers are responsible for reporting information about positive COVID-19 tests to their workers’ compensation claims administrator within specified time frames and on an ongoing basis for as long as the law is in effect. All employee positive COVID-19 results must be reported regardless of whether the employer learns or believes that the employee contracted the virus from work or outside of the workplace.

Specifically, employers must:

  • Retrospectively report by Oct. 29 employee positive COVID-19 tests that occurred between July 6 and Sept. 17.
  • Report within three business days any employee positive COVID-19 result that occurred on Sept. 18 and until Jan. 2, 2023.

The law states that “when an employer knows or reasonably should know that an employee has tested positive for COVID-19, the employer shall report to their claims administrator” by email or fax within three days the following:

  • An employee tested positive for COVID-19 (via the polymerase chain reaction, or PCR, test only).
  • The date the employee tested positive (date specimen was collected for testing).
  • The address or addresses of the employee’s place of employment during the 14 days preceding the date the employee tested positive for COVID-19.
  • The highest number of employees who reported to work at the employee’s specific place of employment in the 45-day period preceding the last day the employee worked at each specific place of employment.

If an employee complains of pain, strain or discomfort due to wearing PPE, initiate a discussion with your employee and determine what may be causing these issues to ensure the schedule is allowing for and they are taking their mandatory meal and rest breaks. Make sure that your employees are staying safe during their breaks by staggering their breaks or closing your break room if it is not possible to maintain social distancing of 6 feet when more than one individual is in the room.

You may also consider alternatives, such as allowing short breaks in between seeing patients or even working with the employee to determine if there is alternative PPE that is suitable. Some individuals may find working with a powered air purifying respirator more comfortable than a tight-fitting respirator.

If your employee continues to have issues with wearing PPE or if you need additional information on employer best practices, call the Risk Management Advice Line at 800.733.0633.

Lastly, inform your employees of their right to file a workers’ compensation claim and provide them with a workers’ compensation DWC 1 claim form should they decide to seek treatment.

Employers of five or more employees must notify their workers’ compensation carrier of employees with positive test results regardless of where the employee became infected. If you are a TDIC policyholder, review the reporting flow chart and use the Excel spreadsheet to report it to Sedgwick.  

From Sept 18, 2020, until Jan. 1, 2023, employers in this category must report within three business days of learning or reasonably knowing an employee tested positive for COVID-19 under SB 1159

An employee who believes they became ill or tested positive for COVID-19 due to an exposure at work can also file a workers’ compensation claim and must be given a claim form. 

Exposures and Office Closures

First, it may not be necessary to close your practice. As long as you and your employees wore PPE correctly and appropriately and avoided “close contact” (within 6 feet of an infected individual for a cumulative total of 15 minutes or more over a 24-hour period, without wearing PPE that is NIOSH or CDC approved (i.e., not cloth masks) with individuals, you are at low risk of contracting COVID-19. However, if you desire to get COVID-19 tests completed for you and your staff and want to close your facility, you should understand your obligations to continue their pay and return-to-work guidance. An employer is prohibited by OSHA from requiring a negative COVID-19 test in order to return to work. During the time of the employer-directed closure, employees may not lose pay or benefits. The employer may use unused employer-provided paid sick leave (such as Families First Coronavirus Response Act ). The requirement that employers provide paid sick leave and expanded family and medical leave under the FFCRA expired on Dec. 31, 2020, but has been extended until March 31 on a voluntary basis.  
Visit the Wage and Hour Division’s FFCRA Questions and Answers page to learn more about workers’ and employers’ rights and responsibilities after this date.  

The dental office will close when: 

  • The dental practice is experiencing a staff shortage due to illnesses or quarantine orders and cannot sufficiently operate at a reduced capacity. 
  • The local health department orders a closure due to a workplace outbreak, which is classified as three or more employees receiving a positive COVID-19 diagnosis within 14 days. 
  • The California Division of Occupational Safety and Health finds dangerous conditions exist at the workplace.

