If he's involved in an accident that damages those teeth, workers' comp benefits might pay for the treatment, even though the dentist would have to address the existing damage along with the work-related injury. Dental injuries that occur outside of work, or that are the result of poor dental hygiene, are not covered by workers' compensation.
Full Answer
What is a specific dental injury?
A Specific Dental Injury usually occurs when there is some form of head trauma. This can happen when there is a blow to the head or face. These can occur as a result of a physical assault or being struck in the face by an object. Sometimes, people can walk into a stationary object such as a glass door or wall and sustain a dental trauma.
How does dental injury affect a person?
Dental Injuries can have a significant impact on a worker’s ability to perform their job. Dental Injuries can impact on an Injured Worker’s ability to perform Activities of Daily Living. Dental Injuries can require expensive medical treatment. This article discusses work-related dental injuries. The article will address issues ...
Can dental work injuries be compensable?
These mechanisms of work-related dental injuries can range from specific injuries to cumulative trauma injuries. It is also not uncommon that Dental Injuries arise as a compensable consequence to an underlying industrial injury.
Can a worker take a medication that can cause damage to teeth?
Frequently, Injured Workers take medications that can have harmful effects on one’s teeth. Some medications can cause damage to teeth. Other medications can cause dry mouth which is also known as xerostomia. Xerostomia is essentially dry mouth. This is caused by reduced or absent saliva flow.
Can dental insurance be sued?
Yes. Dental Injuries can be a source of litigation. Dental Care’s significant cost provides a tremendous incentive on behalf of Insurance Companies to seek to limit the nature and extent of dental treatment.
Does dental workers compensation pay for co-payments?
While other forms of dental insurance may have deductible or co-payment associated with it, workers’ compensation insurance pays 100 percent of the bill .
Can xerostomia cause tooth loss?
Xerostomia is an original hidden cause of gum disease and tooth loss. Xerostomia can contribute to cavities. Dry Mouth can be a work-related injury. For example, Injured Workers who suffer from orthopedic injuries may be prescribed medications that may cause xerostomia.
What is workers compensation?
Workers’ compensation statutes are designed to award employees damages for injuries suffered during the normal course of their employment, and also to limit the employer’s liability for costly damages which could be awarded for personal injuries suffered by their employees. There are some aspects to workers’ compensation law ...
Is a worker who is totally disabled protected by disability discrimination laws?
Though the interaction of disability law and workers compensation law is sometimes complex, a worker who is totally disabled because of a workplace injury is not protected by disability discrimination laws if they cannot perform the essential functions of or her position.
Can dental assistants claim workers compensation?
In dental offices, the issue of the coverage of carpal tunnel syndrome is important to consider when looking at what injuries an employee can claim workers’ compensation benefits for, particularly because many of the procedures performed by dentists, hygienists, and dental assistants require the use of hands and arms in repetitive movements. The courts have made it difficult for any dental practice to avoid providing workers’ compensation benefits, either in part or in full, to dentists, hygienists and dental assistants for carpal tunnel syndrome, even if the employee worked for another practice for most of his or her career. If it is an injury or disease occurring in the course of employment that is work-related the workers compensation benefits are allowable. If a hand or arm injury occurs because of a non-work related incident, such as a car accident, a doctor is usually consulted to determine which is the predominant contributing cause of the hand or arm injury which interferes with treating patients, the non-work related incident or carpal tunnel disease.
Is a dentist covered by workers compensation?
There are some aspects to workers’ compensation law that all dental practices should be aware of, some of which pertain particularly to dental offices and their employees. All employees are covered under the workers’ compensation statute in Massachusetts, and although independent contractors are not covered, it is difficult in the dental industry to avoid workers compensation coverage through labeling persons to work in the practice as independent contractors. If someone who works at the office location is under direction and control of the practice or does not operate an independently established business they are covered by the workers’ compensation statute.
Is hand injury a work related injury?
If it is an injury or disease occurring in the course of employment that is work-related the workers compensation benefits are allowable. If a hand or arm injury occurs because of a non-work related incident, such as a car accident, a doctor is usually consulted to determine which is the predominant contributing cause of ...
Is defamation a worker's compensation claim?
