Brokers placing professional liability for dental practices may want to rethink where they focus risk conversations with clients. New data from The Doctors Company finds documentation failures generate higher average indemnity payments than technical skill errors, even though technical errors occur far more often.
The Doctors Company, the nation's largest physician-owned medical malpractice insurer, released its August 2026 Malpractice Risk Review covering dentistry claims from 2010 to 2025. The dataset of 1,358 closed cases shows a gap between claim frequency and claim cost with direct implications for how brokers counsel dental clients.
Technical skill failures were the most common contributing factor, appearing in nearly 70% of claims. Documentation failures ranked fifth in frequency at about 22% of cases, yet they carried the highest average indemnity payment of $165,000. Clinical judgment issues ranked second in severity at $162,000, while the overall average indemnity across the dataset was $121,000.
The errors a dental practice is most likely to make are not the ones most likely to produce the largest losses.
That pattern holds across medical specialties. A separate Doctors Company analysis of plastic surgery claims found that documentation failures appeared as a contributing factor in 27% of claims.
The study described the medical record as the practitioner's "silent witness" in any subsequent defense.
Negligence allegations were dominated by medical treatment concerns, appearing in 95% of claims. That category covers issues including improper procedure performance, unnecessary treatment, and retained foreign bodies.
Diagnosis-related allegations covered delayed, failed, or wrong diagnoses and were the next most frequent category. Thirty-six percent of dentistry cases required an indemnity payment to close, with average gross expense incurred at $29,000.
The report includes a case summary showing how a delayed oral cancer diagnosis can escalate losses. A patient with lichen planus was presented with a white patch on the gum. Over several years, new lesions appeared and were treated, but no definitive diagnosis was reached.
By the time squamous cell carcinoma was confirmed, the patient had progressed to stage IV cancer requiring surgery, chemotherapy, and radiation.
The patient survived but sustained lasting impairments, including facial droop, reduced motor control, and speech difficulty. Plaintiff experts argued that rebiopsy every three to six months could have produced an earlier diagnosis and reduced treatment severity.
The survival-rate data reinforces how directly diagnostic delays translate into loss severity. A study cited in the report found that localized oral cancers carry a five-year survival rate exceeding 80%, compared to 38% for metastatic cases.
The dentistry findings land against a market backdrop of sustained upward pressure on dental professional liability premiums. Malpractice insurance premiums for dental practices have seen double-digit increases at some carriers, according to Risk Strategies' 2025 insurance market outlook. Higher claim payouts and a rise in state board complaints filed against dentists are the primary drivers.
Data from AM Best shows the broader MPL segment recording its 10th consecutive year of underwriting losses in 2024, with a combined ratio of 108% and direct written premiums of approximately $6.9 billion. Rising claim severity, nuclear verdicts, and the erosion of state tort reforms are the primary drivers.
"Our monthly malpractice risk review series delivers actionable insights grounded in real malpractice claims data, helping clinicians and healthcare leaders identify vulnerabilities, strengthen communication, and support safer patient care," said Julie Ritzman, senior vice president of patient safety and risk management at The Doctors Company.
Communication failures and patient nonadherence to treatment plans also ranked as leading contributing factors. Risk mitigation guidance in the report centers on documentation practices, standardized patient evaluation protocols, and informed consent processes.
The data provides insurance brokers a concrete basis for renewal conversations with dental clients, particularly around documentation systems and diagnostic surveillance protocols.