The OSHA COVID-19 prevention regulation does not require an employer to compensate all employees if the employer voluntarily decides to close the practice due to COVID concerns. If a practice owner decides to close the practice without meeting the criteria listed above, in order to minimize staff attrition and avoid potential complaints or investigation, dentists are encouraged to continue paying wages to their employees during the voluntary closure, but are not required to do so. Employees also can apply for unemployment.

For more information on determining your office’s exposure risk level, CDA’s flowcharts, tutorial and other resources can help guide you on managing COVID-19 exposures in the workplace. 

Infection Control

When a patient presents to the office:

  • Provide a face mask if the patient is not wearing one.
  • Take a temperature reading to verify the absence of a fever (any temperature above 100.4 F).
  • Reconfirm the screening questions by observation and verbally with the patient. We recommend using a screening form like CDA’s patient screening form, which is regularly updated with the most recent CDC guidelines.
  • Complete necessary documentation and discussion, such as health history and planned treatment and associated informed consent form(s). Have the patient sign a statement agreeing to notify the dental practice if within two weeks of treatment they test positive for COVID-19.
  • A dental practice has a legal and ethical obligation to inform patients if a staff member they have been in “close contact” (within 6 feet of an infected individual for a cumulative total of 15 minutes or more over a 24 hour period, without wearing PPE that is NIOSH or CDC approved (i.e., not cloth masks) has tested positive for COVID-19.

Interim CDC guidance for businesses and employers recommends that:

  • Employers place posters that encourage coughing and sneezing etiquette and proper hand hygiene at the entrance to their workplace and in other areas where the posters are likely to be seen.
  • Clean and disinfect public areas frequently, including door handles, chairs and bathrooms.
  • Employees who report symptoms of acute respiratory illness should stay home and not return to work until they are free of symptoms for at least 24 hours without the use of fever-relieving or symptom-altering medications.
  • If an employee appears to be sick upon arrival to work, they should be separated from other employees and sent home immediately.
  • Employees should cover a cough or sneeze with a tissue and disinfect frequently touched objects and surfaces using an appropriate disinfectant product.
  • Employees should wash hands often with soap and water for at least 20 seconds. If soap and water are not readily available, an alcohol-based hand sanitizer with at least 60% alcohol can be used.

For non-urgent care: Defer care until after symptoms have resolved (24 hours since last fever without anti-fever medications and improved cough or other symptoms) AND at least 10 days (20 days if patient illness was severe) have elapsed since symptom onset.

For emergency care: Work with medical care provider to identify the appropriate care facility.

State laws restrict employers from regulating where employees can go on vacation, but practice owners can develop a travel policy that includes a pre-travel inquiry and post-travel quarantine that could help protect patients and staff from potential exposure. Once developed, employers should distribute the policy to each employee and retain a signature acknowledgment from each employee. As a best practice, the policy should be universally applied to all employees of the practice.

Download a sample Travel and other Conduct Away from the Workplace During the COVID-19 Pandemic Policy.

Informed Consent

While we know that there are sample consent or “waiver” forms available from various sources on the internet, from a legal standpoint, CDA and TDIC advise against using a separate COVID-19 form. Instead, you should be obtaining basic informed consent for the specific treatment, as you ordinarily would.

An informed consent form, by itself, is insufficient to shield a medical provider from liability, and creating one specific to COVID-19 may provide a dentist with a false sense of security. Rather, an informed consent form is designed to be a part of a process of obtaining a patient’s agreement, following an explanation and discussion of why treatment is needed, as well as the risks of and alternatives to a procedure. The best approach is to have a full and honest discussion with the patient as to the procedure, the alternatives, why the treatment is immediately necessary (or unnecessary as the case may be) and the infection control protocols the dentist and staff are utilizing to protect the patient. The documentation should also include the specific steps taken to minimize risk and maximize protections for everyone, including patients, the dentists and dental staff. These steps include proper screening of patients (e.g., temperature, recent travel, recent tests for or exposure to COVID-19) and following all current OSHA, CDC and any other credible organizations and entities for updated guidelines for increased infection control measures. We recommend that the practice maintain and retain detailed documentation of these safety protocols.