Other types of injuries claimed that happened during employment and were intentionally caused by another employee or the employer, such as defamation, invasion of privacy, and violations of civil rights, are not compensable under workers’ compensation. Physical and emotional injuries are not the main focus of the injury claims, the courts reason. Discrimination claims that an employee make against an employer are not compensable under workers’ compensation, and as a result damages for discrimination can be greater in a civil lawsuit.
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How to file a workers comp claim?
It usually begins with reporting your injury to your employer and completing a claim form, and often involves an independent medical exam with a workers' comp doctor. If your claim is denied, you always have the option to appeal. If you're successful, you should receive reimbursement for the medical (or dental) care you received, and up to two-thirds of your wages for as long as you were out of work due to your injury.#N#The timeframes for completing those steps, from reporting your injury to appealing a denial, can be strict. If you miss any of the deadlines, your claim can potentially be dismissed. A workers' compensation attorney with knowledge of your state's rules and procedures can help you meet the legal deadlines and present the most persuasive case possible to the workers' comp board.
What to do if you have a dental injury?
If you have suffered a dental injury at work, consider contacting an experienced workers' compensation attorney. Most workers' comp lawyers don't charge anything up-front, and only collect a fee if you win your case.
How does a state maintain workers compensation?
Each state maintains a workers' compensation as a form of insurance. Employers fund these systems through payroll taxes. If an employee makes a successful claim, their employer may have to pay more towards workers' compensation, much like how a driver's car insurance premiums might go up if they have an accident or get too many speeding tickets. Employers have an opportunity to challenge workers' compensation claims by their employees.
What is workers compensation?
Workers' compensation provides injured workers with benefits to cover medical expenses and lost wages, without regard to who was at fault for the injury. That means you can collect workers' compensation benefits without having to prove your employer did anything wrong. Each state has its own workers' compensation system, and maintains its own rules for eligibility and claims.
Does workers compensation cover tooth repair?
If you suffer one of these injuries at work, you'll likely have to see a dentist (or oral surgeon) for treatment. Workers' compensation benefits usually only cover treatment for the work-related injury, even if a dentist's services go further than that . If a dentist, while repairing a chipped tooth, also finds that the worker has periodontal disease and needs a root canal, workers' compensation will only pay for the chipped tooth repair. However, there may be exceptions, as discussed below, when a work-related dental injury worsens an existing condition.
Can you get workers comp for dental work?
If you suffered a dental injury at work, you could be entitled to workers' comp benefits.
What happens if an employee sues their employer?
If the employee chooses to sue their employer, they waive their rights to workers’ compensation benefits. If successful in their suit, the court may award them payment for their medical expenses, lost wages, pain and suffering, and punitive damages.
What is workers compensation for dentists?
Workers’ Compensation for Dentists. In most states, employers are deemed responsible for their employees’ physical health while they are at work. Workers’ compensation insurance provides benefits if an employee has a work-related injury or illness.
Can you sue an employer for workers compensation?
Because workers’ compensation assists the employee with the costs of their injury or illness there is generally no reason to sue the employer. However, if the employer’s reckless or intentional action caused the employees injury, they do have the right to sue.
Is work related injury a no fault claim?
They could be a result of repetitive strain that results in carpal tunnel syndrome, tendonitis and back pain. Workers’ compensation is a no-fault system.
Does every state have workers compensation?
Every U.S. state has its own workers’ compensation insurance program. Benefits vary by state . In general, workers’ compensation provides the following: Check with your Dentist’s Advantage advisor to learn the benefits in your state. Speak to a Dentist’s Advantage advisor to become familiar with the laws in your state.
Is a sole proprietorship considered an employee?
In the case of a sole proprietorship or partnership, the owner (s) are not considered an employee, and therefore not covered. If the practice is incorporated, the owner is an employee of the corporation and may be included in coverage. Speak to a Dentist’s Advantage advisor to become familiar with the laws in your state.
Does it matter if a worker is injured?
It does not matter if the workers’ actions contributed to the injury. If it happened at work, they are covered. Exceptions include self-inflicted injuries, committing a crime, being intoxicated/high or violating company policy.
What is the difference between workers compensation and other treatment plans?
The biggest difference between a workers’ compensation claim and other treatment plans is that workers’ compensation covers clinical care only for the work-related injury — As dentists know, teeth perform three vital functions: they enable a person to speak and eat, and they support facial structure.