As always, a note in the chart indicating the patient was given an opportunity to ask questions and that all questions were answered is exceedingly helpful, especially in this setting.

Please note:

This does not constitute legal advice. TDIC recommends checking with legal counsel regarding specific employment scenarios. Feel free to contact TDIC’s risk management department if you need an attorney referral.

Telehealth Considerations

“Telehealth” is the mode of delivering health care services via telephone or video technologies to facilitate the diagnosis, consultation, treatment, education, care management and self-management of a patient’s health while the patient and the health care provider are at distant sites. 
Telehealth can be delivered in two modes: synchronous and asynchronous. Synchronous services occur in real time, such as a consultation using video technology. Asynchronous or store-and-forward services occur when data or information is transmitted before or after the appointment. 
Each state regulates telehealth according to its own laws, and your state dental board is the best source of information for specific regional, legal and ethical considerations. 

Virtual visits may free patients and the practice from worries about the spread of infection. Offering a telehealth consultation can allow the dentist to address urgent patient concerns and allow triage of patients to appropriate emergency dental services, keeping patients out of the emergency room due to dental emergencies.

The standard of care is the same, whether services are in the office or over telehealth platforms. Initial consultations can be done remotely, but functions such as perio charting and radiographs may not be done remotely without a qualified auxiliary performing those functions. 

TDIC policyholders generally have the same professional liability protection from legal obligations resulting from claims of wrongful or neglectful practices, whether the care is delivered in person or through teledentistry modes. However, TDIC can’t make blanket coverage determinations, and a claim would have to be submitted for TDIC to fully evaluate coverage for your particular case.

Telehealth is not without risks, and while the scope of coverage under the policy remains the same, dentists must adhere to proper protocols and the current limits of their state licensure to ensure they are insurable with TDIC upon renewal. Contact your trusted TDIC advisor to learn more or discuss coverage specific to your situation.

Prior to the delivery of health care via telehealth, the provider should verbally inform the patient that telehealth may be used, obtain verbal consent from the patient for this use and document consent in the patient’s record. Check your state laws for specific requirements.

TDIC recommends that dentists also provide a consent form, which notes telehealth risks, benefits, confidentiality and rights, for the patient to review and sign before the virtual visit. Your dental association may be able to provide additional resources to help you comply with state-specific rules and regulations.

In addition, obtain up-to-date health histories for new and current patients, and document patient charts with virtual visit notes, just as you would for an in-office visit. 

When using telehealth technology, especially when practice staff who are working remotely have access to patient data, dentists should have protocols in place to protect the patient and the practice from risk.

The communications technology should not be public facing. Examples of nonpublic facing technologies include Skype, Apple FaceTime and video chat via Facebook Messenger, Jabber, WhatsApp and Google Hangouts. In normal circumstances, HIPAA requires a covered entity to have a business associate agreement with these platforms and include them in security risk analyses prior to use. Once the current emergency ceases, covered entities are expected to again be in full compliance with the regulations.

The Office for Civil Rights at the U.S. Department of Health and Human Services recently issued guidance on telehealth remote communications following its “Notification of Enforcement Discretion.” The OCR is currently exercising its enforcement discretion to not impose penalties for HIPAA violations against health care providers in connection with their good faith provision of telehealth using communication technologies during the COVID-19 nationwide public health emergency. Learn more about the HHS notification and get additional guidance from the OCR about HIPAA and telehealth.

While dentists are always mindful of privacy and confidentiality concerns, remember that best practices protect the patient experience and practice reputation whether or not OCR violations are enforced.

The utilization of new technologies often brings new security considerations. The facilitation of telehealth may create new cyber exposures for the practice. Existing technologies may already have exposures that could adversely affect your ability to securely provide telehealth. Contact your TDIC trusted advisor to discuss possible exposures, coverage implications and steps to reduce your risk.

Be aware that ransomware hackers are already using the COVID-19 pandemic to their advantage. TDIC will keep you informed about emerging risks and timely prevention and response tactics. If you are a TDIC policyholder, you can login to access our Cyber Liability Guide and Cyber Event Checklist under Risk Management Reference Guides.

Dentists are cautioned to only see patients who are located in a state in which they are licensed or authorized to see patients under a federal or state waiver. The delivery of teledentistry services must comply with each state’s scope of practice laws or regulations.

According to the patients’ rights in the ADA Policy on Teledentistry, dental patients have the right to expect that any dentist delivering services using teledentistry technologies will be licensed in the state where the patient receives services or be providing these services as otherwise authorized by that state’s dental board. Additionally, patients have the right to access the licensure and board certification qualifications of the oral health care practitioner who is providing the care in advance of the visit.

HIPAA and Privacy

When an employee reports that they are COVID positive, start by asking the employee if there are others that they have come in close contact within the office. Once you have identified those individuals, you can have a conversation to confirm “close contact” and then determine if they should be sent home and instructed to reach out to their medical provider. Follow CDA’s flowchart and watch the e-learning module.

Yes, the local health department can investigate and take the steps it deems necessary to prevent the spread of communicable disease or a disease suspected of being communicable to protect public health. Only provide the information required and do not offer up additional information.

If your employee’s illness has put them in the hospital, that would qualify as a severe illness.

(3) Division of Occupational Safety and Health Access.

(A) Each employer shall, upon request, and without derogation of any rights under the Constitution of the United States, the Constitution of the State of California or the California Occupational Safety and Health Act of 1973, Labor Code sections 6300 et seq., that the employer chooses to exercise, assure the prompt access of representatives of the Chief of the Division of Occupational Safety and Health (DOSH) to employee exposure and medical records and analyses using exposure or medical records.

(B) Whenever DOSH seeks access to personally identifiable employee medical information by presenting to the employer a written access order, the employer shall prominently post a copy of the written access order and its accompanying cover letter for at least fifteen (15) working days. §3204. Access to Employee Exposure and Medical Records

Yes, you can comply. However, make sure you follow HIPAA and provide the “minimum amount of information” necessary to accomplish and adhere to the request. 

There is no obligation to reveal the patient’s name. In reality, an employee may see the information when accessing the patient’s file for work purposes. It is a best practice to remind all employees of the confidentiality of patient information and to only use or disclose the minimum necessary information.

If the local department of health requests my patients’ names and phone numbers in order to perform contact tracing, am I obligated to provide this information?

Yes, you can comply. However, make sure you follow HIPAA and provide the “minimum amount of information” necessary to accomplish and adhere to the request.

Liability Coverage

TDIC can’t make a blanket coverage determination, and a claim would have to be filed for TDIC to fully evaluate coverage for your particular case.

You should notify your professional liability carrier immediately to advise of a potential claim. Regardless of whether a patient can conclusively demonstrate that they acquired the virus from your practice, you should consult with your professional liability carrier to develop a plan to address the patient’s concerns. The best approach may simply be to demonstrate the appropriate infection control procedures the office has taken and to have further discussion with the patient to determine when they first developed symptoms.

Whenever you are in doubt about how to handle a situation, TDIC’s Risk Management analysts can work with you to find a solution. To schedule a confidential consultation with an experienced risk management analyst, visit or call 800.733.0633.

Our Professional and Business Liability product was written specifically to follow the scope of dental practice to provide protection in situations like the ones faced this year.

Dentists are already skilled at administering injections, making them well-poised to support the acceleration of COVID-19 vaccination administration. TDIC's Professional Liability insurance covers policyholders who perform COVID-19 vaccinations, as long as their state dental board permits the policyholder to administer the vaccination and the policyholder has the training or certification the dental board or other government agency requires to administer the vaccine.

  • Check with your state dental board to determine if you are approved to administer the vaccination and what training or certification may be required.
  • See ADA’s interactive map for the latest information about vaccine availability and administration regulations for dentists by state.
  • Review vaccine considerations for dentists to consider prior to administering the COVID-19 vaccine. 

Risk Management Advice Line

Get one-on-one guidance navigating potential liabilities related to COVID-19 from an experienced TDIC analyst.