What is a clinical exam for dental?
If a patient presents with a dental complaint that isn’t trauma, a clinical exam can be performed to determine causation to find out if it is, in fact, a work-related injury. 2. Getting guidance at the start of the claim — There are services that can assist dentists at the outset of a workers’ compensation claim to ensure ...
How did you lose that tooth?
Sometimes the answer to “How did you lose that tooth?” reveals that the injury occurred while the patient was on the job. Work-related injuries are covered under the state’s workers’ compensation system. Managing a workers’ compensation dental claim can seem complicated at first, but it's a source of income for the practice and is certainly an instance when a patient needs good dental care. Another benefit of treating workers’ compensation cases is that these patients may not have a regular dentist, and they might become new patients for your practice.
What to look for when visiting a dentist?
1. Identifying the workers’ compensation case — When patients visit the practice, there are several clues to look for to determine if their problems occurred on the job. Paperwork for new patients, such as the American Dental Association (ADA) form, often asks if a dental problem occurred at work.
Is dental work covered by workers compensation?
Work-related injuries are covered under the state’s workers’ compensation system. Managing a workers’ compensation dental claim can seem complicated at first, but it's a source of income for the practice and is certainly an instance when a patient needs good dental care. Another benefit of treating workers’ compensation cases is ...
Is dry mouth a disease?
Dry mouth (xer ostomia) is reduced or saliva flow is absent — While this is not a disease, it may be a symptom or side effect of various medical conditions or medications. The long-term use of opioids or narcotics, which can be prescribed for a workers’ compensation injury, is often associated with this condition. 7.
Can a dental worker's comp claim be a challenge?
Workers’ compensation dental claims may seem challenging at first, but keeping these best practices in mind will be helpful when managing a workers’ compensation claim . Experienced clinical partners can provide valuable insights starting at the beginning of a claim and can coach dentists through how best to handle these complex cases in order to produce positive results.
What is the importance of finding a dentist who has experience in workers compensation?
Finding a dentist who has experience in workers compensation and coordinating the right specialists are important, but dental injuries also require in-depth clinical expertise to manage claims throughout their life cycle. Risk managers must consider the following guidelines to ensure their provider network will properly manage dental claims.
How many visits does a dental claim take?
And many organizations lack protocols and guidelines on how to mange these claims. Unlike other types of services, such as X-rays or MRIs, which may only be required once or twice during the life of a claim, the average dental claim requires 17 dental provider visits.
What is a complex dental claim?
Complex dental claims require a clinical team consisting of care coordinators and clinicians who have years of dental experience. For example, imagine a box falls on a delivery driver and hits him in the mouth. He complains of jaw pain and a loose tooth. He has not seen a dentist in two years and has a history of periodontal disease. The clinical team will recognize that while the payer is not liable for the entire dental history, the infection must be sufficiently cleared up before the injury-specific dental care can occur. Otherwise, future complications may result.
How to determine appropriate reserves for dental claims?
Determining appropriate reserves for dental claims is complicated. A network should provide clinical knowledge of dental procedures and pricing, and work with adjusters to set appropriate reserves. If the network presents a treatment plan, this will help adjusters estimate costs so proper funds can be set aside.
How many visits to handle dental claims?
A simple chipped tooth or filling, for example, can be handled in one or two dental visits, whereas a case that requires oral surgery may be open for several months and require the additional services of various specialists. If the treatment plan is complicated, the clinical team will coordinate various specialist providers.
What is TMJ in dentistry?
Temporomandibular joint ( TMJ) disorder can be triggered by impact to the jaw or post-traumatic stress that leads to grinding of the teeth and jaw. This disorder is one of the most costly dental injuries. Treatment ranges from injections to relax jaw muscles to complete joint replacement, which can easily exceed $100,000 in costs. Another challenge is that additional stress or a secondary bump to the jaw can set recovery back and require treatment to start over. For such complex dental conditions, a network must provide clinical oversight to ensure claims are optimally managed.
Do dentists work in workers comp?
Traditional workers compensation networks have not focused on recruiting dentists. Finding a dentist who understands and is willing to work within the workers comp system can be challenging. A network should not only recruit dentists but also help them navigate the system with appropriate forms and procedures. With this guidance, dentists are more likely to accept work-related injury referrals.